ARTICLE

Reduction of Frequent Otitis Media and Pressure-

Equalizing Tube Insertions in Children After
Introduction of Pneumococcal Conjugate Vaccine
Katherine A. Poehling, MD, MPHa, Peter G. Szilagyi, MD, MPHb, Carlos G. Grijalva, MD, MPHc, Stacey W. Martin, MSd, Bonnie LaFleur, PhD, MPHe,
Ed Mitchel, MSc, Richard D. Barth, BSb, J. Pekka Nuorti, MD, DScd, Marie R. Griffin, MD, MPHc,f

Departments of aPediatrics, cPreventive Medicine, eBiostatistics, and fMedicine, Vanderbilt University Medical Center, Nashville, Tennessee; bDepartment of Pediatrics and
Strong Childrens Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York; dNational Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

The authors have indicated they have no nancial relationships related to this article to disclose.

ABSTRACT
OBJECTIVE. Streptococcus pneumoniae is an important cause of otitis media in children.
In this study we estimated the effect of routine childhood immunization with
www.pediatrics.org/cgi/doi/10.1542/
heptavalent pneumococcal conjugate vaccine on frequent otitis media (3 episodes peds.2006-2138
in 6 months or 4 episodes in 1 year) and pressure-equalizing tube insertions. doi:10.1542/peds.2006-2138
PATIENTS AND METHODS. The study population included all children who were enrolled The views in this article are the sole
responsibility of the authors and do not
at birth in TennCare or selected upstate New York commercial insurance plans as necessarily represent the ofcial views of
of July 1998 and continuously followed until 5 years old, loss of health plan the Centers of Disease Control and
enrollment, study outcome, or end of the study. We compared the risk of devel- Prevention.

oping frequent otitis media or having pressure-equalizing tube insertion for 4 birth Dr Poehlings current afliation is
Department of Pediatrics, Wake Forest
cohorts (1998 1999, 1999 2000, 2000 2001, and 20012002) by using Cox University Medical Center, Winston-Salem,
regression analysis. We used data from the National Immunization Survey to NC.
estimate the heptavalent pneumococcal conjugate vaccine uptake for children in Key Words
otitis media, pressure-equalizing tubes,
these 4 birth cohorts in Tennessee and New York. middle ear ventilation tubes,
tympanostomy tubes, epidemiology,
RESULTS. The proportion of children in Tennessee and New York who received at pneumococcal conjugate vaccine
least 3 doses of heptavalent pneumococcal conjugate vaccine by 2 years of age Abbreviations
increased from 1% for the 1998 1999 birth cohort to 75% for the 2000 2001 PCV7 heptavalent pneumococcal
conjugate vaccine
birth cohort. By age 2 years, 29% of Tennessee and New York children born in PETpressure-equalizing tube
2000 2001 had developed frequent otitis media, and 6% of each of these birth ICD-9 International Classication of
cohorts had pressure-equalizing tubes inserted. Comparing the 2000 2001 birth Diseases, Ninth Revision
NISNational Immunization Survey
cohort to the 1998 1999 birth cohort, frequent otitis media declined by 17% and
Accepted for publication Dec 12, 2006
28%, and pressure-equalizing tube insertions declined by 16% and 23% for Address correspondence to Katherine A.
Tennessee and New York children, respectively. For the 2000 2001 to the 2001 Poehling, MD, MPH, Department of Pediatrics,
Wake Forest University Medical Center,
2002 birth cohort, frequent otitis media and pressure-equalizing tubes remained Medical Center Blvd, Winston-Salem, NC
stable in New York but increased in Tennessee. 27157. E-mail: kpoehlin@wfubmc.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
CONCLUSIONS. After heptavalent pneumococcal conjugate vaccine introduction, chil- Online, 1098-4275); published in the public
dren were less likely to develop frequent otitis media or have pressure-equalizing domain by the American Academy of
Pediatrics
tube insertions.

PEDIATRICS Volume 119, Number 4, April 2007 707

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S treptococcus pneumoniae is an important cause of otitis
media, a common childhood illness that has resulted
in an estimated $5.3 billion annually in direct medical
costs across the United States.1,2 The efficacy of 7-valent
pneumococcal conjugate vaccine (PCV7) in reducing oti-
tis media was evaluated in 2 randomized, controlled
trials. The Finnish and Kaiser Permanente trials found
that young children who received PCV7 had a 6% and
7.8% overall reduction in the prevalence of otitis media,
respectively, but this decline was statistically significant
only in the Kaiser study.3,4 The vaccine efficacy for pre-
vention of pressure-equalizing tube (PET) insertions, the
most common surgical procedure in children,5 was 23%
by 3.5 years in the Kaiser trial and 39% by 4 to 5 years
in the Finnish trial.4,6
Since PCV7 was incorporated into the routine immu-
nization schedule in the United States by mid 2000,7,8
several studies have demonstrated a dramatic decrease
in invasive pneumococcal disease.9,10 National survey
data indicated that otitis media visits have decreased by
246 per 1000 children, a 20% decline with no compen-
satory increase in other respiratory visits.11 Our previous
evaluation of children enrolled in Tennessee Medicaid
and private insurance programs in the Rochester, New
York, area showed declines in otitis media visits consis-
tent with these national data.12 To date, there have been
no evaluations of PCV7 program effectiveness by using
longitudinal data from individual children to measure
the change in risk of developing frequent otitis media or
having PETs inserted.
In this study, we used an ecological analysis to deter-
mine the risk of frequent otitis media (3 episodes in 6
months or 4 episodes in 1 year) and PET insertions
among 4 birth cohorts (1998 1999, 1999 2000, 2000
2001, and 20012002). We hypothesized that the risk of
frequent otitis media and PETs would decrease from the
1998 1999 birth cohort, in which few children received
PCV7 doses, to subsequent birth cohorts who had pro-
gressively increasing PCV7 uptake.
PATIENTS AND METHODS
Sources of Data
TennCare is Tennessees managed care program that
includes the Medicaid population and other low-income
children. Each enrollee selects from 1 of 7 managed care
organizations. During the study period, it included 50%
of children born in Tennessee and all state children who
were enrolled in Medicaid, with a high proportion of
children from racial and ethnic minority groups and
low-income families. The upstate New York database
contains data from 3 commercial insurance managed
care organizations, which together provided coverage
for nearly 70% of children in the Rochester, New York,
region.
Because of incomplete PCV7 vaccination information
708 POEHLING et al
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in these administrative databases, data from the National
Immunization Surveys conducted in 20012004 were
used to estimate PCV7 vaccination coverage among chil-
dren born between February 1998 and May 2003. This
survey is designed to measure vaccination coverage in a
nationally representative sample of US children aged 19
to 35 months. The National Immunization Survey used
random-digit dialing to identify households with age-
appropriate children and followed these telephone in-
terviews with mailed surveys to the childrens vaccina-
tion providers. Only provider-verified vaccination
histories are included in the analysis.
Study Population
We identified children born between July 1 and June 30,
1998 1999, 1999 2000, 2000 2001, and 20012002,
and enrolled within 30 days of birth in TennCare or in
commercial insurance plans of upstate New York. These
birth cohorts were continuously followed until age 5,
loss of enrollment, death, study outcome, or end of the
surveillance period (June 30, 2004). For each birth co-
hort, we estimated the cumulative proportion of chil-
dren who developed frequent otitis media or had PETs
inserted.
Birth cohorts were defined by using a July to June
year for 2 reasons. Although PCV7 was licensed in the
United States in February 2000, coverage of PCV7 by
most health insurance companies did not begin at that
time. The routine administration of PCV7 began in the
summer of 2000, when the American Academy of Pedi-
atrics and the Advisory Committee on Immunization
Practices published recommendations and the Vaccines
for Children Program began to cover PCV7.7,8,13 A survey
of primary health care providers in Tennessee and up-
state New York confirmed that routine administration of
PCV7 began after the summer of 2000 in these regions.14
Another reason for a July to June year was that each
year includes 1 winter respiratory virus season as com-
pared with a calendar year, which may include 0, 1, or 2
winter respiratory viral seasons.
Institutional review boards of Vanderbilt University,
the State of Tennessee, University of Rochester, and the
Centers for Disease Control and Prevention approved
this study.
Study Outcomes
We identified 2 outcomes in cohort children: develop-
ment of frequent otitis media and PET insertions. We
identified all hospitalizations, emergency department
visits, and outpatient visits for otitis media by Interna-
tional Classification of Diseases, Ninth Revision (ICD-9) codes
(ICD-9 381.0 381.4, 382.x). An episode of otitis media
was the first such visit or a visit at least 21 days after a
previous otitis media visit to distinguish reinfections
from relapses or persistent infections.4,15,16 A child devel-
oped frequent otitis media on the date of the first of the
following: the third episode of otitis media within 6
months or the fourth episode within 1 year.3 A child was
determined to have PET insertions on the date of the first
visit with this procedure code (Current Procedural Ter-
minology, Fourth Edition, 69433 or 69436).
Statistical Analysis
For each birth cohort, we used the Kaplan-Meier esti-
mator to determine the cumulative proportion of chil-
dren who developed frequent otitis media or had PETs
inserted according to age in days; this method adjusts for
children who drop out of the cohorts before experienc-
ing the outcomes of interest. In addition, we used Cox
regression models to evaluate the association between
birth cohort (1998 1999, 1999 2000, 2000 2001, and
20012002) and risk of developing frequent otitis media
or having PET insertion from birth through 2 years of
age. Birth cohort was analyzed as a categorical variable
using the 1998 1999 cohort as the reference. Of chil-
dren enrolled at birth, 24% of Tennessee children and
39% of New York children, respectively, dropped out by
2 years of age. Separate analyses of outcomes in the first
year of life for children who did and did not drop out
showed similar patterns, suggesting absence of informa-
tive censoring (data not shown). To verify that the cri-
teria for PET insertions were similar across cohorts, we
compared the age-specific proportion of children with
PETs who met the study criteria for frequent otitis media
at the time of surgery.
We used National Immunization Survey (NIS) data
(20012004) from Tennessee and New York to estimate
PCV7 vaccination coverage by 2 years of age in the 4
birth cohorts of interest.17 For each birth cohort, we
combined the NIS survey years that sampled children
with appropriate birthdays. Because 2 to 3 NIS survey
years were used for each estimate of PCV7 coverage by 2
years, each estimate was adjusted by dividing the indi-
vidual weights for the included surveys by the total
number of surveys used.18 Coverage estimates and 95%
confidence intervals were calculated for the subgroup of
children in the birth cohort, accounting for the complex
survey design.19
RESULTS
The demographics of the study populations are shown in
Table 1. Each of the 4 birth cohorts from Tennessee
accounted for 25% of the Tennessee population,
whereas each birth cohort from New York accounted for
21% to 27% of the upstate New York population. The
proportion of children who had either frequent otitis
media or were continuously enrolled until 1 and 2 years
of age was 77% and 63% in the TennCare population
and 59% and 50% in the upstate New York private
insurance population.
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TABLE 1 Demographics of Study Populations From TennCare and
From Private Insurance of the Rochester, New York,
Region
Demographics n (%)
Tennessee New York
N 150 122 26 409
Birth cohort
19981999 36 939 (25) 7198 (27)
19992000 37 437 (25) 7037 (27)
20002001 37 905 (25) 6588 (25)
20012002 37 841 (25) 5586 (21)
Censored or continuously enrolled, ya
1 116 279 (77) 18 408 (59)
2 94 290 (63) 13 215 (50)
Insurance
Public 150 122 (100) 0 (0)
Private 0 (0) 26 409 (100)
a Censored means that the children met criteria for frequent otitis media before this age. Chil-
dren who were censored or were still enrolled are included in the data analysis.
Frequent Otitis Media
Tennessee
The TennCare population included 150 122 children
with an average of 37 531 children per birth cohort.
From the 1998 1999 through the 20012002 birth co-
horts, 11 007 (7%) and 38 905 (26%) children lost en-
rollment during the first and second years of life, respec-
tively. Overall, 39 763 (26%) children had frequent
otitis media by 2 years of age. The cumulative proportion
with frequent otitis media by 2 years old was 33%
among children born in 1998 1999 compared with
29%, 29%, and 31% for the subsequent 3 birth cohorts
(Fig 1A). In comparison to the 1998 1999 birth cohort,
the decrease in frequent otitis media was 16% for the
1999 2000 cohort, 17% for the 2000 2001 cohort, and
8% for the 20012002 birth cohort (Table 2 ). Exclusion
of serous otitis codes (ICD-9 381.0 381.4) from the def-
inition of otitis media in the Tennessee data resulted in a
3% decrease in frequent otitis media visits for all birth
cohorts and no change in any of the hazard ratios.
New York
The New York commercial insurance population in-
cluded 26 409 children with an average of 6602 per
birth cohort. In the first 3 birth cohorts, 5457 (26%)
and 2656 (21%) children lost enrollment during the
first and second years of life, respectively. Overall,
6067 (32%) children had frequent otitis media by 2
years of age. The cumulative proportion with frequent
otitis media by 2 years old was 38% among children
born 1998 1999 compared with 33%, 29%, and 27%
in the 3 subsequent birth cohorts (Fig 1B). In compar-
ison to the 1998 1999 birth cohort, there was a pro-
gressive decline in frequent otitis media that ranged
from 16% to 33% (Table 2).
PEDIATRICS Volume 119, Number 4, April 2007 709
FIGURE 1
Cumulative percent with frequent otitis media in TennCare (A) and New York private insurance (B) according to age for each birth cohort. Note that for more recent cohorts, fewer years
of follow-up were available.

710 POEHLING et al
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 TABLE 2 Hazard Ratios for Developing Frequent Otitis Media and
Having PETs Inserted at 2 Years Compared With the 1998
1999 Birth Cohort in Tennessee and New York
Birth Cohort Hazard Ratio (95% Condence Interval)
Frequent Otitis Media
Tennessee
19981999
19992000 0.84 (0.810.86)
20002001 0.83 (0.810.86)
20012002 0.92 (0.890.94)
New York
19981999
19992000 0.84 (0.790.89)
20002001 0.72 (0.670.77)
20012002 0.67 (0.620.72)
indicates reference group.
PETs
Tennessee
PETs were inserted in 8223 children. Corresponding
with the decline in frequent otitis media, the proportion
of children with PETs by 2 years of age declined (Fig 2A)
from 7.1% in the 1998 1999 birth cohort to 6.3% and
6.1% in 2 subsequent birth cohorts then increased back
to 7.1% in the 20012002 birth cohort. This change in
PET insertions (Table 2) from the 1998 1999 cohort
represented a 12% and a 16% decline in the 1999 2000
and 2000 2001 birth cohorts but no change for the
20012002 birth cohort.
Among the TennCare population, 78% of children at
1 year of age and 89% at 2 years of age had frequent
otitis media before PET procedure, with no significant
differences in these proportions in the 4 birth cohorts.
New York
PETs were inserted in 1121 children. The cumulative
proportion with PET insertions by 2 years of age in each
birth cohort declined (Fig 2B) from 7.1% in the 1998
1999 cohort to 6.3%, 5.5%, and 5.8% in subsequent
cohorts. This change in PET insertions represented a
13% to 23% decline (Table 2).
Among the New York commercial insurance popula-
tion, 93% of children at 1 year of age and 95% at 2 years
of age had developed frequent otitis media by the time of
PET procedure, with no trends in these proportions over
time.
PCV7 Vaccination Coverage
According to the NIS data, the proportion of children
receiving PCV7 by 2 years of age according to state and
birth cohort increased over time (Fig 3). The proportion
of children who received 3 doses of PCV7 by 2 years of
age progressively increased for the 1998 1999 to the
20012002 cohorts from 0% in both states to 73% in
Tennessee and 82% in New York. The proportion of
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children who received 4 doses of PCV7 by 2 years of age
increased from 0% in both states to 35% in Tennessee
and 53% in New York.
DISCUSSION
PETs
For the 2000 2001 birth cohort, we found a 17% and
28% decline, respectively, in frequent otitis media
0.88 (0.820.93) among Tennessee and New York children since PCV7
0.84 (0.790.89) was incorporated into the childhood immunization
0.97 (0.921.03) schedule. Similarly, PET procedures by 2 years of age
declined 16% and 23% since PCV7 introduction. This
0.87 (0.751.01)
ecologic approach is supported by NIS PCV7 coverage
0.77 (0.650.90) estimates indicating that few children in the 1998 1999
0.79 (0.670.94) birth cohort received PCV7 doses whereas progressively
more children in the subsequent birth cohorts received
PCV7.17 Interestingly, frequent otitis media and PET pro-
cedures progressively decreased for all birth cohorts in
New York and through the 2000 2001 cohort in Ten-
nessee. For the 20012002 Tennessee birth cohort, fre-
quent otitis media was less than the 1998 1999 cohort
but higher than the 2000 2001 cohort whereas PET
procedures were similar to the 1998 1999 cohort. Al-
though others have reported efficacy of PCV7, to our
knowledge, this study is the first to evaluate the devel-
opment of frequent otitis media and PET procedures in
defined populations after PCV7 was recommended.
The reduction in the proportion of children with fre-
quent otitis media and PET procedures was more
marked in the New York private insurance population
than in the TennCare population. Several factors likely
contributed to this difference. According to the NIS data,
PCV7 uptake and the proportion fully vaccinated was
higher among New York children than among Tennes-
see children. Recent studies suggest that mucosal anti-
body response rarely develops after the primary series
but is often demonstrated at age 13 or 14 months after
receiving the booster dose, suggesting its importance for
local mucosal immunity and, consequently, protection
against otitis media.20 These children may have different
rates of exposure to known risk factors, such as day care
attendance and passive smoke exposure, which we did
not measure. There may also be geographical differences
among physicians as to what criteria they use to diag-
nose otitis media. Previous studies have found that chil-
dren were more likely to have had PET procedures if
they were from the South than the Northeast, were in
day care, had no gaps in health coverage, or were of
non-Hispanic white race and ethnicity.21 Furthermore, a
higher proportion of New York than Tennessee children
at each age group met criteria for frequent otitis media at
the time of PET insertions, suggesting that the criteria for
PET insertions may have been more stringent in the New
York population.
The increase in frequent otitis media and PET inser-
tions in the 20012002 birth cohort in Tennessee as
compared with the 2 previous birth cohorts is a surpris-
PEDIATRICS Volume 119, Number 4, April 2007 711
FIGURE 2
Cumulative percent with PETs in TennCare (A) or New York private insurance (B) placed according to age and birth cohort.

ing and potentially important observation because the pneumococcal disease from nonvaccine serotypes from
20012002 cohort represents children with high PCV7 the pre-PCV7 to post-PCV7 era has been reported for
vaccination rates. It may reflect one or a combination of invasive disease and in one study on otitis media.2226
many factors. The increase in laboratory-confirmed Temporal changes in the children who are enrolled and

712 POEHLING et al
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FIGURE 3
Proportion of children who had 3 (A) or 4 (B) doses of PCV7 at 24 months
of age by birth cohort and state according to the National Immunization
Survey.
disenrolled from insurance plans may have contributed
to this discrepancy. Overall medical care utilization may
have increased, which may obscure the vaccine effect.
An increase in medical care utilization could increase
visit rates for otitis media even if disease rates remained
stable or decreased.
The incidence of PET insertions in our study popula-
tions is comparable to those reported for other popula-
tions. In a large, rural Kentucky practice, 2.0% to 2.2%
of children received PETs by 1 year of age and 4.0 to
5.8% received PETs during the second year of life.27
Similarly, Paradise et al28 reported 1.8% and 4.2% of
children had PETs placed during the first and second
years of life, respectively. Our cumulative frequency of
PETs for the 1998 1999 birth cohorts was 2.5% by 1
year of age and 7% by 2 years of age. Our 16% and 23%
reduction in PETs in Tennessee and New York is com-
parable to the 20% decline reported in the Kaiser Per-
manente trial.29
Our results should be interpreted in light of some
potential limitations. In this ecologic study, we cannot
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exclude the possibility that other concurrent factors,
such as the encouragement of the judicious use of anti-
biotics, may have influenced physicians diagnostic pat-
terns for otitis media.30 Furthermore, administrative data
claims incompletely capture individual vaccinations and
the PCV7 status of the study population is not known.
However, national estimates show an increase in full
PCV7 vaccination by 2 years of age from 20012002 to
20032004.17 Because few children in the 1998 1999
were vaccinated whereas most were vaccinated in the
20012002 cohort, we cannot compare those who did
and did not receive PCV7 within each cohort. Even if
feasible, comparing children who are or are not vacci-
nated is problematic because children who receive vac-
cinations are more likely to seek care and thus may be
more likely to have otitis media diagnosed. In addition,
it is possible that unvaccinated children indirectly ben-
efited because of lower pneumococcal carriage rates and
decreased transmission of vaccine serotypes with imple-
mentation of PCV7 vaccination in the populations.3133
Study results were limited to the children who qual-
PEDIATRICS Volume 119, Number 4, April 2007 713
ified for TennCare and upstate New York commercial
insurance. Because the eligibility criteria for Medicaid
vary by state and over time, Tennessee results may not
be representative of all Medicaid populations. The mi-
crobiology of otitis media and the proportion attributable
to S pneumoniae cannot be ascertained from this study.
However, our results are compatible with findings
through 2003 that the microbiology of acute otitis media
has changed since the introduction of PCV7 with 35%
reduction in the prevalence of S pneumoniae isolates
among bacteria causing otitis media and minimal re-
placement with nonvaccine pneumococcal serotype iso-
lates.34,35
We found a greater decline in frequent otitis media
for the 2000 2001 birth cohort, 17% and 28% in Ten-
nessee and New York, than the 9.3% decline in the
Kaiser Permanente trial.29 The cumulative proportion of
children with frequent otitis media in the 1998 1999
birth cohort was slightly higher (33% in Tennessee and
36% in New York) than in previous studies. In the
Kaiser trial, 28% of control children had frequent otitis
media (3 episodes within 6 months) by 3.5 years of age.29
In other populations, 17.3% of Boston children had 3
episodes of otitis media in their first year of life,16 and
28% to 31% of rural Kentucky children had 4 or more
episodes of otitis media by age 1 year.27 Our definition of
otitis media included the code for serous otitis media,
which may account for our modestly higher estimates.36
In Tennessee, we found that the proportion with fre-
quent otitis media decreased by 3% when serous otitis
media was excluded and that the hazard ratios were not
impacted. Another possible explanation for the greater
reduction in frequent otitis media than that seen in
clinical trials is that there could be both direct and indi-
rect benefits of PCV7 for partially vaccinated and non-
vaccinated children.3133 From 2001 to 2004, there was a
significant decline in nasopharyngeal carriage for vac-
cine-serotype pneumococcus among healthy children
7 years of age who resided in a state with high PCV7
coverage.37 In contrast, no change in nasopharyngeal
carriage of vaccine-serotype pneumococcus was found
among children 2 to 5 years of age who had participated
in a PCV7 trial but lived in a largely unvaccinated com-
munity.38
Estimating PCV7 coverage for the study birth cohorts
has some limitations. Because the NIS is designed to
provide data on nationally representative coverage, es-
timates for individual states should be interpreted with
caution because they are less precise than national esti-
mates.39 In addition, the survey weights were not origi-
nally designed for analysis by birth cohort but were
adjusted by using a standard statistical technique.18 Fi-
nally, as in any survey, incomplete reporting may have
resulted in an underestimate of coverage. However, this
rapid rise of PCV7 coverage in the survey for New York
correlated well and at the same time period noted by a
714 POEHLING et al
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community-wide random sample of medical charts in
the Rochester, New York area, the same geographic area
as this study.40
CONCLUSIONS
The declines in frequent otitis media and PET insertions
matched or exceeded the results in randomized, con-
trolled trials, suggesting direct and indirect benefits to
children who were or were not fully vaccinated. These
findings are particularly encouraging in light of PCV7
shortages. Furthermore, these reductions in frequent
otitis media and PETs are higher than that seen in ran-
domized, controlled trials and may have important im-
plications on the cost-effectiveness analyses for PCV7.
However, whether these findings continue or wane, as
suggested by the 20012002 birth cohort from New York
and Tennessee, respectively, is important and deserves
additional study and monitoring.
ACKNOWLEDGMENTS
This project was supported by cooperative agreement
U38/CCU417958 from the Centers for Disease Control
and Prevention (CDC) and U50/CCU30086, TS-0825
from American Teachers of Preventive Medicine/CDC.
Dr Poehling also received support from K23 AI065805
(National Institute of Allergy and Infectious Diseases,
National Institutes of Health) and the Robert Wood
Johnson Generalist Physician Faculty Scholars Program.
Data to conduct the study were obtained from the
Tennessee Department of Health and the TennCare Bu-
reau.
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PEDIATRICS Volume 119, Number 4, April 2007 715
ERRATA Patel JA, Nair S, Revai K, et al. Association of Proinflammatory
Cytokine Gene Polymorphisms With Susceptibility to Otitis Media.
PEDIATRICS 2006;118:22732279.
Errors occurred in the article by Patel et al, titled Association of Proinflam-
matory Cytokine Gene Polymorphisms With Susceptibility to Otitis Media,
published in the December 2006 issue of Pediatrics (doi:10.1542/peds.2006-
0764). In Tables 2 and 3 on pages 2275 and 2276, respectively, the authors
reported the genotypes for TNF-308 and IL-6174 incorrectly. For TNF-
308, footnote c should be assigned to G/G and footnote d should be
assigned to G/A or A/A. For IL-6174, footnote c should be assigned to
G/G and footnote d should be assigned to G/C or C/C. On page 2277,
Discussion section, second paragraph, line 7, IL-6174 GG polymorphism
should be replaced with TNF-308 AA/AG polymorphism.

doi:10.1542/peds.2007-1095

Poehling KA, Szilagyi PG, Grijalva CG, et al. Reduction of Frequent

Otitis Media and Pressure-Equalizing Tube Insertions in Children
After Introduction of Pneumococcal Conjugate Vaccine.
PEDIATRICS 2007;119:707715.
An error occurred in the article by Poehling et al, titled Reduction of
Frequent Otitis Media and Pressure-Equalizing Tube Insertions in Children
After Introduction of Pneumococcal Conjugate Vaccine, published in the
April 2007 issue of Pediatrics (doi:10.1542/peds.2006-2138). On page 715,
reference 11 has an error in an authors name. Nuorti PJ should be Nuorti
JP.

doi:10.1542/peds.2007-1030

Claudius I, Keens T. Do All Infants With Apparent Life-

Threatening Events Need to Be Admitted? PEDIATRICS 2007;119:
679 683.
An error occurred in the article by Claudius and Keens, titled Do All Infants
With Apparent Life-Threatening Events Need to Be Admitted? published in
the April 2007 issue of Pediatrics (doi:10.1542/peds.2006-2549). On page
679, in the Results section of the Abstract, on lines 4-6, the authors wrote:
In our study group, the high-risk criteria of age of 1 year and multiple
apparent life-threatening events yielded a negative predictive value of 100%
to identify the need for hospital admission. It should read: In our study
group, the high-risk criteria of age of 1 month and multiple apparent
life-threatening events yielded a negative predictive value of 100% to iden-
tify the need for hospital admission.

doi:10.1542/peds.2007-1123

1270 ERRATA
Reduction of Frequent Otitis Media and Pressure-Equalizing Tube Insertions in
Children After Introduction of Pneumococcal Conjugate Vaccine
Katherine A. Poehling, Peter G. Szilagyi, Carlos G. Grijalva, Stacey W. Martin,
Bonnie LaFleur, Ed Mitchel, Richard D. Barth, J. Pekka Nuorti and Marie R. Griffin
Pediatrics 2007;119;707
DOI: 10.1542/peds.2006-2138

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/119/4/707.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2007 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Reduction of Frequent Otitis Media and Pressure-Equalizing Tube Insertions in
Children After Introduction of Pneumococcal Conjugate Vaccine
Katherine A. Poehling, Peter G. Szilagyi, Carlos G. Grijalva, Stacey W. Martin,
Bonnie LaFleur, Ed Mitchel, Richard D. Barth, J. Pekka Nuorti and Marie R. Griffin
Pediatrics 2007;119;707
DOI: 10.1542/peds.2006-2138
Updated Information & including high resolution figures, can be found at:
Services /content/119/4/707.full.html

References This article cites 34 articles, 15 of which can be accessed free

at:
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright 2007 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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