Although recent clinical trials suggest that conjugate vaccination will be less effective for the prevention of AOM than for IPD, these trials have demonstrated impressive reductions in the incidence of AOM due to invasive and antibiotic-resistant pneumococcal serotypes. These data suggest that if serotype replacement does occur in immunized children, the causative agents are likely to be less virulent than vaccine strains. Furthermore, a recent cost-effectiveness analysis projected that immunization of healthy infants with the heptavalent conjugate vaccine could prevent over one million episodes of AOM and 12,000 cases of invasive pneumococcal disease. Because significant reductions have been demonstrated in the incidence of frequently recurrent AOM, children with the worst disease stand to benefit most from vaccination. Based on data currently available, however, the conjugate vaccine is not going to eradicate AOM. Consequently, there will continue to be a need to scrutinize the threshold for prescribing antibiotics. In addition, there will be an ongoing need for surgery in some cases of recurrent AOM and persistent OME.
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