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Seasonality of Acute Otitis Media and the Role of Respiratory Viral Activity in Children

Stockmann, Chris MSc*; Ampofo, Krow MD*; Hersh, Adam L. MD, PhD*; Carleton, Scott T. MD; Korgenski, Kent MS, MT(ASCP)*‡; Sheng, Xiaoming PhD*; Pavia, Andrew T. MD*; Byington, Carrie L. MD*

The Pediatric Infectious Disease Journal: April 2013 - Volume 32 - Issue 4 - p 314–319
doi: 10.1097/INF.0b013e31827d104e
Original Studies

Background: Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infections in young children. AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM.

Methods: This retrospective study included 9 seasons of respiratory viral activity (2002 to 2010) in Utah. We used Intermountain Healthcare electronic medical records to assess community respiratory viral activity via laboratory-based active surveillance and to identify children <18 years with outpatient visits and International Classification of Diseases, Ninth Revision codes for AOM. We assessed the strength of the association between AOM and individual respiratory viruses using interrupted time series analyses.

Results: During the study period, 96,418 respiratory viral tests were performed; 46,460 (48%) were positive. The most commonly identified viruses were respiratory syncytial virus (22%), rhinovirus (8%), influenza (8%), parainfluenza (4%), human metapneumovirus (3%) and adenovirus (3%). AOM was diagnosed during 271,268 ambulatory visits. There were significant associations between peak activity of respiratory syncytial virus, human metapneumovirus, influenza A and office visits for AOM. Adenovirus, parainfluenza and rhinovirus were not associated with visits for AOM.

Conclusions: Seasonal respiratory syncytial virus, human metapneumovirus and influenza activity were temporally associated with increased diagnoses of AOM among children. These findings support the role of individual respiratory viruses in the development AOM. These data also underscore the potential for respiratory viral vaccines to reduce the burden of AOM.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics, Division of Pediatric Infectious Diseases; Department of Pediatrics, Division of Hospitalist Medicine, University of Utah Health Sciences Center; and Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT.

Accepted for publication November 6, 2012.

Presented in part at the Pediatric Academic Societies Annual Meeting, April 28, 2012, Boston, MA.

Multiple contributors were required to complete this study. Each author has seen and approved the final article that is being submitted. C.S. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He assisted with development of the study design, conducted statistical analyses of the data and wrote the article. K.A. provided pivotal input to the study design, helped write the article and critically edited the final submission. A.L.H. assisted with study design, selection of appropriate statistical tests and edited the article. S.T.C. assisted with study design and edited the article. K.K. identified patients in Intermountain Healthcare’s electronic data records, developed the database for performing statistical analyses and edited the article. X.S. assisted C.S. with the statistical analyses and development of the ARIMA model. X.S. also edited the article. A.T.P. participated in the conception of the study design and interpretation of the data, critically reviewed and revised the content of the article and approved the final version to be published. C.L.B. supervised the development of the study design, provided input on the statistical analyses, helped write the article and approved the final product.

This work was supported by grants from the National Institute of Allergy and Infectious Diseases [grant number U01A1082482] (to K.A., C.L.B.), [grant number U01AI074419-01] (to C.L.B., A.T.P.), [grant number U01AI082184-01] (to A.T.P.), the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, [grant number UL1RR025764] (to C.L.B.) and the Centers for Disease Control Prevention [U18-IP000303-01] (to C.S., K.A., C.L.B., A.T.P.). This project was further supported by the University of Utah, Department of Pediatrics, through the Children’s Health Research Center and the Pediatric Clinical and Translational Research Scholars Program, the H. A. and Edna Benning Presidential Endowment and the Primary Children’s Medical Center Foundation. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Chris Stockmann, MSc, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, 295 Chipeta Way, 2S010, Salt Lake City, UT 84108. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.