ID-5184 Wonca Abstracts supplement L-Z 13-10-23 - Flipbook - Page 18
WONCA 2023 Supplement 2: WONCA 2023 abstracts (L–Z)
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Prevalence of otitis media, hearing impairment and
language delay in First Nations children, birth to age
3 years
Prof Amanda Leach1,2, Nicole Wilson1,2, Beth Arrowsmith1,2,14, Jemima Beissbarth1,2,
Kim Mulholland3,4,5, Mathuram Santosham6,7, Paul Torzillo8,9, Peter McIntyre9,10, Heidi Smith-Vaughan1,2,
Sue Skull11,15, Mark Chatfield1,12, Deborah Lehmann14, Michael Binks1,2, Ross Andrews17,
Anne Chang1,2,13, Jonathan Carapetis11,14, Tom Snelling9, Vicki Krause16, Paul Licciardi3,4,
Victor Oguoma1,2,12, Peter Morris1,2,18
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Menzies School of Health Research, 2Charles Darwin University, 3Murdoch Children’s Research
Institute, 4University of Melbourne, 5London School of Hygiene and Tropical Medicine,
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Johns Hopkins Bloomberg School of Public Health, 7Center for American Indian Health,
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Royal Prince Alfred Hospital, 9University of Sydney, 10University of Otago, 11Perth Children’s Hospital,
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University of Queensland, 13Queensland University of Technology, 14Telethon Kids Institute,
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University of Western Australia, 16Centre for Disease Control (CDC) – Environmental Health,
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Queensland Health, 18Royal Darwin Hospital
Background
In remote communities of northern Australia, First Nations children with hearing impairment (HI) are
disproportionately at risk of poor school readiness and performance compared with their peers
without HI. Our objective was to determine a mixed pneumococcal conjugate vaccine (PCV) schedule
to maximise immunogenicity and thereby reduce bacterial otitis media (OM), disabling HI and
developmental delays from birth to age 3 years.
Methods
We conducted two parallel open-label randomised controlled trials. Eligible infants were first allocated
1:1:1 to standard or mixed primary PCV schedules at age 28–38 days, then at age 12 months to
a booster dose (1:1) of 13-valent PCV (PCV13; Prevenar13®; +P) or 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugated vaccine (PHiD-CV10; Synflorix®; +S).
Findings
From March 2013 to September 2018, 261 children were allocated to booster +P (n = 131) or +S
(n = 130). Adverse events, primary and select secondary outcomes to age 18 months have been
reported. Here we report six-monthly by booster dose, standardised ear, hearing and developmental
assessments from age 12 to 36 months. We found high levels and non-significant group differences in
the prevalence of OM at each age (eg 88% and 91%, respectively at age 18 months; difference –3%
[95% CI: –11, 5]). Analyses stratified by primary schedules were non-significant. Compared with +S,
the +P group had a significantly lower prevalence of moderate HI at age 18 months (23% and 42%,
respectively), and a lower prevalence of expressive language delays (differences 17% to 20%) at ages
24 and 30 months.
Interpretation
Our study adds evidence of the high prevalence of chronic OM and early life trajectory of disability and
disadvantage associated with OM and HI. Communities, primary healthcare services and specialists
must be resourced and directed to evidence-based OM prevention and treatment for this population.
Expanded-valency PCVs should be evaluated.
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