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Berman-Rosa M, O'Donnell S, Barker M, Quach C. Efficacy and Effectiveness of the PCV-10 and PCV-13 Vaccines Against Invasive Pneumococcal Disease. Pediatrics 2020; 145:peds.2019-0377. [PMID: 32156773 DOI: 10.1542/peds.2019-0377] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pneumococcal conjugate vaccines (PCVs) (pneumococcal 13-valent conjugate vaccine [PCV-13] and pneumococcal 10-valent conjugate vaccine [PCV-10]) are available for prevention of pneumococcal infections in children. OBJECTIVE To determine the vaccine effectiveness (VE) of PCV-13 and PCV-10 in preventing invasive pneumococcal disease (IPD) and acute otitis media (AOM) in children <5 years. DATA SOURCES Systematic searches of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Cochrane. STUDY SELECTION Eligible studies examined the direct effectiveness and/or efficacy of PCV-10 and PCV-13 in reducing the incidence of disease in healthy children <5 years. DATA EXTRACTION Two reviewers independently conducted data extraction and methodologic quality assessment. RESULTS Significant effectiveness against vaccine-type IPD in children ≤5 years was reported for ≥1 dose of PCV-13 in the 3 + 1 (86%-96%) and 2 + 1 schedule (67.2%-86%) and for PCV-10 for the 3 + 1 (72.8%-100%) and 2 + 1 schedules (92%-97%). In children <12 months of age, PCV-13 VE against serotype 19A post-primary series was significant for the 3 + 1 but not the 2 + 1 schedule. PCV-10 crossprotection against 19A was significant in children ≤5 years with ≥1 dose (82.2% and 71%). Neither PCVs were found effective against serotype 3. PCV-13 was effective against AOM (86%; 95% confidence interval [CI]: 61 to 94). PCV-10 was effective against clinically defined (26.9%; 95% CI: 5.9 to 43.3) and bacteriologically confirmed AOM (43.3%; 95% CI: 1.7 to 67.3). LIMITATIONS Because of the large heterogeneity in studies, a meta-analysis for pooled estimates was not done. CONCLUSIONS Both PCVs afford protection against pneumococcal infections, with PCV-10 protecting against 19A IPD, but this VE has not been verified in the youngest age groups.
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Affiliation(s)
- Melissa Berman-Rosa
- Department of Epidemiology, Biostatistics, and Occupational Health and.,Vaccine Study Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Shauna O'Donnell
- Department of Epidemiology, Biostatistics, and Occupational Health and.,Vaccine Study Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Infection Prevention and Control Unit, Department of Clinical Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Mackenzie Barker
- St Francis Xavier University, Antigonish, Nova Scotia, Canada; and
| | - Caroline Quach
- Department of Epidemiology, Biostatistics, and Occupational Health and .,Vaccine Study Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Infection Prevention and Control Unit, Department of Clinical Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, Quebec, Canada
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Interplay Between Socioeconomic Status and Otitis Media Disease Burden in Resource-rich and Resource-poor Nations. Otol Neurotol 2019; 39:e817-e824. [PMID: 30080766 DOI: 10.1097/mao.0000000000001943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize global differences in otitis media (OM)-related disease burden between socioeconomically advantaged and disadvantaged nations. METHODS Using the Global Health Data Exchange, worldwide OM burden was evaluated using age-standardized disability-adjusted life years (DALYs) per 100,000 individuals in 183 countries from 1990 to 2015. Countries were organized by socioeconomic status using Human Development Index (HDI) values collected from the United Nations Development Program. Gini coefficients and concentration indices were employed to analyze disparities in OM disease burden. RESULTS From 1990 to 2015, the mean DALY rate across all nations decreased by 21.9%. When considering disease burden in relation to socioeconomic status, age-standardized DALYs decreased as HDI values increased (p < 0.001). For both children and adults, DALY rates were significantly different between HDI groups (p < 0.01). Gini coefficients decreased from 0.821 in 1990 to 0.810 in 2015, indicating a modest reduction in international health inequality. Global disparities in OM disease burden, as measured by the concentration index, worsened from 1990 to 2010 before showing a small trend reversal in 2015. CONCLUSIONS To our knowledge, this is the first analysis investigating socioeconomic-related global disparities in OM disease burden using HDI values, Gini coefficients, and concentration indices. While the overall mean decrease in DALY rate from 1990 to 2015 is encouraging, the net decrease in concentration index during this period suggests less-developed nations continue to shoulder a disproportionate burden. Greater resource allocation to resource-poor nations may be warranted, as disease burden negatively impacts these countries to a greater degree.
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The Effect of the 10-Valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine on H. influenzae in Healthy Carriers and Middle Ear Infections in Iceland. J Clin Microbiol 2019; 57:JCM.00116-19. [PMID: 31068412 PMCID: PMC6595461 DOI: 10.1128/jcm.00116-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/27/2019] [Indexed: 11/20/2022] Open
Abstract
Vaccinations with the 10-valent pneumococcal conjugated vaccine (PHiD-CV) started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine and may provide protection against PD-positive H. influenzae. Vaccinations with the 10-valent pneumococcal conjugated vaccine (PHiD-CV) started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine and may provide protection against PD-positive H. influenzae. We aimed to evaluate the effect of PHiD-CV vaccination on H. influenzae in children, both in carriage and in acute otitis media (AOM). H. influenzae was isolated from nasopharyngeal swabs collected from healthy children attending 15 day care centers in 2009 and from 2012 to 2017 and from middle ear (ME) samples from children with AOM collected from 2012 to 2017. All isolates were identified using PCR for the hpd and fucK genes. Of the 3,600 samples collected from healthy children, 2,465 were culture positive for H. influenzae (68.5% carriage rate); of these, 151 (6.1%) contained hpd-negative isolates. Of the 2,847 ME samples collected, 889 (31.2%) were culture positive for H. influenzae; of these, 71 (8.0%) were hpd negative. Despite the same practice throughout the study, the annual number of ME samples reduced from 660 in 2012 to 330 in 2017. The proportions of hpd-negative isolates in unvaccinated versus vaccinated children were 5.6% and 7.0%, respectively, in healthy carriers, and 5.4% and 7.8%, respectively, in ME samples. The proportion of hpd-negative isolates increased with time in ME samples but not in healthy carriers. The number of ME samples from children with AOM decreased. The PHiD-CV had no effect on the proportion of the hpd gene in H. influenzae from carriage, but there was an increase in hpd-negative H. influenzae in otitis media. The proportions of hpd-negative isolates remained similar in vaccinated and unvaccinated children.
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Thomas SR, Leung S, Knox K, Wilkinson TMA, Staples KJ, Lestrate P, Wauters D, Gorringe A, Taylor SC. Development of flow cytometric opsonophagocytosis and antibody-mediated complement deposition assays for non-typeable Haemophilus influenzae. BMC Microbiol 2018; 18:167. [PMID: 30373523 PMCID: PMC6206646 DOI: 10.1186/s12866-018-1314-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haemophilus influenzae is found in the nasopharynx of 80% of the human population. While colonisation with non-typeable Haemophilus influenzae (NTHi) is usually asymptomatic, it is capable of causing acute and chronic otitis media (OM) in infants, invasive disease in susceptible groups and is the leading cause of exacerbations of patients with chronic obstructive pulmonary disease (COPD). Current methods for assessing functional antibody immunity to NTHi are limited and labour intensive. Flow cytometric assays could provide an attractive alternative to evaluate immune responses to candidate vaccines in clinical trials. RESULTS We have developed a duplexed flow-cytometric uptake and oxidative burst opsonophagocytosis assay (fOPA). We have also developed a duplexed antibody-mediated complement C3b/iC3b and C5b-9 deposition assay (CDA). Antibody-mediated C3b/iC3b deposition correlated with opsonophagocytic uptake (r = 0.65) and with opsonophagocytic oxidative burst (r = 0.69). Both fOPA and CDA were reproducible, with the majority of samples giving a coefficient of variation (CV) of < 20% and overall assay CVs of 14% and 16% respectively. CONCLUSIONS The high-throughput flow cytometric assays developed here were successfully optimised for use with NTHi. Assays proved to be sensitive and highly reproducible for the measurement of bacterial uptake and oxidative burst opsonophagocytosis and antibody-mediated deposition of C3b/iC3b and C5b-9. These assays are useful tools for use in large scale epidemiological studies and to assist in the assessment of functional antibody induced by NTHi candidate vaccines.
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Affiliation(s)
- Stephen R Thomas
- Public Health England, Microbiological Services, Porton Down, Salisbury, SP4 0JG, UK.
| | - Stephanie Leung
- Public Health England, Microbiological Services, Porton Down, Salisbury, SP4 0JG, UK
| | - Katy Knox
- Public Health England, Microbiological Services, Porton Down, Salisbury, SP4 0JG, UK
| | - Tom M A Wilkinson
- Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Karl J Staples
- Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, UK
| | | | | | - Andrew Gorringe
- Public Health England, Microbiological Services, Porton Down, Salisbury, SP4 0JG, UK
| | - Stephen C Taylor
- Public Health England, Microbiological Services, Porton Down, Salisbury, SP4 0JG, UK
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Varghese L, Talbot L, Govender A, Zhang XH, Mungall BA. A Cost-Effectiveness Analysis of the 10-Valent Pneumococcal Non-Typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) Compared to the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) for Universal Mass Vaccination Implementation in New Zealand. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:331-345. [PMID: 29633160 PMCID: PMC5940727 DOI: 10.1007/s40258-018-0387-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Invasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) still represent a significant medical burden in children < 5 years of age in New Zealand (NZ), with marked disparities across socio-economic and ethnic groups. This cost-effectiveness evaluation aims to compare the potential impact of two childhood universal immunisation strategies: vaccination with a 3 + 1 schedule of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix, GSK) and the 13-valent pneumococcal conjugate vaccine (PCV13, Prevenar 13, Pfizer). METHODS A static Markov-process cohort model was used to simulate the epidemiological and economic burden of pneumococcal diseases on a single-birth cohort over its lifetime. Costs and outcomes were discounted annually at 3.5%. Epidemiological and cost inputs were extracted from the most recently available NZ data, or derived from the most relevant reference countries' sources. The most updated evidence on the efficacies of the corresponding vaccines were used, particularly the significant effectiveness for PHiD-CV against IPD caused by serotype 19A. RESULTS The model estimated that both vaccines have a broadly comparable impact on IPD-related diseases and pneumonia. Due to the additional benefits possible through broader impact on AOM, PHiD-CV is estimated to potentially provide additional discounted cost offsets of approximately NZD 0.8 million over the lifetime of the birth cohort. CONCLUSIONS To ensure health equity in children, given the substantial burden of pneumonia and AOM, decision-makers should also take into account the impact of PCVs on these diseases for decisions relating to routine infant immunization. GSK STUDY IDENTIFIER HO-15-16775.
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Affiliation(s)
- Lijoy Varghese
- GSK Pte Ltd, 23 Rochester Park, Singapore, 139234 Singapore
| | | | | | - Xu-Hao Zhang
- GSK Pte Ltd, 23 Rochester Park, Singapore, 139234 Singapore
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Sriram KB, Cox AJ, Clancy RL, Slack MPE, Cripps AW. Nontypeable Haemophilus influenzae and chronic obstructive pulmonary disease: a review for clinicians. Crit Rev Microbiol 2017; 44:125-142. [PMID: 28539074 DOI: 10.1080/1040841x.2017.1329274] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. In the lower airways of COPD patients, bacterial infection is a common phenomenon and Haemophilus influenzae is the most commonly identified bacteria. Haemophilus influenzae is divided into typeable and nontypeable (NTHi) strains based on the presence or absence of a polysaccharide capsule. While NTHi is a common commensal in the human nasopharynx, it is associated with considerable inflammation when it is present in the lower airways of COPD patients, resulting in morbidity due to worsening symptoms and increased frequency of COPD exacerbations. Treatment of lower airway NTHi infection with antibiotics, though successful in the short term, does not offer long-term protection against reinfection, nor does it change the course of the disease. Hence, there has been much interest in the development of an effective NTHi vaccine. This review will summarize the current literature concerning the role of NTHi infections in COPD patients and the consequences of using prophylactic antibiotics in patients with COPD. There is particular focus on the rationale, findings of clinical studies and possible future directions of NTHi vaccines in patients with COPD.
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Affiliation(s)
- Krishna Bajee Sriram
- a Department of Respiratory Medicine , Gold Coast University Hospital, Gold Coast Health , Southport , Australia.,b Griffith University School of Medicine , Southport , Australia
| | - Amanda J Cox
- c Menzies Health Institute , Griffith University School of Medical Science , Gold Coast , Australia
| | - Robert L Clancy
- d Faculty of Health and Medicine , University of Newcastle , Callaghan , Australia
| | - Mary P E Slack
- b Griffith University School of Medicine , Southport , Australia
| | - Allan W Cripps
- b Griffith University School of Medicine , Southport , Australia
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Simões EAF, Kiio F, Carosone-Link PJ, Ndegwa SN, Ayugi J, Macharia IM. Otitis Media and Its Sequelae in Kenyan Schoolchildren. J Pediatric Infect Dis Soc 2016; 5:375-384. [PMID: 26407271 PMCID: PMC5181359 DOI: 10.1093/jpids/piv038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/09/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The goal of this study was to obtain representative Kenyan data on the point prevalence of acute otitis media (AOM) and its sequelae (otitis media with effusion [OME] and chronic suppurative otitis media [CSOM]), a major cause of preventable hearing loss in children in developing countries. In Africa, there are limited studies on the prevalence of AOM and its sequelae in children. METHODS Study subjects were children aged 2 to 15 years and were enrolled from randomly selected preprimary and primary schools. After parental or guardian consent, subjects had a questionnaire administered, otoscopy and tympanometry were done, and audiometry was performed on those with ear problems detected on these examinations. RESULTS A total of 9825 (75%) children was from rural schools. The prevalence of CSOM was 15 of 1000, OME was 15 of 1000, and AOM was 7 of 1000 children. Rural Rift Valley schoolchildren had the highest prevalence of CSOM (24 of 1000) compared with other regions (12 of 1000; P < .0001). Ear discharge occurred before 3.5 years in 50% of 901 children with ear discharge. A history of ear discharge was associated with abnormal tympanograms (odds ratio [OR], 11.9-19.2) and mild-to-severe hearing loss (OR, 21.6-38.6), even in children without ear disease (OR, 10.7-24.4). CONCLUSIONS The burden of AOM sequelae in Kenyan preschool and schoolchildren is significant, and it occurs mostly in the first 4 years of life. By preventing early recurrent AOM, pneumococcal vaccination might partly avert nonreversible sequelae.
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Affiliation(s)
- Eric A. F. Simões
- Department of Pediatrics, University of Colorado School of Medicine, Aurora,Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora,Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora
| | - Francis Kiio
- Department of Surgery, College of Health Sciences, University of Nairobi, Kenya,Kenyatta National Hospital, Nairobi, Kenya
| | | | - Serah N. Ndegwa
- Department of Surgery, College of Health Sciences, University of Nairobi, Kenya,Kenyatta National Hospital, Nairobi, Kenya
| | - John Ayugi
- Department of Surgery, College of Health Sciences, University of Nairobi, Kenya,Kenyatta National Hospital, Nairobi, Kenya
| | - Isaac M. Macharia
- Department of Surgery, College of Health Sciences, University of Nairobi, Kenya,Kenyatta National Hospital, Nairobi, Kenya
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Dagan R, Pelton S, Bakaletz L, Cohen R. Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:480-92. [PMID: 27036355 DOI: 10.1016/s1473-3099(15)00549-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/22/2022]
Abstract
Otitis media is a common childhood infection of the middle ear and a major cause of morbidity. This multifactorial disease manifests as a spectrum of clinical syndromes from uncomplicated acute otitis media to more complex recurrent and chronic cases (frequently polymicrobial), with the major pathogens involved being Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Pneumococcal conjugate vaccines (PCVs) target only a few serotypes that cause otitis media; however, results from studies suggest that existing PCVs can prevent early episodes of disease associated with vaccine serotypes, resulting in a reduction of subsequent complex cases caused by non-vaccine serotypes and other otopathogens, which contribute considerably to the disease burden. In this Review, we discuss the role of pneumococcus in the disease continuum and assess clinical evidence showing the effect of prevention of early episodes on the complex interplay between bacterial species implicated in otitis media.
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Affiliation(s)
- Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Lauren Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, and Unité Court Séjour, Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Paris, France
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Leach AJ, Wigger C, Beissbarth J, Woltring D, Andrews R, Chatfield MD, Smith-Vaughan H, Morris PS. General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines. Int J Pediatr Otorhinolaryngol 2016; 86:224-32. [PMID: 27260611 DOI: 10.1016/j.ijporl.2016.05.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009. METHODS We continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine. RESULTS Mean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist. CONCLUSIONS The general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.
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Affiliation(s)
- Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Christine Wigger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Donna Woltring
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Iwata S, Kawamura N, Kuroki H, Tokoeda Y, Miyazu M, Iwai A, Oishi T, Sato T, Suyama A, François N, Shafi F, Ruiz-Guiñazú J, Borys D. Immunogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) co-administered with DTPa vaccine in Japanese children: A randomized, controlled study. Hum Vaccin Immunother 2016; 11:826-37. [PMID: 25830489 PMCID: PMC4514407 DOI: 10.1080/21645515.2015.1012019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This phase III, randomized, open-label, multicenter study (NCT01027845) conducted in Japan assessed the immunogenicity, safety, and reactogenicity of 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, given intramuscularly) co-administered with diphtheria-tetanus-acellular pertussis vaccine (DTPa, given subcutaneously). Infants (N=360 ) were randomized (2:1) to receive either PHiD-CV and DTPa (PHiD-CV group) or DTPa alone (control group) as 3-dose primary vaccination (3–4–5 months of age) and booster vaccination (17–19 months of age). Immune responses were measured before and one month after primary/booster vaccination and adverse events (AEs) were recorded. Post-primary immune responses were non-inferior to those in pivotal/efficacy European or Latin American pneumococcal protein D-conjugate vaccine studies. For each PHiD-CV serotype, at least 92.6% of infants post-primary vaccination and at least 97.7% of children post-booster had pneumococcal antibody concentrations ≥0.2 μg/ml, and at least 95.4% post-primary and at least 98.1% post-booster had opsonophagocytic activity (OPA) titers ≥8 . Geometric mean antibody concentrations and OPA titers (except OPA titer for 6B) were higher post-booster than post-priming for each serotype. All PHiD-CV-vaccinated children had anti-protein D antibody concentrations ≥100 EL.U/ml one month post-primary/booster vaccination and all were seroprotected/seropositive against each DTPa antigen. Redness and irritability were the most common solicited AEs in both groups. Incidences of unsolicited AEs were comparable between groups. Serious AEs were reported for 47 children (28 in PHiD-CV group); none were assessed as vaccine-related. In conclusion, PHiD-CV induced robust immune responses and was well tolerated when co-administered with DTPa in a 3-dose priming plus booster regimen to Japanese children.
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Key Words
- 7vCRM, 7-valent pneumococcal CRM-conjugate vaccine
- AE, adverse event
- AOM, acute otitis media
- ATP, according-to-protocol
- CAP, community-acquired pneumonia
- CI, confidence interval
- COMPAS, Clinical Otitis Media and PneumoniA Study
- DTPa, diphtheria-tetanus-acellular pertussis
- ELISA, enzyme-linked immunosorbent assay
- GMC, geometric mean concentration
- GMT, geometric mean titer
- HBV, hepatitis B virus
- Hib, Haemophilus influenzae type b
- IPD, invasive pneumococcal disease
- Japan
- NTHi, nontypeable Haemophilus influenzae
- OPA, opsonophagocytic activity
- PCV, pneumococcal conjugate vaccine
- PHiD-CV, 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine
- POET, Pneumococcal Otitis Efficacy Trial
- SAE, serious adverse event
- SAS, Statistical Analysis System
- SDD, SAS Drug and Development
- WHO, World Health Organization
- children
- co-administration
- immunogenicity
- pneumococcal conjugate vaccine
- safety
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Affiliation(s)
- Satoshi Iwata
- a Department of Infectious Diseases ; School of Medicine; Keio University ; Shinjuku-ku , Tokyo , Japan
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Naturally Acquired HMW1- and HMW2-Specific Serum Antibodies in Adults and Children Mediate Opsonophagocytic Killing of Nontypeable Haemophilus influenzae. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 23:37-46. [PMID: 26512048 DOI: 10.1128/cvi.00502-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/23/2015] [Indexed: 12/11/2022]
Abstract
The HMW1 and HMW2 proteins are highly immunogenic adhesins expressed by approximately 75% of nontypeable Haemophilus influenzae (NTHi) strains, and HMW1- and HMW2-specific antibodies can mediate opsonophagocytic killing of NTHi. In this study, we assessed the ability of HMW1- and HMW2-specific antibodies in sera from healthy adults and convalescent-phase sera from children with NTHi otitis media to mediate killing of homologous and heterologous NTHi. The serum samples were examined pre- and postadsorption on HMW1 and HMW2 affinity columns, and affinity-purified antibodies were assessed for ability to mediate killing of homologous and heterologous strains. Adult serum samples mediated the killing of six prototype NTHi strains at titers of <1:10 to 1:1,280. HMW1- and HMW2-adsorbed sera demonstrated unchanged to 8-fold decreased opsonophagocytic titers against the homologous strains. Each affinity-purified antibody preparation mediated the killing of the respective homologous strain at titers of <1:10 to 1:320 and of the five heterologous strains at titers of <1:10 to 1:320, with most preparations killing most heterologous strains to some degree. None of the acute-phase serum samples from children mediated killing, but each convalescent-phase serum sample mediated killing of the infecting strain at titers of 1:40 to 1:640. HMW1- and HMW2-adsorbed convalescent-phase serum samples demonstrated ≥4-fold decreases in titer. Three of four affinity-purified antibody preparations mediated killing of the infecting strain at titers of 1:20 to 1:320, but no killing of representative heterologous strains was observed. HMW1- and HMW2-specific antibodies capable of mediating opsonophagocytic killing are present in the serum from normal adults and develop in convalescent-phase sera of children with NTHi otitis media. Continued investigation of the HMW1 and HMW2 proteins as potential vaccine candidates for the prevention of NTHi disease is warranted.
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Whitby PW, Seale TW, Morton DJ, Stull TL. Antisera Against Certain Conserved Surface-Exposed Peptides of Nontypeable Haemophilus influenzae Are Protective. PLoS One 2015; 10:e0136867. [PMID: 26390432 PMCID: PMC4577129 DOI: 10.1371/journal.pone.0136867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/09/2015] [Indexed: 12/19/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) cause significant disease, including otitis media in children, exacerbations of chronic obstructive pulmonary disease, and invasive disease in susceptible populations. No vaccine is currently available to prevent NTHi disease. The interactions of NTHi and the human host are primarily mediated by lipooligosaccharide and a complex array of surface-exposed proteins (SEPs) that act as receptors, sensors and secretion systems. We hypothesized that certain SEPs are present in all NTHi strains and that a subset of these may be antibody accessible and represent protective epitopes. Initially we used 15 genomic sequences available in the GenBank database along with an additional 11 genomic sequences generated by ourselves to identify the core set of putative SEPs present in all strains. Using bioinformatics, 56 core SEPs were identified. Molecular modeling generated putative structures of the SEPs from which potential surface exposed regions were defined. Synthetic peptides corresponding to ten of these highly conserved surface-exposed regions were used to raise antisera in rats. These antisera were used to assess passive protection in the infant rat model of invasive NTHi infection. Five of the antisera were protective, thus demonstrating their in vivo antibody accessibility. These five peptide regions represent potential targets for peptide vaccine candidates to protect against NTHi infection.
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Affiliation(s)
- Paul W. Whitby
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Thomas W. Seale
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Daniel J. Morton
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Terrence L. Stull
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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13
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Danhauer JL, Johnson CE, Baker JA, Ryu JA, Smith RA, Umeda CJ. Will Parents Participate in and Comply With Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children? Lang Speech Hear Serv Sch 2015; 46:127-40. [DOI: 10.1044/2015_lshss-14-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022] Open
Abstract
Purpose
Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen of xylitol for preventing AOM in their preschool- and kindergarten-aged children.
Method
An Internet questionnaire was designed and administered to parents of young children in preschool and kindergarten settings.
Results
Most parents were unaware of xylitol's use for AOM and would not likely comply with regimens for preventing AOM in their children; however, parents having previous knowledge of xylitol and whose children had a history of AOM would be more likely to do so.
Conclusions
Generally, most of these parents did not know about xylitol and probably would not use it to prevent ear infections. Unfortunately, these results parallel earlier findings for teachers and schools, which present obstacles for establishing ear infection prevention programs using similar protocols for young children. The results showed that considerable education and age-appropriate vehicles for administering xylitol are needed before establishing AOM prevention programs in schools and/or at home.
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14
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Mills N, Best EJ, Murdoch D, Souter M, Neeff M, Anderson T, Salkeld L, Ahmad Z, Mahadevan M, Barber C, Brown C, Walker C, Walls T. What is behind the ear drum? The microbiology of otitis media and the nasopharyngeal flora in children in the era of pneumococcal vaccination. J Paediatr Child Health 2015; 51:300-6. [PMID: 25175818 PMCID: PMC4406153 DOI: 10.1111/jpc.12710] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
AIM This study aims to describe the microbiology of middle ear fluid (MEF) in a cohort of children vaccinated with Streptococcus pneumoniae conjugate vaccine (PCV7) having ventilation tube insertion. Nasopharyngeal (NP) carriage of otopathogens in these children is compared with children without history of otitis media. METHODS Between May and November 2011, MEF and NP samples from 325 children aged <3 years were collected in three major centres in New Zealand at the time of ventilation tube insertion. An age-matched non-otitis-prone comparison group of 137 children had NP samples taken. A questionnaire was completed by both groups. RESULTS Immunisation coverage with at least one dose of PCV7 was 97%. Haemophilus influenzae was cultured in 19.4% of MEF and was polymerase chain reaction (PCR) positive in 43.4%. S. pneumoniae and Moraxella catarrhalis were cultured in <10% of MEF samples but were PCR positive for 23.1% and 38.7%, respectively. H. influenzae was the most common organism isolated from NP samples (60%) in the grommet group, while M. catarrhalis (56%) was the most common in the non-otitis prone group. S. pneumoniae was more commonly found in the nasopharynx of children with ear disease (41% vs. 29%). 19F was the most prominent S. pneumoniae serotype in NP samples of both groups, but no serotype dominated in MEF. Ninety-five per cent of H. influenzae isolates were confirmed to be non-typeable H. influenzae. CONCLUSION In this cohort of children with established ear disease requiring surgical intervention, non-typeable H. influenzae is the dominant pathogen in both the nasopharynx and MEF.
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Affiliation(s)
- Nikki Mills
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand
| | - Emma J Best
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand,Department of Paediatrics, University of AucklandAuckland, New Zealand
| | - David Murdoch
- Canterbury Health Laboratories, Christchurch Hospital, University of OtagoChristchurch, New Zealand,Department of Pathology, University of OtagoChristchurch, New Zealand
| | - Melanie Souter
- Canterbury District Health Board, Christchurch Hospital, University of OtagoChristchurch, New Zealand
| | - Michel Neeff
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand
| | - Trevor Anderson
- Canterbury Health Laboratories, Christchurch Hospital, University of OtagoChristchurch, New Zealand
| | - Lesley Salkeld
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand,Counties Manukau District Health Board, Manukau SuperclinicAuckland, New Zealand
| | - Zahoor Ahmad
- Counties Manukau District Health Board, Manukau SuperclinicAuckland, New Zealand
| | - Murali Mahadevan
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand
| | - Colin Barber
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand
| | - Colin Brown
- Auckland District Health Board, Starship Children's HospitalAuckland, New Zealand
| | - Cameron Walker
- Engineering, University of AucklandAuckland, New Zealand
| | - Tony Walls
- Canterbury District Health Board, Christchurch Hospital, University of OtagoChristchurch, New Zealand,Paediatrics, University of OtagoChristchurch, New Zealand
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15
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Xu JH, Dai WJ, Chen B, Fan XY. Mucosal Immunization with PsaA Protein, Using Chitosan as a Delivery System, Increases Protection Against Acute Otitis Media and Invasive Infection byStreptococcus pneumoniae. Scand J Immunol 2015; 81:177-85. [PMID: 25565478 DOI: 10.1111/sji.12267] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- J.-H. Xu
- Department of Otology and Skull Base Surgery; Eye Ear Nose & Throat Hospital of Fudan University; Key Laboratory of Health Ministry for Hearing Medicine; Shanghai China
| | - W.-J. Dai
- Department of Otology and Skull Base Surgery; Eye Ear Nose & Throat Hospital of Fudan University; Key Laboratory of Health Ministry for Hearing Medicine; Shanghai China
| | - B. Chen
- Department of Otology and Skull Base Surgery; Eye Ear Nose & Throat Hospital of Fudan University; Key Laboratory of Health Ministry for Hearing Medicine; Shanghai China
| | - X.-Y. Fan
- Shanghai Public Health Clinical Center Affiliated to Fudan University; Shanghai China
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Abstract
Mucosal immune responses within the middle ear and eustachian tube generally provide an effective and efficient response to the presence of microbial pathogens, with approximately 80% of clinically recognizable middle ear infections resolved within 7 days. Particularly for young children aged less than 3 years of age, the proximity and direct connection of the middle ear, via the eustachian tube, to the nasopharynx provide increased risk of commensal bacteria and upper respiratory tract viruses infecting the middle ear. Mucosal immunological defense in the middle ear and eustachian tube utilizes a number of mechanisms, including physicochemical barriers of mucus and the mucosal epithelial cells and innate immune responses such as inflammation, cellular infiltration, effusion, and antimicrobial protein secretions, in addition to adaptive host immune responses. Recent advances in otopathogen recognition via microbial pattern recognition receptors and elucidation of complex signaling cascades have improved understanding of the coordination and regulation of the middle ear mucosal response. These advances support vaccine development aiming to reduce the risk of otitis media in children.
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Shiragami M, Mizukami A, Leeuwenkamp O, Mrkvan T, Delgleize E, Kurono Y, Iwata S. Cost-Effectiveness Evaluation of the 10-Valent Pneumococcal Non-typeable Haemophilus influenzae Protein D Conjugate Vaccine and 13-Valent Pneumococcal Vaccine in Japanese Children. Infect Dis Ther 2014; 4:93-112. [PMID: 25527448 PMCID: PMC4363214 DOI: 10.1007/s40121-014-0053-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Diseases caused by Streptococcus pneumoniae represent a major public health problem. The purpose of this study was to compare, in the Japanese context, the projected health benefits, costs and cost-effectiveness of the latest generation of pneumococcal conjugate vaccines which may provide important insight into the potential public health impact of interventions in the context of local disease-specific epidemiology. METHODS A Markov model was used to compare two vaccination strategies which involve routine infant immunization with either the 13-valent pneumococcal conjugate vaccine (PCV-13; Prevenar 13™, Pfizer, Pearl River, NY, USA) or the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV; Synflorix™, GlaxoSmithKline Biologicals SA, Rixensart, Belgium) over a time horizon of 5 years from the healthcare provider and societal perspectives. Estimates for key model parameters were obtained from locally available databases and published literature. Incremental benefits in terms of costs and quality-adjusted life-year and cost-effectiveness were assessed. RESULTS A 3 + 1 vaccination schedule for infants with PHiD-CV is expected to have a similar impact on invasive pneumococcal disease and pneumonia and a larger impact on acute otitis media-related outcomes compared with PCV-13. Assuming price parity for these vaccines, the model projected that vaccination with PHiD-CV would result in cost savings of 1.9 and 3.9 billion Japanese yen from the provider and societal perspectives, respectively. This was largely due to a reduction in highly prevalent acute otitis media. Vaccination with PHiD-CV was expected to generate a gain of 433 quality-adjusted life-years compared to PCV-13 translating into dominance over PCV-13. Sensitivity analyses showed robustness of model outcome to changes in key model parameters and substantiated that the model outcome was consistently driven by the incremental benefit of PHiD-CV in averting acute otitis media. CONCLUSION In comparison to PCV-13, vaccination with PHiD-CV is projected to be cost saving for Japan from both the healthcare provider and societal perspectives.
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Affiliation(s)
- Makoto Shiragami
- Social and Administrative Pharmacy Science, School of Pharmacy, Nihon University, Funabashi-shi, Chiba Japan
| | - Akiko Mizukami
- Healthoutcomes Department, Development and Medical Affairs Division, GlaxoSmithKline K.K., Shibuya-ku, Tokyo, Japan
| | | | - Tomas Mrkvan
- Vaccine Value and Health Science, GSK Vaccines, Wavre, Belgium
| | | | - Yuichi Kurono
- Department of Otolaryngology, Faculty of Medicine, Kagoshima University, Kagoshima-shi, Kagoshima Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Shinjuku-ku, Tokyo Japan
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18
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García-Cobos S, Moscoso M, Pumarola F, Arroyo M, Lara N, Pérez-Vázquez M, Aracil B, Oteo J, García E, Campos J. Frequent carriage of resistance mechanisms to β-lactams and biofilm formation in Haemophilus influenzae causing treatment failure and recurrent otitis media in young children. J Antimicrob Chemother 2014; 69:2394-9. [PMID: 24891432 DOI: 10.1093/jac/dku158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Non-typeable Haemophilus influenzae are a major cause of acute otitis media (AOM), including chronic and recurrent otitis in young children. The objective of this study was to determine whether non-typeable H. influenzae isolates causing these infections produce biofilms and carry resistance mechanisms to β-lactams. METHODS A collection of 48 H. influenzae isolates was obtained by tympanocentesis or from otorrhoea samples from individual patients <3 years of age and diagnosed with recurrent or treatment failure AOM. Each isolate was surveyed for the presence of blaTEM genes, amino acid substitutions in the transpeptidase domain of penicillin-binding protein 3 (PBP3) and biofilm formation in microtitre plates. RESULTS In 43 of the 48 isolates (89.6%), at least one of the three tested conditions was identified: biofilm formation (83.3%) and resistance mechanisms to β-lactams (33.3%), modifications in the transpeptidase domain of PBP3 being the most prevalent (22.9%), followed by β-lactamase production (10.4%). Additionally, 13 (27.1%) isolates had two or more of these three traits. In relation to biofilm formation, those isolates with an amoxicillin MIC ≤ 0.5 mg/L had higher optical density values than isolates with an amoxicillin MIC ≥ 1 mg/L (Mann-Whitney U-test, P=0.048). CONCLUSIONS These findings suggest that the successful treatment of non-typeable H. influenzae causing chronic and recurrent AOM in young children may be compromised by the high biofilm-forming capacity of the isolates and the presence of β-lactam resistance mechanisms, particularly PBP3 mutations.
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Affiliation(s)
- Silvia García-Cobos
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Moscoso
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Félix Pumarola
- Servicio de Otorrinolaringología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Margarita Arroyo
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Noelia Lara
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Pérez-Vázquez
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Belén Aracil
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jesús Oteo
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ernesto García
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - José Campos
- Antibiotic and Haemophilus Laboratory, Bacteriology Service, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain Consejo Superior de Investigaciones Científicas, Madrid, Spain
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19
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Antibodies to the HMW1/HMW2 and Hia adhesins of nontypeable haemophilus influenzae mediate broad-based opsonophagocytic killing of homologous and heterologous strains. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:613-21. [PMID: 24574538 DOI: 10.1128/cvi.00772-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The HMW1/HMW2 and Hia proteins are highly immunogenic surface adhesins of nontypeable Haemophilus influenzae (NTHi). Approximately 75% of NTHi strains express HMW1/HMW2 adhesins, and most of the remaining 25% express an Hia adhesin. Our objective in this study was to assess the ability of antisera raised against purified HMW1/HMW2 proteins or recombinant Hia proteins to mediate opsonophagocytic killing of a large panel of unrelated NTHi strains. Native HMW1/HMW2 proteins were purified from three HMW1/HMW2-expressing NTHi strains. Recombinant fusion proteins expressing surface-exposed segments of either of two prototype Hia proteins were purified from Escherichia coli transformants. Immune sera raised in guinea pigs were assessed for their ability to mediate killing of NTHi in an opsonophagocytic assay with the HL-60 phagocytic cell line. The three HMW1/HMW2 antisera mediated killing of 22 of 65, 43 of 65, and 28 of 65 unrelated HMW1/HMW2-expressing NTHi strains, respectively. As a group, the three sera mediated killing of 48 of 65 HMW1/HMW2-expressing strains. The two Hia immune sera mediated killing of 12 of 24 and 13 of 24 unrelated Hia-expressing NTHi strains, respectively. Together, they mediated killing of 15 of 24 Hia-expressing strains. Neither the HMW1/HMW2 nor the Hia antisera mediated killing of NTHi expressing the alternative adhesin type. Antibodies directed against native HMW1/HMW2 proteins and recombinant Hia proteins are capable of mediating broad-based opsonophagocytic killing of homologous and heterologous NTHi strains. A vaccine formulated with a limited number of HMW1/HMW2 and Hia proteins might provide protection against disease caused by most NTHi strains.
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20
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Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE. The diagnosis and management of acute otitis media. Pediatrics 2013; 131:e964-99. [PMID: 23439909 DOI: 10.1542/peds.2012-3488] [Citation(s) in RCA: 750] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.
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Affiliation(s)
- Allan S Lieberthal
- American Academy of Pediatrics and American Academy of Family Physicians
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Farkouh R, Klok R, Roberts C, Mack A, Strutton D. Reply to: economic evaluation of second generation pneumococcal conjugate vaccines in Norway. Vaccine 2013; 31:439-41. [PMID: 22433959 DOI: 10.1016/j.vaccine.2012.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
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Response to “Reply to: Economic evaluation of second generation pneumococcal conjugate vaccines in Norway”. Vaccine 2013. [DOI: 10.1016/j.vaccine.2012.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pneumococcal conjugate vaccines and otitis media: an appraisal of the clinical trials. Int J Otolaryngol 2012; 2012:312935. [PMID: 22701486 PMCID: PMC3371682 DOI: 10.1155/2012/312935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/18/2011] [Accepted: 02/03/2012] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae is the predominant otitis media pathogen and its prevention through effective vaccination could diminish childhood illness and antibiotic use. This paper reviews 5 pneumococcal conjugate vaccine (PCV) trials that used otitis media as an endpoint: Northern California Kaiser Permanente (NCKP; vaccine, 7-valent PCV [PCV7]-CRM); Finnish Otitis Media (FinOM; vaccines, PCV7-CRM or PCV7-OMPC); Native American Trial (vaccine, PCV7-CRM); Pneumococcal Otitis Efficacy Trial (POET; vaccine, 11-valent PCV [PCV11]-PD). For the microbiological endpoint, vaccine efficacy against vaccine-serotype pneumococcal otitis media was about 60% across trials. Against the clinical endpoint of all episodes, vaccine efficacy was 7% (PCV7-CRM/NCKP), 6% (PCV7-CRM/FinOM), −1% (PCV7-OMPC/FinOM), and −0.4% (PCV7-CRM/Native American Trial); 34% against first episodes of ear, nose, and throat specialist-referral cases (PCV11-PD/POET). Both follow-up through 2 years of age, for the 5 trials, and long-term follow-up, for PCV7-CRM/NCKP and PCV7-CRM/FinOM, demonstrated greater vaccine efficacy against recurrent AOM and tympanostomy-tube placement, suggesting that vaccination against early episodes of AOM may prevent subsequent episodes of complicated otitis media. Although study designs varied by primary endpoint measured, age at follow-up, source of middle-ear fluid for culture, case ascertainment, and type of randomization, each clinical trial demonstrated vaccine efficacy against microbiological and/or clinical otitis media.
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Danhauer JL, Kelly A, Johnson CE. Is mother-child transmission a possible vehicle for xylitol prophylaxis in acute otitis media? Int J Audiol 2011; 50:661-72. [DOI: 10.3109/14992027.2011.590824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Levy C, Thollot F, Corrard F, Lécuyer A, Martin P, Boucherat M, Koskas M, Romain O, Goldrey M, Hausdorff WP, Cohen R. Otite moyenne aiguë en pédiatrie ambulatoire : caractéristiques épidémiologiques et cliniques après l’introduction du vaccin antipneumococcique conjugué 7 valent (PCV7). Arch Pediatr 2011; 18:712-8. [DOI: 10.1016/j.arcped.2011.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/15/2011] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
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Danhauer JL, Johnson CE, Caudle AT. Survey of K–3
rd
-Grade Teachers' Knowledge of Ear Infections and Willingness to Participate in Prevention Programs. Lang Speech Hear Serv Sch 2011; 42:207-22. [DOI: 10.1044/0161-1461(2011/10-0043)] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
Ear infections are prevalent in kindergarten through 3
rd
-grade (K–3
rd
) children and can affect their performance at school. Chewing gum, when administered by parents and teachers, can help prevent ear infections in children. This pilot study surveyed K–3
rd
-grade teachers in the Santa Barbara School Districts to assess their knowledge about ear infections and their willingness to participate in ear infection prevention programs.
Method
A 37-item questionnaire was developed and was e-mailed to a convenience sample of 112 teachers in February 2010.
Results
Response rate was 26%; 29 teachers responded. Most respondents were experienced females ≥36 years of age who said that their education provided no information about ear infections. Less than half said that they knew signs of ear infections or that ear infections could be prevented, but more than half believed that ear infections could hinder children’s development and quality of life. All of the schools and almost all of the teachers did not permit chewing gum on campus or in their classrooms, but most teachers said they would participate in ear infection prevention programs, let students chew xylitol gum if it prevented ear infections, and wanted more information on this topic.
Conclusion
Although teachers said they would participate in ear infection prevention programs, obstacles were identified that could preclude the use of xylitol chewing gum. Prevention programs should be developed, but xylitol gum prophylaxis regimens may be better directed at in-home use.
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Armbruster CE, Swords WE. Interspecies bacterial communication as a target for therapy in otitis media. Expert Rev Anti Infect Ther 2011; 8:1067-70. [PMID: 20954869 DOI: 10.1586/eri.10.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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The multifunctional host defense peptide SPLUNC1 is critical for homeostasis of the mammalian upper airway. PLoS One 2010; 5:e13224. [PMID: 20949060 PMCID: PMC2951362 DOI: 10.1371/journal.pone.0013224] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/14/2010] [Indexed: 12/15/2022] Open
Abstract
Otitis media (OM) is a highly prevalent pediatric disease caused by normal flora of the nasopharynx that ascend the Eustachian tube and enter the middle ear. As OM is a disease of opportunity, it is critical to gain an increased understanding of immune system components that are operational in the upper airway and aid in prevention of this disease. SPLUNC1 is an antimicrobial host defense peptide that is hypothesized to contribute to the health of the airway both through bactericidal and non-bactericidal mechanisms. We used small interfering RNA (siRNA) technology to knock down expression of the chinchilla ortholog of human SPLUNC1 (cSPLUNC1) to begin to determine the role that this protein played in prevention of OM. We showed that knock down of cSPLUNC1 expression did not impact survival of nontypeable Haemophilus influenzae, a predominant causative agent of OM, in the chinchilla middle ear under the conditions tested. In contrast, expression of cSPLUNC1 was essential for maintenance of middle ear pressure and efficient mucociliary clearance, key defense mechanisms of the tubotympanum. Collectively, our data have provided the first in vivo evidence that cSPLUNC1 functions to maintain homeostasis of the upper airway and, thereby, is critical for protection of the middle ear.
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Naturally fluctuating low incidence of invasive pneumococcal infections not affected by large-scale haemophilus influenzae type B vaccination. Pediatr Infect Dis J 2010; 29:777-9. [PMID: 20354461 DOI: 10.1097/inf.0b013e3181dbd820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since many pathogens colonize the child's oro/nasopharynx in a similar manner, elimination of diseases such as those caused by Haemophilus influenzae type b (Hib) has a potential of augmenting other serious infections. Streptococcus pneumoniae is an agent of special interest now that Hib conjugates have been used widely for more than 2 decades. PATIENTS AND METHODS All blood and cerebrospinal fluid isolations of Hib and S. pneumoniae were collected prospectively from 85,000 Finnish children at age 0-15 years by one central laboratory during 27 years. RESULTS Hib vaccination, launched in 1986-1988, led to a quick decline of cases until the last was detected in 1991. In the next few years, the incidence of bacteremic S. pneumoniae infections increased, but now for 15 years, the numbers of cases have been slowly declining. This finding is not explained by less active sample-taking because the number of blood cultures have almost doubled in the past years. CONCLUSIONS Large-scale Hib vaccination does not increase the incidence of pneumococcal diseases which continue their year-to-year fluctuation at low levels. Only a years-long follow-up permits conclusions on a vaccination's potential influence on the epidemiology of other diseases.
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Milne RJ, Vander Hoorn S. Burden and cost of hospital admissions for vaccine-preventable paediatric pneumococcal disease and non-typable Haemophilus influenzae otitis media in New Zealand. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2010; 8:281-300. [PMID: 20804222 DOI: 10.2165/11535710-000000000-00000] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Streptococcus pneumoniae (Sp.) is a leading cause of paediatric bacterial meningitis, pneumonia and acute otitis media, as is non-typable Haemophilus influenzae (NTHi) for acute otitis media. In 2008, a 7-valent conjugated pneumococcal vaccine (PCV7) was included in the New Zealand (NZ) childhood immunization schedule. OBJECTIVE To estimate the potentially vaccine-preventable annual hospital admissions and cost to the NZ Government of paediatric admissions for pneumococcal disease and NTHi otitis media prior to the immunization programme. METHODS Admissions (2000-7) and deaths (2000-5) in children aged<20 years with pneumococcal meningitis or bacteraemia, pneumonia or otitis media were identified in national datasets and linked by unique patient identifiers. New episodes of illness were defined as admissions occurring >30 days after discharge from a previous admission. Informed by the literature, pneumococcal pneumonia episodes were estimated at 33% of all-cause pneumonia admissions; Sp. and NTHi otitis media episodes were estimated jointly at 72% of otitis media admissions. Each episode was assigned a single diagnosis according to the following hierarchy: meningitis>bacteraemia>pneumonia>otitis media. Incidence rates for episodes were determined for 2000-7 (meningitis, bacteraemia and pneumonia) and 2006-7 (otitis media). Annual DRG-based costs for pneumococcal meningitis, bacteraemia, pneumonia and otitis media were estimated as (episode rate)x(DRG cost weight per episode)x(2007 population)x(national price per cost weight). RESULTS Episode rates for pneumococcal meningitis, bacteraemia and pneumonia were stable in 2000-7, highest in the second 6 months of life and declined steeply over the first 5 years of life. Mean rates per 100000 in 2000-7 were 18.4, 27.6 and 464 for pneumococcal meningitis, bacteraemia and pneumonia, respectively, for children aged<2 years; 8.4, 14.9 and 295 for children aged<5 years (including those aged<2 years); and 2.2, 4.4 and 97 for children aged<20 years (including those aged<5 years). Mean rates per 100000 in 2006-7 for Sp. and NTHi otitis media combined were 631 (surgical) and 197 (medical) for children aged<2 years; 691 and 116 for children aged<5 years; and 281 and 35 for children aged<20 years. Pacific Island and indigenous Māori children generally had higher rates than European/other children. Rates increased with socioeconomic disadvantage, across all diagnoses. The annual cost to Government of pneumococcal disease and NTHi otitis media admissions for children aged<20 years was estimated at New Zealand dollars ($NZ)9.95 million (range 7.7-12.2 million) [about $US7.1 million]. Most of this cost was shared between pneumococcal pneumonia (48%) and otitis media (45%), and 78% was incurred in the first 2 years of life. Estimated annual paediatric mortality rates per 100 000 for children aged<5 years were 0.48, 0.30 and 0.54 for pneumococcal meningitis, bacteraemia and pneumonia, respectively. The analysis predicted four or five pneumococcal deaths per year (range 1-8) for children aged<5 years. CONCLUSIONS Prior to the introduction of a national Sp. immunization programme, hospital admissions for Sp. disease and NTHi otitis media in NZ cost about $NZ10 million annually, mostly for children aged<2 years and particularly for those living in relative socioeconomic deprivation and for Pacific Island and Māori children. There were about five pneumococcal deaths annually. With adjustment for local serotypes, vaccine serotype coverage and uptake, immunization with any of the three available pneumococcal vaccines would reduce this burden substantially.
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Affiliation(s)
- Richard J Milne
- School of Population Health, Department of Statistics, University of Auckland, Auckland, New Zealand.
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