Otitis media: prospects for prevention.

Alternatives to vaccination for preventing the considerable morbidity of otitis media (OM) are limited. Non-typable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae together account for approximately 80% of OM cases worldwide, so vaccines against these most serious pathogens should materially reduce the burden of OM. Early trial data for a vaccine prototype including NTHi and 11 pneumococcal serotypes, interpreted carefully in relation to other trials, suggest that OM can now be considered a vaccine-preventable disease. Despite differences of scenario according to healthcare and bacteriology circumstances of different countries, a provisional analysis of health-economic precedents and policy considerations favours vaccination.