We analyzed outpatient visits, incidence, antimicrobial prescriptions, and medical expenditures for acute otitis media (AOM) in the United States during 2011-2016. Data sources included the National Disease and Therapeutic Index (NDTI™) projections by IQVIA (for AOM cases), The Medical Expenditure Panel Survey (for medical expenditures) and the US Census (for population estimates). Analyses focused on children aged ≤9 years between 2011 and 2016. We used the 2014 medical expenditure estimate per otitis media episode ($520) as proxy for all years. In 2011, there were an estimated 11.5 million AOM episodes in children aged 0-9 years in the US with AOM incidence rates (IR) of 476, 204, and 284 episodes per 1000 children aged 0-2, 3-9, and 0-9 years, respectively. All subsequent years had lower IRs, and by 2016, IR was 25.1% lower than in 2011 in children 0-9 years. In addition, there were estimates of 10.8 million and 9.2 million fewer cumulative AOM episodes and antimicrobial prescriptions for AOM nationwide between 2012 and 2016, compared to annual 2011 estimates, representing a ∼$5.6 billion decrease in direct medical expenditures. The average number of antibiotic prescriptions per AOM visit remained stable with 0.89 and 0.86 prescriptions per visit in 2011 and 2016, respectively. AOM incidence, antimicrobial prescriptions, and associated medical expenses decreased substantially between 2011 and 2016 in the United States. Antimicrobial prescribing practices remain unchanged. Additional studies are warranted to assess causality.

Introduction: Most of the current evidence regarding pneumococcal upper respiratory colonization in adults suggests that despite high disease burden, carriage prevalence is low. Contemporary studies on adult pneumococcal colonization have largely followed the pediatric approach by which samples are obtained mostly from the nasopharynx and bacterial detection is evaluated by routine culture alone. Recent evidence suggests that the “pediatric approach” may be insufficient in adults and pneumococcal detection in this population may be improved by longitudinal studies that include samples from additional respiratory sites combined with more extensive laboratory testing. Areas covered: In this article, relevant literature published in peer review journals on adult pneumococcal colonization, epidemiology, detection methods, and recommendations were reviewed. Expert opinion: Respiratory carriage of Streptococcus pneumoniae has been underestimated in adults. Contemporary pneumococcal carriage studies in adults that collect samples from alternative respiratory sites such as the oropharynx, saliva, or nasal wash; are culture-enriched for pneumococcus; and use molecular diagnostic methods designed to target two pneumococcal DNA sequences should enhance pneumococcal detection in the adult respiratory tract. This finding may have implications for the interpretation of dynamics of pneumococcal transmission and vaccination.

The addition of pneumococcal conjugate vaccines (PCVs) to the United States (US) national immunization program led to significant reductions in incidence, mortality, and associated sequelae caused by pneumococcal disease (PD) in children and adults through direct and indirect protection. However, there remains clinical and economic burden due to PD caused by serotypes not included in the current 13-valent PCV (PCV13) formulation. To address this unmet need, 15-valent PCV (PCV15) and 20-valent PCV (PCV20), containing additional serotypes to PCV13, were recently approved in the US for adults and are anticipated for pediatrics in the near future. The study objective was to estimate the annual number of cases, deaths, and economic burden of PD due to serotypes included in PCV13, PCV15, and PCV20 for both US pediatric and adult populations. An Excel-based model was developed to calculate clinical and economic outcomes using published age-group specific serotype coverage; incidence of invasive PD, community-acquired pneumonia, and acute otitis media; case fatality rates; and disease-related costs. The results showed that across all age groups, the estimated annual PD cases and associated deaths covered by PCV13 serotypes were 914,199 and 4320, respectively. Compared with PCV13 serotypes, the additional 2 and 7 serotypes covered by PCV15 and PCV20 were attributed with 550,475 and 991,220 annual PD cases, as well as 1425 and 3226 annual deaths, respectively. This clinical burden translates into considerable economic costs ranging from $903 to $1,928 million USD that could be potentially addressed by PCV15 and PCV20. The additional serotypes included in PCV20 contribute substantially to the clinical and economic PD burden in the US pediatric and adult populations. Despite the success of the PCV13 pediatric national immunization program and increased adult uptake of PCV13 and 23-valent polysaccharide vaccine, broader PCV serotype coverage is needed across all ages to further reduce pneumococcal disease burden.

Background: Impact of pneumococcal conjugate vaccines (PCVs) on pneumococcal disease is well described; pneumococcus is infrequently identified by culture in pneumonia. Yield is higher when pleural fluid is cultured. Polymerase chain reaction (PCR) in pleural fluid samples improves pathogen identification, particularly in the case of S. pneumoniae. Methods: Healthy children with empyema who underwent pleural fluid drainage were eligible. Demographics and PCV immunization status were collected. Blood/pleural fluid cultures were obtained. Pleural fluid samples were sent for PCR for pathogen. Serotyping was done by Neufeld-Quellung reaction on pneumococcus isolates, and PCR in culture negative cases. Results: From December 2018 to September 2023, 74 patients were enrolled. Pathogens were cultured in 22 patients (29.7%), with pneumococcus found in 6 (27.3%). PCR identified additional pathogens in 23 patients (31.1%), including 18 pneumococci (81.8%) and real-time PCR identified 5 more pneumococci, totaling 29 pneumococci, with 23 (79.3%) detected by PCR only. Serotype information was available for 27 (93.1%) pneumococci; 22 (81.5%) were identified as PCV-13 serotypes, with serotype 3 being present in 17 (63%) cases. Among patients with a PCV-13 serotype detected through culture or molecular methods, 15 (68.2%) were fully vaccinated with PCV-13, including 11 of 17 (65%) with serotype 3. Conclusion: S. pneumoniae, particularly serotype 3, is the leading bacterial pathogen in children ≤18 years old. Molecular diagnosis enhances pathogen detection. Ongoing surveillance is crucial to monitor etiology changes as new pneumococcal vaccines are introduced.

Pediatric populations contribute to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission through a combination of exposure, susceptibility, and transmissibility. In this narrative review, SARS-CoV-2 infection in children is assessed to ascertain their role in transmission, by considering the characteristics of pediatric populations regarding their exposure and susceptibility to SARS-CoV-2 infection and COVID-19, and their transmission of the virus. A series of PubMed searches were conducted between November 2020 and February 2023 to identify articles describing SARS-CoV-2 transmission in children. The literature suggests that schools are key areas of exposure of children and adolescents to SARS-CoV-2, which contributed to school closures to mitigate spread and break transmission chains. However, the effectiveness of these measures is debated. Although SARS-CoV-2 appeared to infect children and adolescents less frequently than adults early in the pandemic, infection rates have risen considerably among the pediatric population with the emergence of variants of concern. Compared with adults and populations at high risk, children generally have a milder course of disease. The predominant role of children in transmission of SARS-CoV-2 is thought to involve household and school settings, although the relative contribution of each to transmission is questioned. Through their exposure, susceptibility, and transmissibility of SARS-CoV-2, children and adolescents are a key population contributing to the transmission of the virus. Our continued and evolving understanding of the role of children in transmission of SARS-CoV-2 has important implications to define appropriate preventive and therapeutic strategies for the pediatric population and the wider community.