Impact of COVID-19 on Pneumococcal Acute Otitis Media, Antibiotic Resistance, and Vaccination in Children

Streptococcus pneumoniae is the main pathogen that plays a dual role, on the one hand as an asymptomatic carrier in the nasopharyngeal mucosa and on the other hand directly responsible for triggering invasive pneumococcal infections with various important localizations, especially in the pediatric population. Thus, invasive pneumococcal infections represent one of the main causes of mortality and morbidity in children under 5 years of age. Immunization is a key preventive measure against these infections. The evolution of these infections caused by S. pneumoniae is influenced both directly and indirectly by several factors: the immunization status of the patient, the regional and seasonal distribution of pneumococcal serotypes, susceptibility to anti-biotics, the existence of viral or bacterial co-infections and the socio-economic conditions specific to each region. This review gathers the current open-access PubMed evidence on the incidence of invasive pneumococcal infections and their susceptibility to antibiotics in the 0-5 age group during and after the COVID-19 pandemic. We have chosen this association with the SARS-COV- 2 virus because this pandemic has caused major changes on all personal, social, professional, and medical levels worldwide. Both pneumococcal disease and COVID-19 have similar risk factors, and S. pneumoniae was one of the most common co-infecting agents during the COVID-19 pandemic. The attention was focused on 8 clinical trials published in the pre- and post COVID-19 period that had as main subject acute otitis media caused by Streptococcus pneumoniae in children aged 0-5 years. The studies were collected from different geographical regions, both from socio-economically developed and developing countries such as Niger, Malawi, China and Papua New Guinea, Japan, Australia, Italy, in order to have a global overview. In conclusion, the COVID-19 pandemic had a major impact on the quality of life of pediatric patients diagnosed with pneumococcal acute otitis media both in terms of non-vaccine serotypes and antimicrobial resistance.