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  • Cited by 7
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What effect has pneumococcal vaccination had on acute mastoiditis?

  • M Daniel (a1) (a2), S Gautam (a1), T A Scrivener (a3), C Meller (a1), B Levin (a1) and J Curotta (a1)
  • DOI:
  • Published online: 28 November 2012

Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period.


Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000–2010), comparing patients seen prior to vaccination introduction (period one, 2000–2004), around the time of vaccine introduction (period two, 2005–2007) and post-vaccination (period three, 2008–2010).


We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened.


Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.

Corresponding author
Address for correspondence: Dr Matija Daniel, Department of Paediatric Otorhinolaryngology Head and Neck Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia 2145 Fax: +61 (0)2 9845 2078 E-mail:
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Presented orally at the Australian Society of Otolaryngology Head and Neck Surgery Meeting, 31 March 2012 to 4 April 2012, Adelaide, Australia, and as a poster at the European Society of Pediatric Otorhinolaryngology Meeting, 20 May 2012 to 23 May 2012, Amsterdam, The Netherlands

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5M Van Den Aardweg , MM Rovers , J Alexander de Ru , FWJ Albers , AGM Schilder . A systematic review of diagnostic criteria for acute mastoiditis in children. Otol Neurotol 2008;29:751–7

8J Spratley , H Silveira , I Alvarez , M Pais-Clemente . Acute mastoiditis in children: review of the current status. Int J Pediatr Otorhinolaryngol 2000;56:3340

10M Nussinovitch , R Yoeli , K Elishkevitz , I Varsano . Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years. Clin Pediatr 2004;43:261–7

11PJ Antonelli , N Dhanani , CM Giannoni , PS Kubilis . Impact of resistant pneumococcus on rates of acute mastoiditis. Otolaryngol Head Neck Surg 1999;121:190–4

12MG Roddy , SS Glazier , D Agrawal . Pediatric mastoiditis in the pneumococcal conjugate vaccine era. Pediatr Emerg Care 2007;23:779–84

13S Quesnel , M Nguyen , S Pierrot , P Contencin , Y Manach , V Couloigner . Acute mastoiditis in children: a retrospective study of 188 patients. Int J Pediatr Otorhinolaryngol 2010;74:1388–92

17SL Block , J Hedrick , CJ Harrison , R Tyler , A Smith , R Findlay Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Pediatr Infect Dis J 2004;23:829–33

22MR Jacobs , CE Good , S Bajaksouzian , A Windau . Emergence of streptococcus pneumoniae serotypes 19A, 6C and 22F and serogroup 15 in Cleveland, Ohio, in relation to introduction of the protein-conjugated pneumococcal vaccine. Clin Infect Dis 2008;47:1388–95

26LH Pang , MS Barakate , TE Havas . Mastoiditis in a paediatric population: a review of 11 years experience in management. Int J Pediatr Otorhinolaryngol 2009;73:1520–4

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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