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Ruttkay Pereira DR, Pereira MR, Rotta Pereira MB, Costa SS, Mott MP, Cantarelli V. Otopathogens in the middle ear and nasopharynx of children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2023; 169:111552. [PMID: 37120991 DOI: 10.1016/j.ijporl.2023.111552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study aimed to describe the microbiology of the middle ear and nasopharynx, determining the prevalence of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in a group of children vaccinated with pneumococcal conjugate vaccine (PCV) who underwent ventilation tube insertion for recurrent acute otitis media. METHODS We analyzed 278 middle ear effusion and 139 nasopharyngeal samples obtained from 139 children who underwent myringotomy and ventilation tube insertion for recurrent acute otitis media between June 2017 and June 2021. The children's ages ranged from 9 months to 9 years, 10 months, with a median of 21 months. The patients had no signs of acute otitis media or respiratory tract infection and were not on antibiotic therapy at the time of the procedure. The middle ear effusion and nasopharyngeal samples were collected with an Alden-Senturia aspirator and a swab, respectively. Bacteriological studies and multiplex PCR were performed for the detection of the three pathogens. Direct molecular determination of pneumococcal serotypes was performed by real-time PCR. The chi-square test was used to verify associations between categorical variables and measures of strength of association based on prevalence ratios, considering a 95% confidence interval a 5% significance level. RESULTS Vaccination coverage was 77.7% with the basic regimen plus booster dose and 22.3% with the basic regimen alone. Middle ear effusion culture identified H. influenzae in 27 children (19.4%), S. pneumoniae in 7 (5.0%), and M. catarrhalis in 7 (5.0%). PCR detected H. influenzae in 95 children (68.3%), S. pneumoniae in 52 (37.4%), and M. catarrhalis in 23 (16.5%), a three-to seven-fold increase compared to culture. In the nasopharynx, culture isolated H. influenzae in 28 children (20.1%), S. pneumoniae in 29 (20.9%), and M. catarrhalis in 12 (8.6%). PCR identified H. influenzae in 84 children (60.4%), S. pneumoniae in 58 (41.7%), and M. catarrhalis in 30 (21.5%), a two-to three-fold increase in detection. The most common pneumococcal serotype was 19A, both in the ears and the nasopharynx. In the ears, of the 52 children who had pneumococcus, 24 (46.2%) had serotype 19A. In the nasopharynx, of the 58 patients who had pneumococcus, 37 (63.8%) had serotype 19A. Of all 139 children, 53 (38.1%) had polymicrobial samples (more than 1 of the 3 otopathogens) in the nasopharynx. Of the 53 children who had polymicrobial samples in the nasopharynx, 47 (88.7%) also had 1 of the 3 otopathogens in the middle ear, mainly H. influenzae (40%-75.5%), especially when it was found in the nasopharynx in conjunction with S. pneumoniae. CONCLUSION The prevalence of bacteria in a group of Brazilian children immunized with the PCV who required ventilation tube insertion for recurrent acute otitis media was similar to that reported in other parts of the world after the advent of PCV. H. influenzae was the most frequent bacteria, both in the nasopharynx and the middle ear, while S. pneumoniae serotype 19A was the most common pneumococcus in the nasopharynx and middle ear. Polymicrobial colonization of the nasopharynx was strongly associated with detection of H. influenzae in the middle ear.
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Affiliation(s)
- Denise Rotta Ruttkay Pereira
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Manuel Ruttkay Pereira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, 90619900, Porto Alegre, RS, Brazil.
| | | | - Sady Selaimen Costa
- School of Medicine, UFRGS, R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Mariana Preussler Mott
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035903, Porto Alegre, RS, Brazil.
| | - Vlademir Cantarelli
- Department of Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), R. Sarmento Leite, 245, 90050170, Porto Alegre, RS, Brazil.
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Kurabi A, Hur DG, Pak K, Gibson M, Webster NJG, Baird A, Eliceiri BP, Ryan AF. The ECRG4 cleavage product augurin binds the endotoxin receptor and influences the innate immune response during otitis media. Front Genet 2022; 13:932555. [PMID: 36092940 PMCID: PMC9461705 DOI: 10.3389/fgene.2022.932555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Otitis media (OM), the most common disease of childhood, is typically characterized by bacterial infection of the middle ear (ME). Prominent features of OM include hyperplasia of the ME mucosa, which transforms from a monolayer of simple squamous epithelium with minimal stroma into a full-thickness respiratory epithelium in 2-3 days after infection. Analysis of the murine ME transcriptome during OM showed down-regulation of the tumor suppressor gene Ecrg4 that was temporally related to mucosal hyperplasia and identified stromal cells as the primary ECRG4 source. The reduction in Ecrg4 gene expression coincided with the cleavage of ECRG4 protein to release an extracellular fragment, augurin. The duration of mucosal hyperplasia during OM was greater in Ecrg4 -/- mice, the number of infiltrating macrophages was enhanced, and ME infection cleared more rapidly. ECRG4-null macrophages showed increased bacterial phagocytosis. Co-immunoprecipitation identified an association of augurin with TLR4, CD14 and MD2, the components of the lipopolysaccharide (LPS) receptor. The results suggest that full-length ECRG4 is a sentinel molecule that potentially inhibits growth of the ME stroma. Processing of ECRG4 protein during inflammation, coupled with a decline in Ecrg4 gene expression, also influences the behavior of cells that do not express the gene, limiting the production of growth factors by epithelial and endothelial cells, as well as the activity of macrophages.
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Affiliation(s)
- Arwa Kurabi
- Department of Otolaryngology, University of California, San Diego, La Jolla, CA, United States,*Correspondence: Arwa Kurabi,
| | - Dong Gu Hur
- Department of Otolaryngology, University of California, San Diego, La Jolla, CA, United States,Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Kwang Pak
- Department of Otolaryngology, University of California, San Diego, La Jolla, CA, United States
| | - Madeline Gibson
- Department of Otolaryngology, University of California, San Diego, La Jolla, CA, United States
| | - Nicholas J. G. Webster
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States,San Diego Veterans Administration Healthcare System, San Diego, CA, United States
| | - Andrew Baird
- Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Brian P. Eliceiri
- Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Allen F. Ryan
- Department of Otolaryngology, University of California, San Diego, La Jolla, CA, United States,San Diego Veterans Administration Healthcare System, San Diego, CA, United States
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Izurieta P, Scherbakov M, Nieto Guevara J, Vetter V, Soumahoro L. Systematic review of the efficacy, effectiveness and impact of high-valency pneumococcal conjugate vaccines on otitis media. Hum Vaccin Immunother 2022; 18:2013693. [PMID: 35020530 PMCID: PMC8973322 DOI: 10.1080/21645515.2021.2013693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Otitis media (OM) is a common disease of childhood and available pneumococcal conjugate vaccines (PCVs), with different compositions, could have different impact on OM reduction. This systematic literature review evaluated available data describing the efficacy, effectiveness, and impact of 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and 13-valent PCV (PCV13) on OM outcomes. Statistically significant reductions in all-cause and complicated OM, tympanostomy tube placement and OM-related hospitalizations were consistently observed after the introduction of PHiD-CV and PCV13. Impact studies with data in children <2 years of age using PCV13 report 47–51% and PHiD-CV 34–43% reduction of all-cause OM (primary care, outpatient, ambulatory, emergency department visits) compared to periods before PCV introduction. When the impact of both vaccines is assessed in comparable settings, some studies suggest PHiD-CV may offer better protection against some OM outcomes. Well-designed, head-to-head comparisons are needed to better understand the differences and guide vaccination policies.
What is the context?
Pneumococcal vaccines are highly effective in preventing pneumonia and meningitis in children. The two main pneumococcal vaccines are PHiD-CV (Synflorix, GSK) and PCV13 (Prevenar 13, Pfizer). Both vaccines have been shown to provide protection against otitis media despite differing in their composition. However, it is currently unknown if both vaccines confer similar level of protection against otitis media.
What is new?
We conducted a literature review to evaluate the effects of PHiD-CV and PCV13 on otitis media. From 33 articles, we found that:‡Both vaccines were effective in reducing doctor visits for otitis media as well as the number of severe cases and cases requiring hospitalization. ‡Four studies suggested a higher level of protection provided by PHiD-CV compared to PCV13, although more data is needed to confirm this finding.
What is the impact?
Available information shows that PHiD-CV and PCV13 are effective in preventing a proportion of otitis media during childhood. Given the remaining substantial burden associated with the disease and the related significant usage of antibiotics, the development of improved vaccines with higher impact on otitis media would be welcome.
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Heo KW, Pak K, Kurabi A, Ryan AF. Leukotriene B4 Is a Major Determinant of Leukocyte Recruitment During Otitis Media. Front Cell Infect Microbiol 2022; 11:768815. [PMID: 35004347 PMCID: PMC8727869 DOI: 10.3389/fcimb.2021.768815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pathogens of otitis media (OM) induce inflammatory responses in the middle ear (ME), characterized by mucosal hyperplasia, leukocyte infiltration, and inflammatory mediators, including arachidonic acid metabolites. We studied the role of the eicosanoid leukotriene B4 (LTB4) in OM. Methods Expression of LTB4-related genes was evaluated by gene array and single-cell RNA-Seq in MEs infected with nontypeable Haemophilus influenzae (NTHi). An inhibitor of LTB4 receptor 1 (i.e. U75302) was also used to block LTB4 responses. Results ME expression of LTB4-related genes was observed by gene arrays and scRNA-Seq. However, not all genes involved in LTB4 generation occurred in any one specific cell type. Moreover, LTB4 receptor inhibition significantly reduced mucosal hyperplasia and virtually eliminated leukocyte infiltration. Conclusions ME expression of LTB4-related genes suggest a functional role in OM disease. The fact that LTB4-generation is spread across different cell types is consistent with a transcellular pathway of eicosanoid biosynthesis involving cell-to-cell signaling as well as transfer of biosynthetic intermediates between cells. The dramatic reduction in ME leukocyte infiltration caused by U75302 indicates that LTB4 plays a major role in ME inflammatory cell recruitment, acting via the LTB4R1 receptor. Given that there are many other chemotactic factors that occur in the ME during OM, the ability of LTB4 to activate leukocytes and stimulate their extravasation may explain the effects of inhibition. Reduction in mucosal hyperplasia due to U75302 administration may be secondary to the reduction in leukocytes since LTB4R1 is not expressed by mucosal epithelial or stromal cells. The results suggest that LTB4 receptor antagonists could be useful in treating OM.
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Affiliation(s)
- Kyung Wook Heo
- Department of Otolaryngology, University Of California San Diego, La Jolla, CA, United States.,Department of Otorhinolaryngology - Head & Neck Surgery, Inje University Busan Paik Hospital, Busan, South Korea
| | - Kwang Pak
- Department of Otolaryngology, University Of California San Diego, La Jolla, CA, United States
| | - Arwa Kurabi
- Department of Otolaryngology, University Of California San Diego, La Jolla, CA, United States
| | - Allen F Ryan
- Department of Otolaryngology, University Of California San Diego, La Jolla, CA, United States.,Research Section, Veterans Administration (VA) San Diego Healthcare System, La Jolla, CA, United States
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Jespersen SI, Demant MN, Pedersen ML, Homøe P. Acute otitis media and pneumococcal vaccination - an observational cross-sectional study of otitis media among vaccinated and unvaccinated children in Greenland. Int J Circumpolar Health 2021; 80:1858615. [PMID: 33407056 PMCID: PMC7801097 DOI: 10.1080/22423982.2020.1858615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 12/25/2022] Open
Abstract
Streptococcus pneumoniae is one of the main pathogens leading to otitis media. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) was implemented in the Greenlandic childhood vaccination programme, but the effect of this change is not yet well documented. The objective of this study is to evaluate the effect of the implementation based on the number of episodes of acute otitis media (AOM). Data are obtained from medical records. We included all children born from 1 January 2015 to 30 September 2016, and thus eligible for the three doses of PCV13 including one year of follow-up time. Exclusion criteria were uncertain vaccination status and predefined comorbidities. The children were divided into two groups based on vaccination status: "Vaccinated" or "Incomplete/delayed". We included 1077 children in total, 742 children were allocated to the "Vaccinated" group and 335 children were allocated to the "Incomplete/delayed" group. There were significantly fewer episodes of AOM in the "Incomplete/delayed" group (p = 0.01). In conclusion Greenlandic children completely and timely vaccinated with PCV13 and born between January 2015 and September 2016 did not have fewer episodes of AOM compared to children who had incomplete or delayed vaccination status. Abbreviations: PCV13: 13-valent pneumococcal conjugate vaccine; OM: otitis media; AOM: acute otitis media; CSOM: chronic suppurative otitis media; WHO: World Health Organisation; NTHi: nontypeable Haemophilus influenzae.
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Affiliation(s)
- Simon Imer Jespersen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Nøhr Demant
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
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Pneumococcal Conjugated Vaccines Decreased Acute Otitis Media Burden: A Population-Based Study in Israel. J Pediatr 2021; 235:233-238.e3. [PMID: 33894263 DOI: 10.1016/j.jpeds.2021.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study time trends in all-cause acute otitis media (AOM) burden by calculating incidence rates of AOM episodes and recurrent acute otitis media (rAOM) cases in highly immunized pediatric population during the pre- and post-pneumococcal conjugated vaccine (PCV) years. STUDY DESIGN In this population-based study, AOM episodes and rAOM cases were identified in Clalit Health Services-insured Israeli children aged 0-10 years between 2005 and 2018 by using a data-sharing platform. Because a near-sequential implementation of PCV-7/PCV-13 occurred within a 1-year period (2009/2010), we compared AOM visits before (2005-July 2009) and after (August 2009-2018) the introduction of PCVs. We focused on children younger than 2 years of age, who are the target population of PCVs and are at AOM peak age. RESULTS We identified 805 389 AOM episodes contributed by 270 137 children. The median number of AOM episodes was 2 (IQR 1-4). A downward trend of incidence rates of AOM episodes was observed during the post-PCV years in children younger than age 9 years (P < .001). The largest decrease (21%) was observed in children younger than 1 year, from 807/1000 children during the pre-PCV years to 640/1000 during the post-PCV years (P < .001). An average annual decrease of ∼14/1000 AOM episodes was calculated in children younger than 1 year old (β = -13.39, 95% CI -16.25 to -10.53, P < .001). Of rAOM cases, documented in 84 237 (31.2%) children, 74% were in children younger than 2 years, and 55% were in boys. The risk to develop rAOM significantly decreased during the post-PCV years in children younger than 2 years (hazard ratio 0.893, 95% CI 0.878-0.908; P < .001). CONCLUSIONS AOM burden significantly decreased following PCVs introduction in highly immunized children.
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Horn M, Behre U, Traskine M, Dobbelaere K, Borys D. Safety, reactogenicity, and immunogenicity of a 12-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine in healthy toddlers: results from a phase I, randomized trial. Hum Vaccin Immunother 2021; 17:1463-1469. [PMID: 33175600 PMCID: PMC8078718 DOI: 10.1080/21645515.2020.1810493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
As a stepping stone toward evaluation in infants, the safety and immunogenicity of an investigational 12-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (12vPHiD-CV) was assessed in toddlers. 12vPHiD-CV contains CRM197-conjugated capsular polysaccharides of serotypes 6A and 19A in addition to capsular polysaccharides of the 10 serotypes in PHiD-CV. In this phase I, double-blind, multicenter study (NCT01485406) conducted in Germany, 61 healthy toddlers aged 12–23 months previously primed with three PHiD-CV doses were randomized (1:1) to receive one dose of 12vPHiD-CV or PHiD-CV. Safety and reactogenicity of 12vPHiD-CV were assessed in terms of occurrence of grade 3 vaccination-related solicited and unsolicited adverse events (AEs) and vaccination-related serious AEs. Immune responses were evaluated 1 month post-vaccination. Grade 3 solicited local AEs (all considered vaccination-related) were reported for two (6.5%, redness) and three (9.7%, swelling) toddlers in the 12vPHiD-CV group and one (3.4%, swelling) in the PHiD-CV group. Grade 3 vaccination-related solicited general AEs were only reported in the PHiD-CV group. No grade 3 unsolicited or serious AEs were reported. For PHiD-CV serotypes, 100% of toddlers in both groups had antibody concentrations ≥0.2 µg/mL 1 month post-vaccination, and antibody geometric mean concentrations increased from pre-boosting. For serotypes 6A and 19A, antibody responses tended to be higher in the 12vPHiD-CV than the PHiD-CV group. A single dose of 12vPHiD-CV administered in toddlers was well tolerated and no safety concerns were identified. Immune responses were comparable to those induced by PHiD-CV when administered in toddlers previously primed with three doses of PHiD-CV.
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Affiliation(s)
| | | | - Magali Traskine
- HPV, Hepatitis and Pneumococcal Vaccines, Clinical R&D, GSK, Wavre, Belgium
| | - Kurt Dobbelaere
- HPV, Hepatitis and Pneumococcal Vaccines, Clinical R&D, GSK, Wavre, Belgium
| | - Dorota Borys
- HPV, Hepatitis and Pneumococcal Vaccines, Clinical R&D, GSK, Wavre, Belgium
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Eythorsson E, Ásgeirsdóttir TL, Erlendsdóttir H, Hrafnkelsson B, Kristinsson KG, Haraldsson Á. The impact and cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the paediatric immunisation programme in Iceland-A population-based time series analysis. PLoS One 2021; 16:e0249497. [PMID: 33831049 PMCID: PMC8031404 DOI: 10.1371/journal.pone.0249497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Streptococcus pneumoniae is a cause of infections that range in severity from acute otitis media (AOM) to pneumonia and invasive pneumococcal disease (IPD). The 10-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic paediatric immunisation programme in 2011. The aim was to estimate the population impact and cost-effectiveness of PHiD-CV10 introduction. METHODS Data on primary care visits from 2005-2015 and hospitalisations from 2005-2017 were obtained from population-based registries. A Bayesian time series analysis with synthetic controls was employed to estimate the number of cases of AOM, pneumonia and IPD that would have occurred between 2013-2017, had PHiD-CV10 not been introduced. Prevented cases were calculated by subtracting the observed number of cases from this estimate. The cost of the programme was calculated accounting for cost-savings due to prevented cases. RESULTS The introduction of PHiD-CV10 prevented 13,767 (95% credible interval [CI] 2,511-29,410) visits for AOM from 2013-2015, and prevented 1,814 (95%CI -523-4,512) hospitalisations for pneumonia and 53 (95%CI -17-177) admissions for IPD from 2013-2017. Visits for AOM decreased both among young children and among children 4-19 years of age, with rate ratios between 0.72-0.89. Decreases were observed in both pneumonia hospitalisations (rate ratios between 0.67-0.92) and IPD (rate ratios between 0.27-0.94). The total cost of implementing PHiD-CV10 in Iceland was -7,463,176 United States Dollars (USD) (95%CI -16,159,551-582,135) with 2.1 USD (95%CI 0.2-4.7) saved for every 1 USD spent. CONCLUSIONS The introduction of PHiD-CV10 was associated with large decreases in visits and hospitalisations for infections commonly caused by pneumococcus and was cost-saving during the first five years of the immunisation programme.
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Affiliation(s)
| | | | - Helga Erlendsdóttir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Karl G. Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Children’s Hospital Iceland, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
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Dagan R, Van Der Beek BA, Ben-Shimol S, Pilishvili T, Givon-Lavi N. Effectiveness of the 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-Serotype Otitis Media. Clin Infect Dis 2021; 73:650-658. [DOI: 10.1093/cid/ciab066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite the demonstrated impact of pneumococcal vaccine (PCV) implementation on otitis media (OM), demonstration of real-life serotype-specific effectiveness of the 7-valent and 13-valent PCVs (PCV7 and PCV13) is lacking owing to the paucity of culture-positive cases. Furthermore, prelicensure PCV13 efficacy against OM was not studied.
Methods
The study was conducted from October 2009 to July 2013. Case patients were children aged 5–35 months with OM (mostly complex OM [recurrent/nonresponsive, spontaneously draining, chronic with effusion]) from whom middle-ear fluid culture was obtained; controls were contemporary children with rotavirus-negative gastroenteritis in a prospective population-based rotavirus surveillance, from the same age group with similar ethnic distribution and geographic location. Vaccine effectiveness (VE) was estimated as 1 minus the odds ratio using unconditional logistic regression, adjusting for time since PCV implementation, age, and ethnicity.
Results
A total of 223 case patients and 1370 controls were studied. Serotypes 19F and 19A together caused 56.1% of all vaccine-type (VT) OM. VE of ≥2 PCV doses in children aged 5–35 months was demonstrated as follows: PCV7 against OM due to PCV7 serotypes, 57.2% (95% confidence interval, 6.0%–80.5%); PCV13 against OM due to PCV13 serotypes, 77.4% (53.3%–92.1%); PCV13 against OM due to the 6 additional non-PCV7 serotypes 67.4% (17.6%–87.1%); PCV13 against OM due to serotype 19F, 91.3% (1.4%–99.2%); and PCV13 against OM due to serotype 3, 85.2% (23.9%–98.4%). PCV7 and PCV13 VE against OM due to serotype 19A in children aged 12–35 months was 72.4% (95% confidence interval, 6.2%–91.9%) and 94.6% (33.9%–99.6%), respectively.
Conclusions
PCV7 and PCV13 were effective against complex OM caused by the targeted serotypes.
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Affiliation(s)
- Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Shalom Ben-Shimol
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Noga Givon-Lavi
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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Edmondson-Jones M, Dibbern T, Hultberg M, Anell B, Medin E, Feng Y, Talarico C. The effect of pneumococcal conjugate vaccines on otitis media from 2005 to 2013 in children aged ≤5 years: a retrospective cohort study in two Swedish regions. Hum Vaccin Immunother 2020; 17:517-526. [PMID: 32574101 PMCID: PMC7899701 DOI: 10.1080/21645515.2020.1775455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced to Sweden in 2009 and replaced by pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) or 13-valent PCV (PCV13) from late 2009. A retrospective cohort study assessed the impact of PCVs on otitis media/acute otitis media (OM) in children aged ≤5 years (NCT02742753) living in Skåne (PCV7 then PHiD-CV) or Västra Götalandsregionen (PCV7 then PCV13) between 2005 and 2013 using linked regional and national databases. Time-series analyses described differences between pre-PCV and post-PCV eras. Adjusted age-period-cohort (APC) predictive models estimated vaccine effectiveness and OM incidence ratios between PCV cohorts. Time-to-first OM diagnosis was estimated in ≤2 year-olds by survival analysis using a Cox proportional hazards model. Descriptive interrupted time-series analyses showed OM incidence in ≤2 year-olds declined by 42% (Skåne) and 25% (Västra Götalandsregionen) after PHiD-CV/PCV13, respectively, versus pre-PCV, but baseline OM incidence and duration of PCV7 use differed between regions. In adjusted APC models, OM incidence decreased after PHiD-CV by 9.9% (95% confidence interval [CI]: 4.4; 15.1, p < .001) and PCV13 by 2.3% (95%CI: −3.2; 7.6, p = .401) compared with pre-PCV. Both PHiD-CV and PCV13 decreased the risk of first OM diagnosis: hazard ratio (95%CI) for PHiD-CV relative to pre-PCV 0.67 (0.65; 0.69); 0.87 (0.85; 0.89) for PCV13 relative to pre-PCV; p < .001 for both comparisons. Within the limitations of this study conducted in two large Swedish regions, descriptive time-series analyses showed that OM incidence rates declined following the introduction of PHiD-CV and PCV13; however, this reduction only reached statistical significance for PHiD-CV in the adjusted APC models.
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Affiliation(s)
| | | | | | | | - Emma Medin
- Parexel International , Stockholm, Sweden
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Petousis-Harris H, Howe AS, Paynter J, Turner N, Griffin J. Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006-2015. Clin Infect Dis 2020; 68:818-826. [PMID: 30032236 DOI: 10.1093/cid/ciy570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/18/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hospitalization rates for infectious diseases in New Zealand (NZ) children have increased since 1989. The highest burden is among Māori and Pacific children, and the most socioeconomically deprived. New Zealand introduced pneumococcal conjugate vaccine (PCV)7 in June 2008, PCV10 in 2011, and PCV13 in 2014. METHODS A retrospective cohort study of NZ children aged <6 years between 2006 and 2015 was performed using administrative databases. Demographics and hospitalizations were linked to evaluate the impact of the PCV vaccination program on cases of invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and otitis media (OM), defined by ICD-10-AM codes, and to explore the effect by ethnicity and deprivation. RESULTS Between 2006 and 2015, there were 640 children hospitalized with IPD, 26589 for ACP, and 44545 for OM. IPD hospitalizations declined by 73% between 2005 and 2015 for children <6 years of age, whereas ACP and OM declined by 8% and 25%, respectively. The highest rates for all diseases were among Māori and Pacific children and those from high deprivation. However, the declines were highest among Māori and Pacific children and those from socioeconomically deprived areas. IPD hospitalizations declined by 79% and 67% for Māori and Pacific children, respectively, between 2006 and 2015. ACP declined by 12% in Māori and 21% in Pacific children. OM declined by 51% in Māori children. CONCLUSION In contrast to the increasing trend of hospitalization rates for infectious disease in New Zealand, the use of PCV appears associated with reductions in ethnic and socioeconomic disparities in hospitalization for IPD, ACP, and OM.
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Affiliation(s)
- Helen Petousis-Harris
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Anna S Howe
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Janine Paynter
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Nikki Turner
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
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Lecrenier N, Marijam A, Olbrecht J, Soumahoro L, Nieto Guevara J, Mungall B. Ten years of experience with the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (Synflorix) in children. Expert Rev Vaccines 2020; 19:247-265. [DOI: 10.1080/14760584.2020.1738226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Negash AA, Asrat D, Abebe W, Hailemariam T, Gebre M, Aseffa A, Vaneechoutte M. Pneumococcal serotype 19A is the major cause of pediatric acute otitis media with ruptured tympanic membrane in Addis Ababa, Ethiopia, 5 years after the introduction of the ten-valent pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2019; 126:109638. [PMID: 31442868 DOI: 10.1016/j.ijporl.2019.109638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In Ethiopia, there is a lack of data on pneumococcal serotypes causing acute otitis media (AOM) in children. We aimed to study the etiology, pneumococcal serotypes and antimicrobial resistance patterns of isolates from children with AOM with spontaneous perforation of the tympanic membrane (SPTM). METHODS We carried out a prospective observational study in children with AOM with SPTM, aged 0-15 years in Addis Ababa, Ethiopia. Middle ear fluid was collected using sterile swabs, cultured and antibiotic susceptibility testing was performed. Serotypes of Streptococcus pneumoniae were determined by sequencing the cpsB gene and by the Quellung reaction. RESULTS A total of 55 children were enrolled. Out of 55 samples that were cultured, 52 (94.5%) were culture positive for a total of 66 bacterial species, and 56.4% (31/55) samples were positive for 41 (62.1%) known pathogenic bacterial species. The most common pathogenic bacterial isolates were S. pneumoniae (36.6%), Staphylococcus aureus (19.5%), Streptococcus pyogenes (14.6%) and Haemophilus influenzae (12.2%). Serotype 19A (73.3%) was the predominant pneumococcal serotype. There was a high rate of non-susceptibility to penicillin (86.6%) and trimethoprim/sulfamethoxazole (80%) among pneumococcal isolates. Out of 21 different isolates tested for amoxicillin susceptibility, 15 (71.4%) were resistant. CONCLUSIONS Pneumococcal serotype 19A was the predominant cause of AOM with SPTM in children in Addis Ababa, Ethiopia, 5 years after introduction of PCV10. There was a high rate of resistance to commonly prescribed antibiotics. The study highlights the need for wide scale surveillance of the etiology and antimicrobial susceptibility of AOM in Ethiopian children.
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Affiliation(s)
- Abel Abera Negash
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia; Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Hailemariam
- Department of Pediatrics and Child Health, Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Meseret Gebre
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
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Soysal A, Gönüllü E, Yıldız I, Aydemir G, Tunç T, Fırat Y, Erdamar B, Karaböcüoğlu M. Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of acute otitis media, recurrent otitis media and tympanostomy tube insertion in children after its implementation into the national immunization program in Turkey. Hum Vaccin Immunother 2019; 16:445-451. [PMID: 31424317 DOI: 10.1080/21645515.2019.1656021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to investigate changes in the incidences of acute otitis media (AOM), recurrent AOM (rAOM) and tympanostomy tube (TT) insertion in children following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national immunization program (NIP) of Turkey in April 2011. National coverage for the PCV7 was 97% in 2009, 93% in 2010, 96% in 2011 and for the PVC13 was 97% in 2012, 97% in 2013, 96% in 2014, 97% in 2015, 98% in 2016, and 96% in 2017 for Turkish children younger than 12 months of age. A total of 499932 pediatric visits were recorded, and AOM was diagnosed in 23005 (4.6%) children. The incidence of AOM in children ≤5 years of age decreased from 10700/100000 (2011) to 4712/100000 (2017), with a significant decreasing trend (p < .001, r = -0.965). When the mean annual incidences of AOM between the transition period of PCV13 (years 2011/2012) were compared with those of a post-PCV13 period (years 2016/2017) for children ≤5 years of age, the incidence of AOM was found to be decreased by 54% (p = 0.013). The mean incidence of TT insertion was found to be decreased by 65% (p = 0.003) between the transition period of PCV13 and a post-PCV13 period for children ≤5 years of age. On the other hand, rAOM incidence was found to be increased in whole pediatric age groups. Our study showed a significant decrease in the incidences of AOM and TT insertion in children ≤5 years old after implementation of PCV13 in the NIP in Turkey.
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Affiliation(s)
- Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital, İstanbul, Turkey
| | - Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital, İstanbul, Turkey
| | - Ismail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital, İstanbul, Turkey
| | - Gökhan Aydemir
- Clinic of Pediatrics, Ataşehir Memorial Hospital, İstanbul, Turkey
| | - Turan Tunç
- Clinic of Pediatrics, Ataşehir Memorial Hospital, İstanbul, Turkey
| | - Yezdan Fırat
- Clinic of Ear-Nose-Throat, Ataşehir Memorial Hospital, İstanbul, Turkey
| | - Burak Erdamar
- Clinic of Ear-Nose-Throat, Şişli Memorial Hospital, İstanbul, Turkey
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Principi N, Esposito S. Experimental and investigational drugs for the treatment of acute otitis media. Expert Opin Investig Drugs 2019; 28:687-694. [DOI: 10.1080/13543784.2019.1638364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Lim HW, Pak K, Kurabi A, Ryan AF. Lack of the hyaluronan receptor CD44 affects the course of bacterial otitis media and reduces leukocyte recruitment to the middle ear. BMC Immunol 2019; 20:20. [PMID: 31226944 PMCID: PMC6588864 DOI: 10.1186/s12865-019-0302-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND CD44 is a multifunctional molecule that plays major roles in both leukocyte recruitment and tissue proliferation. Since mucosal hyperplasia and leukocyte infiltration of the middle ear cavity are major features of otitis media, we evaluated the role of CD44 in the pathophysiology and course of this disease in a mouse model of middle ear infection. Expression of genes related to CD44 function were evaluated using gene arrays in wild-type mice. The middle ears of mice deficient in CD44 were inoculated with non-typeable Haemophilus influenzae. Histopathology and bacterial clearance were compared to that seen in wild-type controls. RESULTS We observed strong up-regulation of CD44 and of genes related to its role in leukocyte extravasation into the middle ear, during the course of acute otitis media. Mice deficient in CD44 exhibited reduced early mucosal hyperplasia and leukocyte recruitment, followed by delayed resolution of infection and persistent inflammation. CONCLUSIONS CD44 plays an important role in OM pathogenesis by altering the mucosal growth and neutrophil enlistment. Targeted therapies based on CD44 could be useful adjuncts to the treatment of middle ear infections.
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Affiliation(s)
- Hyun Woo Lim
- Department of Surgery/Otolaryngology, University of California-San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0666 USA
- Department of Otolaryngology, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Kwang Pak
- Department of Surgery/Otolaryngology, University of California-San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0666 USA
| | - Arwa Kurabi
- Department of Surgery/Otolaryngology, University of California-San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0666 USA
| | - Allen F. Ryan
- Department of Surgery/Otolaryngology, University of California-San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0666 USA
- San Diego VA Medical Center, La Jolla, CA USA
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Kawai K, Adil EA, Barrett D, Manganella J, Kenna MA. Ambulatory Visits for Otitis Media before and after the Introduction of Pneumococcal Conjugate Vaccination. J Pediatr 2018; 201:122-127.e1. [PMID: 29958675 DOI: 10.1016/j.jpeds.2018.05.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/24/2018] [Accepted: 05/30/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the long-term trend of otitis media (OM)-associated ambulatory visits from 1997 to 2014 and to evaluate the impact of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) on OM ambulatory visits. STUDY DESIGN We examined OM-associated ambulatory visits in children, using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. RESULTS A total of 24 148 OM-related visits were identified from 363 240 ambulatory visits. OM visits accounted for 9.5% of all ambulatory visits in 1997-1999, 7.1% in 2002-2009, and 5.5% in 2012-2014. Between the pre-PCV7 and the post-PCV13 period, annual physician's office visits for OM declined from 826 to 387 visits per 1000 children among children younger than 2 years of age. Compared with the pre-PCV7 period, office visit rates for OM significantly declined by 51% (95% CI 42%-58%) among children younger than 2 years of age and by 37% (95% CI 23%-48%) among children 2-4 years of age during the post-PCV13 period. Among children younger than 2 years of age, emergency department visits for OM declined by 47% (95% CI 36%-55%) during the post-PCV13 period, and hospital outpatient visits declined by 30% (95% CI 8%-48%) during the PCV13-transition period. OM-related visits declined across sex, race/ethnicity, health insurance status, and geographic region. CONCLUSION Our nationwide study shows that ambulatory visits for OM have declined following the introduction of PCV7 and PCV13. Future research on the evolving microbiology of OM and continued monitoring of the epidemiology of pneumococcal disease are needed.
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Affiliation(s)
- Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA; Department of Otolaryngology, Harvard Medical School, Boston, MA.
| | - Eelam A Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA; Department of Otolaryngology, Harvard Medical School, Boston, MA
| | - Devon Barrett
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Juliana Manganella
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Margaret A Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA; Department of Otolaryngology, Harvard Medical School, Boston, MA
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van der Linden M. The real impact of pneumococcal conjugate vaccines. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:544-545. [PMID: 30119707 DOI: 10.1016/s2352-4642(18)30183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Mark van der Linden
- Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen 52074, Germany.
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