Surveillance of otitis media in remote communities shows high rates of disease from weeks after birth throughout early childhood, particularly tympanic membrane perforations in the second year of life, and thus supports the need for a booster dose. Between 2008 and 2010, in PCV7-vaccinated children, mean age of tympanic membrane perforation was 18 months; for children with AOM with perforation (AOMwiP), the mean age was 13 months and for chronic suppurative OM (CSOM) 21 months. IPD cases occurring in Indigenous and non-Indigenous children less than 2 years of age for all serotypes; in 2009 there were 7 cases; in 2011 8 cases. The majority of IPD cases in children under 2 years occurred between 12 and 18 months.