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Would you recommend the influenza or pneumococcal vaccine for a child with a history of recurring ear infections? This is an excellent question because of the current emphasis on reducing the use of antibiotics for the treatment of acute otitis media (AOM). Certainly prevention by means of vaccination would be an important step in helping to reduce the overuse of antibiotics for this condition. Current guidelines have not made provisions for the recommendation of influenza or pneumococcal vaccination for children with recurrent ear infections. However, there is evidence in the literature that otherwise healthy children that are predisposed to recurrent otitis media may in fact benefit from influenza vaccine. Studies in Finland and North Carolina have demonstrated a decreased incidence of AOM in children in daycare centres who had received influenza virus vaccines. Recently children in a North American study given a new intranasal, live attenuated, cold-adapted influenza virus vaccine were shown to have a 35% reduction in the incidence of AOM. The currently available 23-valent polysaccharide pneumococcal vaccine is not effective for children under two years of age due to an inadequate immunologic response in these children. Several manufactures are now developing a conjugated pneumococcal vaccine that has been shown to be immunogenic in young infants, who are the most susceptible to recurrent AOM. When these new conjugated vaccines become available they will certainly have an increasing role in protecting young infants and children against recurrent AOM. I suspect that over the next few years the importance of vaccination in preventing ear infections will become increasingly evident Reference: Belshe R., NEJM 1998; 338:1405-1412
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