Eugene Leibovitz

BIODr. Eugene Leibovitz received his medical degree from the Sackler School of Medicine, Tel Aviv, Israel and completed in 1989 his residency in pediatrics at the Kaplan Medical Center in Rehovot, Israel. During 1989-1992 he completed a three-year fellowship in Pediatric Infectious Diseases at New York University, New York, NY. Since 1994 Dr. Leibovitz works as senior physician at the Pediatric Infectious Disease Unit and the Pediatric Division of the Soroka University Medical Center of the Ben-Gurion University of the Negev, Beer-Sheva, Israel. Dr. Leibovitz has published more than 200 research papers in well-known and highly rated medical journals. Dr. Leibovitz's work is primarily in the area of acute otitis media and other respiratory infections, the pathogens responsible for these disease states and their resistance to antibiotics, as well as their prevention by vaccines. His research includes various topics related the etiology and diagnosis of acute otitis media, as well as its appropriate antibiotic treatment, particularly in complicated and nonresponsive to treatment cases. During the last years, dr. Leibovitz worked and published extensively in the field of diagnosis, treatment and prevention of bacteremia in infants and young children, osteoarticular infections, acute otitis media, mastoiditis as well as the diagnosis and management of urinary tract infections in young infants. In 2008, dr. Leibovitz received the title of full Professor of Pediatrics and Pediatric Infectious Diseases at the Ben-Gurion University of the Negev. During 2008-2016 he acted as director of the Pediatric Emergency Medicine Department and during 2016-2018 he was the director of the Pediatric Research Unit at the Soroka University Medical Center of the Ben-Gurion University of the Negev.

Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis (AM) in children

AM is a suppurative infection of the mastoid air cells and the most common intra-temporal complication of acute otitis media (AOM) in children. Incidence rates of AM in the developed world range from 1.2 to 15.0/100,000 children <18 years of age. The most common pathogens causing AOM and also AM are Streptococcus pneumoniae, non-typeableHaemophilus influenzae, Streptococcus pyogenes, Moraxella catarrhalis and Fusobacterium necrophorum.

The pneumococcal conjugate vaccine (PCV) in its 7-valent form (PCV7) was introduced in the USA more than 20 years ago and in Israel, in its 7 and 13-valent (PCV13) from 2009 and 2010, respectively. Both vaccines had been shown to decrease some of the pneumococcal-related morbidities, including AOM. The effect of the sequential introduction of the 2 PCVs on AOM was described in two studies from Israel by Ben-Shimol et al., who showed a significant decline in the incidence of both pneumococcal and nonpneumococcal AOM that required tympanocentesis in children <3 years. Additional prospective studies from USA and Europe reported that PVC13 prevents pneumococcal AOM caused by vaccine serotype.

Taking into consideration the fact that the microbiology of AOM and AM are quite similar, it was expected the incidence of AM will also decrease following the introduction of the PCVs. However, the worldwide incidence rates of AM reported following the introduction of the PCVs are contradictory.  The incidence of AM reported in southern Israel in a tertiary care medical center continued to increase during the last two decades (from 6.1/100,000 during 1990–2001 to 11.5/100, 000 during 2002–2012).  An additional retrospective Italian study, reporting on a total of 913 children with AM diagnosed during 2002-2013,  showed increasing rates of AM only among older children (≥4 years) .  On the other hand, other studies performed before the introduction of PCV13 in Western Europe reported no changes in AM rates, with pediatric incidence rates between 4.8 to 6.3/100,000].

The information on the impact of PCV13 vaccination on the rates and microbiology of AM is limited. We will present the evidence accumulated in the medical literature regarding the impact of PCV13 on AM in children, together with new data analyzing the trends in AM incidence, microbiology, complications and management in children <15 years of age in southern Israel, before and after the PVC13 introduction (2005-2016).


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by Eugene Leibovitz

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