Answers are grounded in this paper and cite their sources.
In 177 children living in an area with high 13-valent pneumococcal conjugate vaccine 13 coverage, who had acute otitis media complicated with spontaneous tympanic membrane perforation, Streptococcus pneumoniae was identified in the middle ear fluid of 48 (27.1%) subjects, with 37 (77.1%) cases caused by nonpneumococcal conjugate vaccine 13 serotypes.
No takes yet. Share an insight, caveat, or question.
Marchisio et al. (2016) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: