The Unneglectable Disease Burden of Otitis Media Among Children in China: A Systematic Review and Meta-analysis

Background: Otitis media (OM) is one of the most commonly diagnosed infections among children yet with obscure disease burden. Methods: The literature published from 1980 to 2022 was retrieved in PubMed, Ovid-EMBASE, Web of Science, CNKI, Wanfang and VIP. Literature screening, quality assessment and data extraction were conducted by 2 independent reviewers. Heterogeneity and publication bias were detected by I 2 , Egger’s and Begg’s tests. The data were pooled using the random-effects model. The number of OM cases was estimated by the multiplied model based on pooled results and the 2020 China census data. Results: A total of 28,378 literatures were identified with 67 finally included for data analysis. The OM incidence among children was 7.89% [95% confidence interval (CI): 5.43%–11.33%] and the prevalence of OM was 5.13% (95% CI: 3.49%–7.49%). The most common pathogen of the OM cases was Streptococcus pneumoniae ( S. pneumoniae ), with a positive rate of 33.52% (95% CI: 26.55%–41.29%). The most common serotypes of S. pneumoniae isolated from OM cases were serotypes 19F, 19A, 6B, 23F and 3, with 85.8% covered by the PCV13. We estimated that there were 8,950,797 (95% CI: 6,080,533–12,928,051) OM cases among under-fives in China in 2020, of which 3,374,451 (95% CI: 1,698,901–6,277,862) cases of OM were caused by S. pneumoniae . Conclusions: The burden of OM in China was considerable yet neglected. To date, S. pneumoniae was the most frequently detected bacterial pathogen of OM. Vaccination may be effective to protect young children from OM.