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King LM, Andrejko KL, Kabbani S, Tartof SY, Hicks LA, Cohen AL, Kobayashi M, Lewnard JA. Pediatric outpatient visits and antibiotic use attributable to higher valency pneumococcal conjugate vaccine serotypes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.24.23294570. [PMID: 37662372 PMCID: PMC10473805 DOI: 10.1101/2023.08.24.23294570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Importance Streptococcus pneumoniae is a known etiology of acute respiratory infections (ARIs), which account for large proportions of outpatient visits and antibiotic use in children. In 2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15, PCV20) were recommended for routine use in infants. However, the burden of outpatient healthcare utilization among U.S. children attributable to the additional, non-PCV13 serotypes in PCV15/20 is unknown. Objective To estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional serotypes (non-PCV13 serotypes) to quantify potential impacts of PCV15/20 on outpatient visits and antibiotic prescriptions for these conditions. Design Multi-component study including descriptive analyses of cross-sectional and cohort data on outpatient visits and antibiotic prescriptions from 2016-2019 and meta-analyses of pneumococcal serotype distribution in non-invasive respiratory infections. Setting Outpatient visits and antibiotic prescriptions among U.S. children. Participants Pediatric visits and antibiotic prescriptions among children captured in the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medicare Care Survey (NHAMCS), and Merative MarketScan, collectively representing healthcare delivery across all outpatient settings. Incidence denominators estimated using census (NAMCS/NHAMCS) and enrollment (MarketScan) data. Main outcomes and measures Pediatric outpatient visit and antibiotic prescription incidence for acute otitis media, pneumonia, and sinusitis associated with PCV15/20-additional serotypes. Results We estimated that per 1000 children annually, PCV15-additional serotypes accounted for 2.7 (95% confidence interval 1.8-3.9) visits and 2.4 (1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2-20.4) visits and 13.2 (9.9-18.0) antibiotic prescriptions annually per 1,000 children. Projected to national counts, PCV15/20-additional serotypes account for 173,000 (118,000-252,000) and 968,000 (722,000-1,318,000) antibiotic prescriptions among U.S. children each year, translating to 0.4% (0.2-0.6%) and 2.1% (1.5-3.0%) of all outpatient antibiotic use among children. Conclusions and relevance PCV15/20-additional serotypes account for a large burden of pediatric outpatient healthcare utilization. Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. These higher-valency PCVs, especially PCV20, may contribute to preventing ARIs and antibiotic use in children.
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Affiliation(s)
- Laura M King
- School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Kristin L Andrejko
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sara Y Tartof
- Kaiser Permanente Department of Research & Evaluation Southern California, Pasadena, CA
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Adam L Cohen
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Miwako Kobayashi
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph A Lewnard
- School of Public Health, University of California, Berkeley, Berkeley, CA
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Kang HM, Kang JH. Effects of nasopharyngeal microbiota in respiratory infections and allergies. Clin Exp Pediatr 2021; 64:543-551. [PMID: 33872488 PMCID: PMC8566799 DOI: 10.3345/cep.2020.01452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/02/2021] [Indexed: 11/27/2022] Open
Abstract
The human microbiome, which consists of a collective cluster of commensal, symbiotic, and pathogenic microorganisms living in the human body, plays a key role in host health and immunity. The human nasal cavity harbors commensal bacteria that suppress the colonization of opportunistic pathogens. However, dysbiosis of the nasal microbial community is associated with many diseases, such as acute respiratory infections including otitis media, sinusitis and bronchitis and allergic respiratory diseases including asthma. The nasopharyngeal acquisition of pneumococcus, which exists as a pathobiont in the nasal cavity, is the initial step in virtually all pneumococcal diseases. Although the factors influencing nasal colonization and elimination are not fully understood, the adhesion of opportunistic pathogens to nasopharyngeal mucosa receptors and the eliciting of immune responses in the host are implicated in addition to bacterial microbiota properties and colonization resistance dynamics. Probiotics or synbiotic interventions may show promising and effective roles in the adjunctive treatment of dysbiosis; however, more studies are needed to characterize how these interventions can be applied in clinical practice in the future.
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Affiliation(s)
- Hyun Mi Kang
- Division of Pediatric Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- Division of Pediatric Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wahyono DJ, Khoeri MM, Darmawan AB, Wijayanti SPM, Mumpuni A, Nawangtantri G, Kusdaryanto WD, Salsabila K, Safari D. Nasopharyngeal carriage rates and serotype distribution of Streptococcus pneumoniae among school children with acute otitis media in Central Java, Indonesia. Access Microbiol 2021; 3:000249. [PMID: 34595398 PMCID: PMC8479961 DOI: 10.1099/acmi.0.000249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae is a common bacterial pathogen that causes acute otitis media (AOM) in children. In this study, we investigated nasopharyngeal carriage rates and serotype distributions of S. pneumoniae among school children with AOM in Banyumas Regency, Central Java, Indonesia, from 2018 to 2019. Nasopharyngeal swab specimens and demographic data were collected from 122 children between the ages of 6 and 12. The specimens were cultured for the identification of S. pneumoniae, and serotyping was performed using a sequential multiplex PCR assay. We found that the S. pneumoniae carriage rate was 73 % (89/122) among children with AOM. Serotypes 23A (11 %) and 6A/6B (10 %) were the most common serotypes among the 91 cultured S. pneumoniae strains, followed by 3 (8 %), 14 (7 %), 6C/6D (7 %), 11A/11D (6 %), 15B/15C (4 %) and 35 B (4 %). Moreover, 41 % of the strains could be covered by the 13-valent pneumococcal conjugate vaccine, PCV13. In conclusion, high nasopharyngeal carriage rates of S. pneumoniae were found in school children with AOM, with almost half of the strains being the vaccine-type. This finding provides a baseline for nasopharyngeal carriage of S. pneumoniae in school children with AOM and supports the implementation of pneumococcal conjugate vaccines in Indonesia.
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Affiliation(s)
| | | | - Anton Budhi Darmawan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Indonesia
| | | | - Aris Mumpuni
- Faculty of Biology, Jenderal Soedirman University, Purwokerto, Indonesia
| | - Gita Nawangtantri
- Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Indonesia
| | - Wahyu Dwi Kusdaryanto
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Indonesia
| | | | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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[Clustering and influencing factors of Streptococcus pneumoniae carriage among kindergarten children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23. [PMID: 33840408 PMCID: PMC8050557 DOI: 10.7499/j.issn.1008-8830.2011078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the clustering and influencing factors of Streptococcus pneumoniae carriage among kindergarten children, and to provide a scientific basis for the prevention of pneumococcal diseases. METHODS The multi-stage stratified cluster sampling method was used to collect nasal swabs via the nasal vestibule at both sides from 1 702 kindergarten children in Liuzhou, China. A questionnaire survey was performed on their parents. The chi-square test and the random effects logistic regression analysis were used to analyze data. RESULTS The carriage rate of Streptococcus pneumoniae was 13.16% (224/1 702) among kindergarten children. The clustering analysis showed that the class-level random effect of Streptococcus pneumoniae carriage was statistically significant (Z=2.07, P=0.038), with an intraclass correlation coefficient of 5.9%. The random effects logistic regression analysis showed that the children aged 5-7 years had a lower risk of Streptococcus pneumoniae carriage than those aged 2-< 5 years (OR=0.55, 95%CI:0.40-0.76, P=0.001), and the children with ≥ 5 family members living together had a higher risk of Streptococcus pneumoniae carriage than those with < 5 family members (OR=1.34, 95%CI:1.01-1.79, P=0.043). CONCLUSIONS Streptococcus pneumoniae carriage shows a class-level clustering effect, and age and the number of cohabitants are important influencing factors for Streptococcus pneumoniae carriage in children.
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Dananché C, Paranhos-Baccalà G, Messaoudi M, Sylla M, Awasthi S, Bavdekar A, Sanghavi S, Diallo S, Pape JW, Rouzier V, Chou M, Eap T, Rakoto-Andrianarivelo M, Maeder M, Wang J, Ren L, Dash-Yandag B, Nymadawa P, Guillen R, Russomando G, Endtz H, Komurian-Pradel F, Vanhems P, Sánchez Picot V. Serotypes of Streptococcus pneumoniae in Children Aged <5 Years Hospitalized With or Without Pneumonia in Developing and Emerging Countries: A Descriptive, Multicenter Study. Clin Infect Dis 2021; 70:875-883. [PMID: 31556939 DOI: 10.1093/cid/ciz277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/02/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Improving knowledge regarding Streptococcus pneumoniae distribution in pneumonia cases is important to better target preventive and curative measures. The objective was to describe S. pneumoniae serotypes in children with or without pneumonia. METHODS It was a case-control study carried out in 8 developing and emerging countries between 2010 and 2014. Cases were children aged <5 years admitted to the hospital for pneumonia. Controls were children admitted for surgery or routine outpatient care. RESULTS In nasopharyngeal samples, S. pneumoniae were detected in 68.2% of the cases and 47.5% of the controls (P < .001). Nasopharyngeal carriage was associated with a higher risk of being a case in 6/8 study sites (adjusted odds ratio ranged from 0.71 [95% confidence interval [CI], .39-1.29; P = .26] in India [Pune/Vadu] to 11.86 [95% CI, 5.77-24.41; P < .001] in Mongolia). The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes were more frequently detected in cases with nasopharyngeal carriage (67.1%) than in controls with nasopharyngeal carriage (54.6%), P < .001. Streptococcus pneumoniae was detected in blood by polymerase chain reaction in 8.3% of the cases. Of 34 cases with an S. pneumoniae serotype detected in blood, 27 (79%) had the same serotype in the nasopharyngeal sample. CONCLUSIONS The results confirm the assumption that the isolate carrying or causing disease in an individual is of the same serotype. Most serotypes independently associated with nasopharyngeal carriage or pneumonia are covered by PCV13, suggesting that increased PCV coverage would reduce the burden of S. pneumoniae-related pneumonia.
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Affiliation(s)
- Cédric Dananché
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France.,Infection Control and Epidemiology Department, Hospices Civils de Lyon, France
| | - Gláucia Paranhos-Baccalà
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France
| | - Mélina Messaoudi
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France
| | | | - Shally Awasthi
- Chatrapati Shahu Ji Maharaj Medical University, Lucknow, India
| | | | | | | | - Jean-William Pape
- Centres Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Centres Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Tekchheng Eap
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Muriel Maeder
- Fondation Mérieux, Centre d'Infectiologie Charles Mérieux, Antananarivo, Madagascar
| | - Jianwei Wang
- Ministry of Health Key Laboratory of the Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, Fondation Mérieux, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Ren
- Ministry of Health Key Laboratory of the Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, Fondation Mérieux, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Rosa Guillen
- Research Institute of Health, Asuncion, Paraguay
| | | | - Hubert Endtz
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France
| | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France
| | - Philippe Vanhems
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France.,Infection Control and Epidemiology Department, Hospices Civils de Lyon, France
| | - Valentina Sánchez Picot
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR)5308, École Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon, France
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Hjálmarsdóttir MÁ, Haraldsson G, Quirk SJ, Haraldsson Á, Erlendsdóttir H, Kristinsson KG. Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland. PLoS One 2020; 15:e0230332. [PMID: 32182260 PMCID: PMC7077842 DOI: 10.1371/journal.pone.0230332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011–2017. Methods and findings All pneumococcal isolates identified at the Landspítali University Hospital in 2011–2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/54 respectively. Conclusions PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multi-resistant lineage. However, emerging multi-resistant NVT isolates are of concern.
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Affiliation(s)
- Martha Á. Hjálmarsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavík, Iceland
- BioMedical Centre of the University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Gunnsteinn Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavík, Iceland
- BioMedical Centre of the University of Iceland, Reykjavik, Iceland
| | - Sigríður Júlía Quirk
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavík, Iceland
- BioMedical Centre of the University of Iceland, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Children´s Hospital Iceland, Landspitali University Hospital, Reykjavík, Iceland
| | - Helga Erlendsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavík, Iceland
| | - Karl G. Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavík, Iceland
- BioMedical Centre of the University of Iceland, Reykjavik, Iceland
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Xu Q, Gill S, Xu L, Gonzalez E, Pichichero ME. Comparative Analysis of Microbiome in Nasopharynx and Middle Ear in Young Children With Acute Otitis Media. Front Genet 2019; 10:1176. [PMID: 31803245 PMCID: PMC6877732 DOI: 10.3389/fgene.2019.01176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/24/2019] [Indexed: 01/05/2023] Open
Abstract
Acute otitis media (AOM) is the most common pediatric infection for which antibiotics are prescribed in the United States. The role of the respiratory tract microbiome in pathogenesis and immune modulation of AOM remains unexplored. We sought to compare the nasopharyngeal (NP) microbiome of children 1 to 3 weeks prior to onset of AOM vs. at onset of AOM, and the NP microbiome with the microbiome in middle ear (ME). Six children age 6 to 24 months old were studied. Nasal washes (NW) were collected at healthy visits 1 to 3 weeks prior to AOM and at onset of AOM. The middle ear fluids (MEF) were collected by tympanocentesis at onset of AOM. Samples were stored in Trizol reagents or phosphate-buffered saline (PBS) at -80°C until use. The microbiome was characterized by 16S rRNA gene sequencing. Taxonomic designations and relative abundance of bacteria were determined using the RDP classifier tool through QIIME. Cumulative sum scaling normalization was applied before determining bacterial diversity and abundance. Shannon diversity index was calculated in Microsoft excel. The relative abundance of each bacteria species was compared via Mann-Whitney U test. We found that the NW microbiome of children during healthy state or at baseline was more diverse than microbiome during AOM. At AOM, no significant difference in microbiome diversity was found between NW and MEF, although some bacteria species appear to differ in MEF than in NW. The microbiome of samples stored in PBS had significant greater diversity than samples stored in Trizol reagent.
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Affiliation(s)
- Qingfu Xu
- Center for Infectious Disease and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Steve Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, United States
| | - Lei Xu
- Center for Infectious Disease and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Eduardo Gonzalez
- Center for Infectious Disease and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Michael E Pichichero
- Center for Infectious Disease and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
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Brugger SD, Kraemer JG, Qi W, Bomar L, Oppliger A, Hilty M. Age-Dependent Dissimilarity of the Nasopharyngeal and Middle Ear Microbiota in Children With Acute Otitis Media. Front Genet 2019; 10:555. [PMID: 31275355 PMCID: PMC6593076 DOI: 10.3389/fgene.2019.00555] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
Acute bacterial otitis media is usually caused by otopathogens ascending to the middle ear from the nasopharynx (NP). However, it is unknown if the nasopharyngeal microbiota of children with acute otitis media (AOM) can serve as an age-dependent or independent proxy for the microbial communities of the middle ear fluid (MEF) as there is a lack of 16S rRNA amplicon sequencing studies simultaneously analyzing the microbial communities of the two sites. Within this study, we performed 16S rRNA next generation sequencing on a total of 286 nasopharyngeal swabs (NPSs) collected between 2004 and 2013 within a Swiss national AOM surveillance program from children (0-6 years) with AOM. In addition, 42/286 children had spontaneous tympanic membrane perforation and, therefore, those MEF could also be analyzed. We found that alpha [Richness, Shannon diversity index (SDI) and Evenness] and beta diversity measurements of the nasopharyngeal bacterial microbiota showed a clear dependency of the increasing age of the children. In more detail, bacterial richness and personalized profiles (measured by beta dispersion) were higher and more frequent in older children, respectively. Dissimilarity values based on the binary distance matrix of the microbiota patterns of the NP and the MEF also correlated with increasing age. In general, positive (PPV) and negative predictive values (NPV) of the most abundant operational taxonomic units (OTUs) in the NP were moderately and well predictive for their presence in the MEF, respectively. This data is crucial to better understand polymicrobial infections and therefore AOM pathogenesis.
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Affiliation(s)
- Silvio D Brugger
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich - University of Zurich, Zurich, Switzerland
| | - Julia G Kraemer
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.,Institute for Work and Health, University of Lausanne, University of Geneva, Épalinges, Switzerland
| | - Weihong Qi
- Functional Genomics Center Zurich, Swiss Federal Institute of Technology Zurich, University of Zurich, Zurich, Switzerland
| | - Lindsey Bomar
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Microbiology, The Forsyth Institute, Cambridge, MA, United States
| | - Anne Oppliger
- Institute for Work and Health, University of Lausanne, University of Geneva, Épalinges, Switzerland
| | - Markus Hilty
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
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Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite broad literature including basic and translational scientific studies, many gaps in our understanding of host-pathogen interactions remain. In this review, pathogen virulence factors that drive lung infection and injury are discussed in relation to their associated host immune pathways. CAP epidemiology is considered, with a focus on Staphylococcus aureus and Streptococcus pneumoniae as primary pathogens. Bacterial factors involved in nasal colonization and subsequent virulence are illuminated. A particular emphasis is placed on bacterial pore-forming toxins, host cell death, and inflammasome activation. Identified host-pathogen interactions are then examined by linking pathogen factors to aberrant host response pathways in the context of acute lung injury in both primary and secondary infection. While much is known regarding bacterial virulence and host immune responses, CAP management is still limited to mostly supportive care. It is likely that improvements in therapy will be derived from combinatorial targeting of both pathogen virulence factors and host immunomodulation.
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Probiotics and carriage of Streptococcus pneumoniae serotypes in Danish children, a double-blind randomized controlled trial. Sci Rep 2018; 8:15258. [PMID: 30323328 PMCID: PMC6189121 DOI: 10.1038/s41598-018-33583-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022] Open
Abstract
This study examined the carriage of Streptococcus pneumoniae in healthy Danish children aged 8–19 months and assessed the effect of the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis on the pneumococcal carriage during daycare enrolment. Potential risk factors of pneumococcal carriage were analysed and the carriage study was compared with registered invasive pneumococcal disease (IPD) data. This study is a part of the ProbiComp study, which was a double-blind, randomized controlled trial, including 290 children allocated to probiotics or placebo for 6 months and recruited during two autumn seasons (2014/2015). Pneumococci were identified by optochin sensitivity, bile solubility, α-hemolysis and/or capsular reaction. Serotyping was performed by latex agglutination kit and Quellung reaction. The carriage rate of S. pneumoniae was 26.0% at baseline and 67.4% at the end of intervention. No significant difference was observed between the placebo group and the probiotics group (p = 0.508). Children aged 8–19 months were carriers of non-pneumococcal vaccine serotypes causing IPD in children aged 0–4 years. However, serotypes causing most IPD cases in Danish elderly were either not found or found with low prevalence suggesting that children are not the main reservoir of those serotypes and other age groups need to be considered as carriers.
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Karppinen S, Teräsjärvi J, Auranen K, Schuez-Havupalo L, Siira L, He Q, Waris M, Peltola V. Acquisition and Transmission of Streptococcus pneumoniae Are Facilitated during Rhinovirus Infection in Families with Children. Am J Respir Crit Care Med 2017; 196:1172-1180. [PMID: 28489454 DOI: 10.1164/rccm.201702-0357oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Laboratory and clinical evidence suggests synergy between rhinoviruses and Streptococcus pneumoniae in the pathogenesis of respiratory tract infections. However, it is unclear whether rhinoviruses promote pneumococcal acquisition and transmission. OBJECTIVES To describe the impact of rhinovirus infection on the acquisition and transmission of pneumococci within families with children. METHODS We investigated 29 families with at least two children. The follow-up started at the onset of respiratory infectious symptoms in any family member and consisted of daily symptom diary and nasal swab samples from each participant twice per week for 3 weeks. Swabs were taken by the parents and sent to a study clinic by mail. Rhinoviruses were detected by reverse transcription-polymerase chain reaction and typed by sequencing. Pneumococci were identified by an antigen test and by standard culture methods, serotyping, and whole-genome sequencing. The effect of rhinovirus infection on the rates of pneumococcal acquisition and within-family transmission was estimated from the observed acquisition events and person-times spent uncolonized, using Poisson regression. MEASUREMENTS AND MAIN RESULTS Rhinovirus was detected in 38 subjects (30%) at the onset and in 86 subjects (67%) during the follow-up. S. pneumoniae was detected on the first day in 9 (7%) and during follow-up in 38 (30%) subjects. Children with rhinovirus infection had a 4.3-fold rate of pneumococcal acquisition from the community (95% confidence interval, 1.1-15.4) and a 14.8-fold rate of within-family transmission (95% confidence interval, 3.1-69.6) compared with children without rhinovirus infection. CONCLUSIONS Rhinovirus infection within families facilitates acquisition and within-family transmission of S. pneumoniae.
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Affiliation(s)
| | | | - Kari Auranen
- 3 Department of Mathematics and Statistics, and.,4 Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Lotta Siira
- 5 Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland; and
| | - Qiushui He
- 2 Department of Medical Microbiology and Immunology.,6 Department of Medical Microbiology, Capital Medical University, Beijing, China
| | - Matti Waris
- 7 Department of Virology and Clinical Virology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Peltola
- 1 Department of Pediatrics and Adolescent Medicine and
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Sáez-Llorens X, Rowley S, Wong D, Rodríguez M, Calvo A, Troitiño M, Salas A, Vega V, Castrejón MM, Lommel P, Pascal TG, Hausdorff WP, Borys D, Ruiz-Guiñazú J, Ortega-Barría E, Yarzabal JP, Schuerman L. Efficacy of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine against acute otitis media and nasopharyngeal carriage in Panamanian children - A randomized controlled trial. Hum Vaccin Immunother 2017; 13:1-16. [PMID: 28368738 PMCID: PMC5489287 DOI: 10.1080/21645515.2017.1287640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We previously reported 10-valent pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) efficacy in a double-blind randomized trial (ClinicalTrials.gov: NCT00466947) against various diseases, including acute otitis media (AOM). Here, we provide further analyses. In the Panamanian subset, 7,359 children were randomized (1:1) to receive PHiD-CV or control vaccine at age 2/4/6 and 15–18 months. Of these, 2,000 had nasopharyngeal swabs collected. AOM cases were captured when parents sought medical attention for children with AOM symptoms; surveillance was enhanced approximately 2 y into the study through regular telephone calls or home visits by study personnel, who advised parents to visit the clinic if their child had AOM symptoms. Mean follow-up was 31.4 months. Clinical AOM (C-AOM) cases were assessed by physicians and confirmed by otorhinolaryngologists. Middle ear fluid samples, taken from children with C-AOM after specific informed consent, and nasopharyngeal samples were cultured for pathogen identification. For 7,359 children, 2,574 suspected AOM cases were assessed by a primary healthcare physician; 649 cases were C-AOM cases as per protocol definition. From the 503 MEF samples collected, 158 resulted in a positive culture. In the intent-to-treat cohort (7,214 children), PHiD-CV showed VE against first C-AOM (24.0% [95% CI: 8.7, 36.7]) and bacterial (B-AOM) episodes (48.0% [20.3, 66.1]) in children <24 months, which declined thereafter with age. Pre-booster VE against C-AOM was 30.7% [12.9, 44.9]; post-booster, −6.7% [−36.4, 16.6]. PHiD-CV VE was 17.7% [−6.1, 36.2] against moderate and 32.7% [−20.5, 62.4] against severe C-AOM. VE against vaccine-serotype pneumococcal NPC was 31.2% [5.3, 50.3] 3 months post-booster, and 25.6% [12.7, 36.7] across all visits. NTHi colonization rates were low and no significant reduction was observed. PHiD-CV showed efficacy against C-AOM and B-AOM in children younger than 24 months, and reduced vaccine-serotype NPC.
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Affiliation(s)
- Xavier Sáez-Llorens
- a Department of Infectious Diseases , Hospital del Niño, Panama City, Panama; Distinguished Member of the SNI , Senacyt , Panama
| | - Stella Rowley
- b Department of Otorhinolaryngology Hospital del Niño , Panama City , Panama
| | - Digna Wong
- c Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT) , Panama City , Panama
| | - Mirna Rodríguez
- c Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT) , Panama City , Panama
| | - Arlene Calvo
- d Health Research International , Panama City , Panama
| | | | - Albino Salas
- d Health Research International , Panama City , Panama
| | - Vielka Vega
- d Health Research International , Panama City , Panama
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Cilveti R, Olmo M, Pérez-Jove J, Picazo JJ, Arimany JL, Mora E, Pérez-Porcuna TM, Aguilar I, Alonso A, Molina F, del Amo M, Mendez C. Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PLoS One 2017; 12:e0170316. [PMID: 28146590 PMCID: PMC5287464 DOI: 10.1371/journal.pone.0170316] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 01/26/2023] Open
Abstract
The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.
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Affiliation(s)
- Robert Cilveti
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
- * E-mail:
| | - Montserrat Olmo
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | | | | | - Emiliano Mora
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Ignacio Aguilar
- CAP Turó de Can Mates, San Cugat del Vallés, Barcelona, Spain
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Pneumococcal Colonization in the Familial Context and Implications for Anti-Pneumococcal Immunization in Adults: Results from the BINOCOLO Project in Sicily. Int J Mol Sci 2017; 18:ijms18010105. [PMID: 28067813 PMCID: PMC5297739 DOI: 10.3390/ijms18010105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 01/23/2023] Open
Abstract
The spread of Streptococcus pneumoniae within families has been scarcely investigated so far. This feasibility study aimed to estimate the prevalence of pneumococcal carriage in school-aged children and co-habiting relatives and to explore the potential link between the family environment and the sharing of pneumococcal serotypes covered by the vaccine. Oropharyngeal samples of 146 subjects belonging to 36 different family groups were molecularly tested for pneumococcal detection and serotyping. The overall prevalence of pneumococcal carriage was 65.8% (n = 96/146), whereas it was higher among schoolchildren (77.8%, n = 28/36); subjects of seven years of age had the highest odds of being colonized (odds ratio, OR = 5.176; p = 0.145). Pneumococcal serotypes included in the 13-valent conjugate vaccine formulation were largely detected in the study population and multiple serotypes colonization was considerable. Factors relating to a close proximity among people at the family level were statistically associated with pneumococcal carriage (OR = 2.121; p = 0.049), as well as active smoking habit with a clear dose-response effect (ORs = 1.017–3.326). About half of family clusters evidenced similar patterns of carried pneumococcal serotypes and the odds of sustaining a high level of intrafamilial sharing increased with household size (ORs = 1.083–5.000). This study highlighted the potential role played by the family environment in sustaining both the circulation and horizontal transmission of pneumococcus.
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Pan H, Cui B, Huang Y, Yang J, Ba-Thein W. Nasal carriage of common bacterial pathogens among healthy kindergarten children in Chaoshan region, southern China: a cross-sectional study. BMC Pediatr 2016; 16:161. [PMID: 27741941 PMCID: PMC5064895 DOI: 10.1186/s12887-016-0703-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/27/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nasal colonization with bacterial pathogens is associated with risk of invasive respiratory tract infections, but the related information for Chinese healthy children is scarce. METHODS This cross-sectional study was conducted with healthy children from 6 kindergartens in the Chaoshan region, southern China during 2011-2012. Nasal swabs were examined for five common bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, and Staphylococcus aureus. RESULTS Among 1,088 children enrolled, 79.6 % (866) were target-bacterial carriers, of which 34.4 % (298/866) were positive for ≥2 bacteria species. The most common pathogen in the bacterial carriers was M. catarrhalis (76.6 %), followed by S. pneumoniae (26.6 %), S. aureus (21.8 %), H. parainfluenzae (12.7 %), and H. influenzae (2.3 %). Multiple logistic regression analyses showed negative associations between age and the overall or multiple bacterial carriage, and between the father's education level and multiple bacterial carriage (all p < 0.05). Age was negatively associated with the carriage of M. catarrhalis and S. pneumoniae, and positively associated with the S. aureus carriage (all p < 0.0001). CONCLUSIONS This study shows high nasal carriage of common pathogenic bacteria and coexistence of multiple pathogens in healthy Chaoshan kindergarten children, with M. catarrhalis as the commonest colonizer. Increasing age of children and higher paternal education are associated with lower risk of bacterial carriage. Longitudinal follow-up studies would be helpful for better understanding the infection risk in bacterial pathogen carriers.
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Affiliation(s)
- Hui Pan
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, 22 Xinling Road, Jinping, Shantou, Guangdong China
| | - Binglin Cui
- Pediatric Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China
| | - Yuanchun Huang
- Department of Clinical Microbiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China
| | - Jiacai Yang
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - William Ba-Thein
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, 22 Xinling Road, Jinping, Shantou, Guangdong China
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, Guangdong 515041 China
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16
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Auranen K, Syrjänen R, Leino T, Kilpi T. New Pneumococcal Carriage Acquired in Association with Acute Respiratory Infection Is Prone to Cause Otitis Media. PLoS One 2016; 11:e0156343. [PMID: 27257789 PMCID: PMC4892487 DOI: 10.1371/journal.pone.0156343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/12/2016] [Indexed: 01/15/2023] Open
Abstract
For considering vaccine-prevention of pneumococcal acute otitis media (PncAOM), relationships between pneumococcal carriage, respiratory infection and PncAOM need to be understood. We analyzed nasopharyngeal samples collected from 329 unvaccinated Finnish children aged 2-24 months at scheduled visits and at visits during respiratory infection in 1994-97. We assessed temporal associations of respiratory infection with pneumococcal acquisition and whether PncAOM hazard depends on the relative timing of acquisition and the infection onset. The data comprised 607 person-years of risk-time for acquisition, 245 person-months of concurrent respiratory infection and carriage, and 119 episodes of PncAOM. The acquisition hazard was 3-fold in the month preceding respiratory sickness (hazard ratio, HR 3.5, 90% credible interval CI 2.9, 4.1) as compared to acquisition in healthy children. Moreover, the PncAOM hazard was markedly higher (HR 3.7, 90% CI 2.4, 5.3) during the first month of carriage acquired around the acute phase of respiratory infection (between 1 month before and 1 week after the sickness onset), as compared to carriage acquired later during sickness. The high proportion (76%) of PncAOM events occurring within 1 month of acquisition was due to frequent acquisition being associated with respiratory infection as well as the susceptibility of such acquisition to cause otitis media.
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Affiliation(s)
- Kari Auranen
- Department of Health Protection, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
- Department of Mathematics and Statistics, 20014 University of Turku, Turku, Finland
- * E-mail:
| | - Ritva Syrjänen
- Department of Health Protection, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
- Department of Health Protection, National Institute for Health and Welfare, Finn-Medi I, Biokatu 6, 33520 Tampere, Finland
| | - Tuija Leino
- Department of Health Protection, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Terhi Kilpi
- Department of Health Protection, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
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Cocolonization of Pneumococcal Serotypes in Healthy Children Attending Day Care Centers: Molecular Versus Conventional Methods. Pediatr Infect Dis J 2016; 35:477-80. [PMID: 26808723 DOI: 10.1097/inf.0000000000001059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pneumococci are common colonizer, especially of children, and cocolonization of different serotypes is an important factor for intraspecies genetic exchange. The aim of this study was to analyze pneumococcal carriage and serotype distribution in unvaccinated healthy children in Iceland and compare conventional culture methods and molecular methods using DNA extracted directly from the samples. METHODS Nasopharyngeal swabs were obtained from 514 children aged 2-6 year attending day care centers in Reykjavik in 2009. The swabs were selectively cultured for pneumococci and the isolates serotyped using latex agglutination. DNA was also extracted directly from the swabs and serotyped using a multiplex PCR panel designed to detect vaccine serotypes and the most commonly carried non-vaccine serotypes. RESULT Pneumococcal carriage was detected in 391 (76.1%) of the children using polymerase chain reaction (PCR) and in 371 (72.2%) using conventional methods. Cocolonization was detected in 92 (23.5%) of the carriers when PCR method was used and in 30 (8.1%) when conventional methods were used, detecting 500 and 401 strains, respectively (P < 0.0001). The most common serotypes were 23F, 19A, 6B, 6A and 19F, rates 13-8%. The number of isolates of serotypes included in the 10-valent and 13-valent vaccines and detected by PCR were 234 (58.4%) and 363 (90.5%), respectively and by conventional methods 186 (46.4%) and 293 (73.1%), respectively. CONCLUSION Cocolonization was detected in a fourth of the children carrying pneumococci using DNA extracted directly from nasopharyngeal swabs. The rate of carriage was very high, but no serotype dominated, and the children were commonly colonized by vaccine serotypes, especially cocolonized children.
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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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Kaur R, Czup K, Casey JR, Pichichero ME. Correlation of nasopharyngeal cultures prior to and at onset of acute otitis media with middle ear fluid cultures. BMC Infect Dis 2014; 14:640. [PMID: 25475135 PMCID: PMC4264249 DOI: 10.1186/s12879-014-0640-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/18/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We sought to determine if nasopharyngeal (NP) cultures taken at times of healthy visits or at onset of acute otitis media (AOM) could predict the otopathogen mix and antibiotic-susceptibility of middle ear isolates as determined by middle ear fluid (MEF) cultures obtained by tympanocentesis. METHODS During a 7-year-prospective study of 619 children from Jun 2006-Aug 2013, NP cultures were obtained from 6-30 month olds at healthy visits and NP and MEF (by tympanocentesis) at onset of AOM episodes. RESULTS 2601 NP and 530 MEF samples were collected. During healthy visits, S. pneumoniae (Spn) was isolated from 656 (31.7%) NP cultures compared to 253 (12.2%) for Nontypeable Haemophilus influenzae (NTHi) and 723 (34.9%) for Moraxella catarrhalis (Mcat). At onset of AOM 256 (48.3%) of 530 NP samples were culture positive for Spn, 223 (42%) for NTHi and 251 (47.4%) for Mcat, alone or in combinations. At 530 AOM visits, Spn was isolated from 152 (28.7%) of MEF compared to 196 (37.0%) for NTHi and 104 (19.6%) for Mcat. NP cultures collected at onset of AOM but not when children were healthy had predictive value for epidemiologic antibiotic susceptibility pattern assessments. CONCLUSIONS NP cultures at onset of AOM more closely correlate with otopathogen mix than NP cultures at healthy visits using MEF culture as the gold standard, but the correlation was too low to allow NP cultures to be recommended as a substitute for MEF culture. For epidemiology purposes, antibiotic susceptibility of MEF isolates can be predicted by NP culture results when samples are collected at onset of AOM.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Katerina Czup
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Janet R Casey
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
| | - Michael E Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
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Development of primary invasive pneumococcal disease caused by serotype 1 pneumococci is driven by early increased type I interferon response in the lung. Infect Immun 2014; 82:3919-26. [PMID: 25001606 DOI: 10.1128/iai.02067-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pneumococcus is the world's foremost respiratory pathogen, but the mechanisms allowing this pathogen to proceed from initial asymptomatic colonization to invasive disease are poorly understood. We have examined the early stages of invasive pneumococcal disease (IPD) by comparing host transcriptional responses to an invasive strain and a noninvasive strain of serotype 1 Streptococcus pneumoniae in the mouse lung. While the two strains were present in equal numbers in the lung 6 h after intranasal challenge, only the invasive strain (strain 1861) had invaded the pleural cavity at that time point; this correlated with subsequent development of bacteremia in mice challenged with strain 1861 but not the noninvasive strain (strain 1). Progression beyond the lung was associated with stronger induction of the type I interferon (IFN-I) response in the lung at 6 h. Suppression of the IFN-I response through administration of neutralizing antibody to IFNAR1 (the receptor for type I interferons) led to significantly reduced invasion of the pleural cavity by strain 1861 at 6 h postchallenge. Our data suggest that strong induction of the IFN-I response is a key factor in early progression of invasive serotype 1 strain 1861 beyond the lung during development of IPD.
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Birdane L, Muluk NB, Cingi C, Burukoglu D, Fidan V, Incesulu A. Evaluation of the efficacy of curcumin in experimentally induced acute otitis media in rats. Ann Otol Rhinol Laryngol 2014; 123:325-32. [PMID: 24642584 DOI: 10.1177/0003489414525925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We investigated the effect of curcumin (CMN) in the treatment of experimentally induced acute otitis media (AOM) in rats. METHOD Thirty-two Sprague-Dawley female rats were used, yielding 64 temporal bones. Group 1 was the control group. For groups 2 to 4, AOM was induced experimentally, and saline, antibiotics (sulbactam-ampicillin), or CMN were administered for 14 days to groups 2, 3, and 4, respectively. During the histological examination, thickening of the tympanic membrane, damage to the epithelium, inflammation, and sclerosis were evaluated. RESULTS The AOM+antibiotic and AOM+CMN groups exhibited reduced histological damage compared with the AOM+saline group. No significant differences in thickening of the tympanic membrane or damage to the epithelium or inflammation were observed between the AOM+antibiotic and the AOM+CMN groups. However, the sclerosis values of the AOM+CMN group were significantly lower than those of the AOM+antibiotic group. CONCLUSION CMN treatment resulted in similar effects on the experimentally induced AOM model as did the antibiotic treatment. The efficacy of this treatment may be related to its effects on the production of various inflammatory cytokines. In light of the worldwide increase in antibiotic resistance and the mild side effects of CMN, we suggest that CMN therapy may be a promising option in AOM treatment.
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Affiliation(s)
- Leman Birdane
- Yunus Emre State Hospital, Department of Otorhinolaryngology, Eskisehir, Turkey
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Competition between Streptococcus pneumoniae strains: implications for vaccine-induced replacement in colonization and disease. Epidemiology 2013; 24:522-9. [PMID: 23676265 DOI: 10.1097/ede.0b013e318294be89] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaccine-induced replacement by nonvaccine serotypes in pneumococcal colonization and disease poses a threat to the long-term effectiveness of pneumococcal vaccination. One of the main drivers for serotype replacement is likely to be the competitive interactions between pneumococcal serotypes. METHODS We used longitudinal datasets of pneumococcal colonization among infants (American Indian and The Gambia) and toddlers (Denmark) to study the strength and mechanism of competition between pneumococcal serotypes. We characterized the strength of competition as the relative reduction in the expected time spent colonized with two serotypes (double colonization) as compared with colonization with no competition. We also assessed the mechanism of competition, that is, whether reduction in double colonization is due to reduced rate of acquisition or enhanced clearance of colonization. The three datasets were analyzed assuming both perfect (100%) and imperfect (50%) sensitivity in detection of double colonization. RESULTS Each dataset showed strong between-serotype competition, and competition in acquisition was clearly identified. These findings remained in the secondary analysis assuming only 50% sensitivity to detect double colonization. Inferences about enhanced clearance due to competition were susceptible to the assumed sensitivity of detection. CONCLUSIONS Strong competition between pneumococcal serotypes can explain the prompt replacement by the nonvaccine serotypes in vaccinated persons and populations. The main mechanism of between-serotype interaction was identified as competition in acquisition, which suggests that replacement in pneumococcal disease depends largely on propensities of the replacing serotypes to cause disease through acquisition of colonization.
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Temporal changes in pneumococcal colonization in a rural African community with high HIV prevalence following routine infant pneumococcal immunization. Pediatr Infect Dis J 2013; 32:1270-8. [PMID: 24061271 DOI: 10.1097/01.inf.0000435805.25366.64] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccine (PCV) immunization of children decreases their risk of nasopharyngeal acquisition of vaccine serotypes. We studied the impact of routine infant PCV immunization alone on the epidemiology of nasopharyngeal pneumococcal colonization among a rural African community with high prevalence of HIV positivity. METHODS Two cross-sectional surveys were undertaken in a rural South African community from May to October 2009 (period 1) and 2011 (period 2). Seven-valent PCV was introduced into the public immunization program for infants in April 2009, without catch-up campaign for older children. Randomly selected households with at least 1 child<2 years of age were recruited. Nasopharyngeal swabs from all consenting household members were obtained for Streptococcus pneumoniae culture and serotyping by Quellung method. RESULTS The median ages (SD) of children enrolled were 4.32 (SD, 3.4) and 3.80 (SD, 3.4) years in periods 1 and 2, respectively. Overall, the prevalence of vaccine serotype colonization declined from 18.3% (368/2010) in period 1 to 11.4% (418/3659) by period 2 (P<0.0001). This included reductions (adjusted risk ratio) of 50% [95% confidence interval (95% CI): 0.42-0.59], 34% (95% CI: 0.48-0.92) and 64% (95% CI: 0.18-0.74) in age groups<2 years, 6-12 years and adults. The prevalence of vaccine serotype colonization among primary caregivers decreased from 10.2% to 5.4% (P≤0.001) by period 2. The prevalence of nonvaccine serotype colonization increased by 35% (95% CI: 1.17-1.56) among <2-year-old children by period 2, while it declined by 45-54% among adolescents and adults. CONCLUSIONS An indirect effect of PCV7 was realized in a high HIV prevalence setting within 2 years of PCV introduction. The unexpected decline in nonvaccine serotypes colonization among adolescents/adults may indicate lag in replacement colonization by nonvaccine serotypes in this group.
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Otsuka T, Kitami O, Kondo K, Ota H, Oshima S, Tsuchiya A, Shirai T, Fujii K, Nakamure M, Shoji Y, Nakamura H, Masuda Y, Komiyama K, Yoshida K, Ishikawa Y, Iwaya A, Takahashi S, Okazaki M, Hotomi M, Yamanaka N. Incidence survey of acute otitis media in children in Sado Island, Japan--Sado Otitis Media Study (SADOMS). PLoS One 2013; 8:e68711. [PMID: 23844235 PMCID: PMC3699511 DOI: 10.1371/journal.pone.0068711] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 06/02/2013] [Indexed: 11/25/2022] Open
Abstract
Background Acute otitis media (AOM) is one of the most common forms of bacterial infection and cause for clinic visits in children. The incidence of AOM was 0.9–1.2 episodes per person-year during the first 2 years of life in previous reports conducted before 2000. The aim of this study was to 1) evaluate the latest AOM incidence in pediatric outpatients and 2) identify the bacterial pathogens from these patients and ascertain their serotypes and resistance. Methods The study was conducted in a closed population, involving all pediatricians and otolaryngologists in Sado Island allowing accurate determination of AOM incidence. In each month, one week was assigned as “surveillance week”, and all outpatients with acute illness aged 0–18 years examined during the surveillance weeks were enrolled. AOM was diagnosed on the basis of otoscopic findings and clinical symptoms were recorded. Specimens were collected from the nasopharynx or middle ear cavity of AOM patients and examined for bacteria. Antimicrobial susceptibilities, serotypes, and molecular typing for resistance were determined among Streptococcus pneumoniae and Haemophilus influenzae. Results In total, 8,283 clinic visits were conducted, and 354 episodes (4.3%, 95% CI: 3.9–4.7%) among 312 children were diagnosed as AOM. The incidence of AOM was highest in children of 1 year of age (0.54 episodes/child/year, 95% CI: 0.44–0.64). Serotype coverage of 7- and 13-valent pneumococcal conjugate vaccines in this study were 38.0% (95% CI: 29.3–47.3) and 62.8% (95% CI: 53.6–71.4), respectively. Of 122 H.influenzae isolates available for typing, 120 were nontypeable and 2 were type b. A high proportion of S. pneumoniae isolates (46%) showed resistance to penicillin. Approximately half of H. influenzae isolates had genetic markers for beta-lactamase-negative ampicillin-resistance. Conclusions Approximately 4–5% of pediatric outpatients, even without AOM-related symptoms, had AOM in our study. Pediatricians as well as otolaryngologists should check the tympanic membrane findings of all pediatric outpatients.
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Affiliation(s)
- Taketo Otsuka
- Department of Pediatrics, Sado General Hospital, Sado, Niigata, Japan.
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Pelton SI, Pettigrew MM, Barenkamp SJ, Godfroid F, Grijalva CG, Leach A, Patel J, Murphy TF, Selak S, Bakaletz LO. Panel 6: Vaccines. Otolaryngol Head Neck Surg 2013; 148:E90-101. [PMID: 23536534 DOI: 10.1177/0194599812466535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To update progress on the effectiveness of vaccine for prevention of acute otitis media (AOM) and identification of promising candidate antigens against Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. REVIEW METHODS Literature searches were performed in OvidSP and PubMed restricted to articles published between June 2007 and September 2011. Search terms included otitis media, vaccines, vaccine antigens, and each of the otitis pathogens and candidate antigens identified in the ninth conference report. CONCLUSIONS The current report provides further evidence for the effectiveness of pneumococcal conjugate vaccines (PCVs) in the prevention of otitis media. Observational studies demonstrate a greater decline in AOM episodes than reported in clinical efficacy trials. Unmet challenges include extending protection to additional serotypes and additional pathogens, the need to prevent early episodes, the development of correlates of protection for protein antigens, and the need to define where an otitis media vaccine strategy fits with priorities for child health. IMPLICATIONS FOR PRACTICE Acute otitis media continues to be a burden on children and families, especially those who suffer from frequent recurrences. The 7-valent PCV (PCV7) has reduced the burden of disease as well as shifted the pneumococcal serotypes and the distribution of otopathogens currently reported in children with AOM. Antibiotic resistance remains an ongoing challenge. Multiple candidate antigens have demonstrated the necessary requirements of conservation, surface exposure, immunogenicity, and protection in animal models. Further research on the role of each antigen in pathogenesis, in the development of correlates of protection in animal models, and in new adjuvants to elicit responses in the youngest infants is likely to be productive and permit more antigens to move into human clinical trials.
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Affiliation(s)
- Stephen I Pelton
- Boston University School of Medicine, Boston, Massachusetts, USA.
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Bacterial respiratory pathogens in children with inherited immune and airway disorders: nasopharyngeal carriage and disease risk. Pediatr Infect Dis J 2013; 32:399-404. [PMID: 23552676 DOI: 10.1097/inf.0b013e31827db77a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with primary immunodeficiencies, sickle cell disease and cystic fibrosis are at risk to develop invasive bacterial infections caused by respiratory tract pathogens, in particular Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. This review article evaluates the role of nasopharyngeal colonization by these pathogens in the high prevalence of respiratory and invasive infections in children with inherited disorders affecting the immune system or the respiratory tract. We conclude that respiratory and invasive diseases that occur in children with primary immunodeficiencies or sickle cell disease are probably a result of increased nasopharyngeal colonization rates compared with healthy children. However, when the inherited disorder is characterized by local airway abnormalities such as in cystic fibrosis, enhanced nasopharyngeal colonization does not seem to play a major role in invasive disease risk. As the evidence for the role of nasopharyngeal colonization in disease risk in these specific patient groups partly comes from experimental studies and animal models, longitudinal studies in children are needed. Detailed understanding of the effect of colonization on the development of respiratory and invasive infections in children with primary immunodeficiencies, sickle cell disease or cystic fibrosis provides a justification for the selective introduction of vaccination and prophylactic antibiotic treatment. Recommendations for the use of (preventive) therapeutic strategies in these patient groups taking into account disease-specific immunologic mechanisms underlying colonization and disease are described.
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Moore DP, Dagan R, Madhi SA. Respiratory viral and pneumococcal coinfection of the respiratory tract: implications of pneumococcal vaccination. Expert Rev Respir Med 2013; 6:451-65. [PMID: 22971069 DOI: 10.1586/ers.12.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The interactions between Streptococcus pneumoniae and other respiratory pathogens have been studied in vitro, in animal models and in humans - including epidemiologic and vaccine probe studies. Interactions of pneumococcus with respiratory viruses are common, and many mechanisms have been suggested to explain this phenomenon. The aim of this review is to explore pneumococcal interactions with respiratory viruses and consider the potential role that the pneumococcal polysaccharide-protein conjugate vaccine may play in modifying pneumococcal-respiratory viral interactions.
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Affiliation(s)
- David Paul Moore
- Department of Science and Technology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Prymula R, Habib A, François N, Borys D, Schuerman L. Immunological memory and nasopharyngeal carriage in 4-year-old children previously primed and boosted with 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) with or without concomitant prophylactic paracetamol. Vaccine 2013; 31:2080-8. [PMID: 23391599 DOI: 10.1016/j.vaccine.2013.01.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/28/2012] [Accepted: 01/23/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prophylactic paracetamol (PP) was previously shown to reduce primary and booster antibody responses against the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). This study further evaluated the effect of PP on antibody persistence, immunological memory and nasopharyngeal carriage (NPC). METHODS Two hundred and twenty children previously primed (3 doses, NCT00370318) and boosted (NCT00496015) with PHiD-CV with (PP group) or without (NPP group) prophylactic paracetamol administration received one PHiD-CV dose in their fourth year of life to assess the induction of immunological memory following previous immunisations. A control group of age-matched unprimed children enrolled in study NCT00496015 received an investigational tetravalent Neisseria meningitidis serogroups A, C, W-135, Y tetanus toxoid-conjugate vaccine, and thus remained unprimed for pneumococcal vaccination. Of these, 223 unprimed children received in the present study at least one PHiD-CV dose of a 2-dose catch-up regimen, which was relevant as control for assessment of immunological memory in PHiD-CV primed children. RESULTS Induction of immunological memory was shown irrespective of PP administration at primary and booster vaccination. Antibody geometric mean concentrations were lower in the PP group for serotypes 1, 4, 7F and 9V. Opsonophagocytic titres did not differ significantly between PP and NPP groups. Previous use of PP seemed to have only a minor impact on kinetics of antibody persistence. Reduced NPC of vaccine pneumococcal serotypes and trends towards increased NPC of non-vaccine and non-cross-reactive serotypes were seen in primed groups versus the control group, with no obvious differences between PP and NPP groups. CONCLUSION Regardless of whether previous PHiD-CV vaccination was given with or without PP, induction of immunological memory and persistence of PHiD-CV's impact on carriage was seen until at least 28 months post-booster vaccination. Our study results therefore suggest that the lower immune responses after primary and booster vaccination with PP are of transient nature.
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Affiliation(s)
- Roman Prymula
- University Hospital, Hradec Králové, Czech Republic.
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Simell B, Auranen K, Käyhty H, Goldblatt D, Dagan R, O'Brien KL. The fundamental link between pneumococcal carriage and disease. Expert Rev Vaccines 2012; 11:841-55. [PMID: 22913260 DOI: 10.1586/erv.12.53] [Citation(s) in RCA: 451] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae (pneumococcus) is a major cause of worldwide mortality and morbidity, and to a large extent is vaccine-preventable. Nasopharyngeal carriage of pneumococcus precedes disease and is the source of pneumococcal spread between people. The use of vaccine effect on carriage as part of the vaccine licensure and post-vaccine introduction evaluation could facilitate and expand the licensure of new, life-saving pneumococcal vaccines and enable a comprehensive estimate of population effects after vaccine introduction. The authors provide a review of the evidence supporting pneumococcal carriage at the individual level as an immediate and necessary precursor to pneumococcal disease. Based on such a causal link between carriage and disease, the authors emphasize the role of information on pneumococcal carriage in vaccine trials and in public health decision-making.
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Affiliation(s)
- Birgit Simell
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
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Coles CL, Rahmathullah L, Kanungo R, Katz J, Sandiford D, Devi S, Thulasiraj RD, Tielsch JM. Pneumococcal carriage at age 2 months is associated with growth deficits at age 6 months among infants in South India. J Nutr 2012; 142:1088-94. [PMID: 22535764 PMCID: PMC3349980 DOI: 10.3945/jn.111.156844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nasopharyngeal colonization is the first step in the pathway to Streptococcus pneumoniae (Spn) infection, a leading cause of childhood morbidity and mortality. We investigated the effect of Spn colonization at ages 2 and 4 mo on growth at age 6 mo among 389 infants living in rural South India by using data from an Spn carriage study nested within a randomized, double-blind, placebo-controlled community trial designed to evaluate the impact of newborn vitamin A supplementation on Spn carriage in the first 6 mo of life. Primary outcomes were weight, length, and anthropometric indices of nutritional status. Growth data at age 6 mo were available for 84% (389 of 464) of infants in the Spn carriage study. Carriage at age 2 mo was associated with increased odds of stunting [OR: 3.07 (95% CI: 1.29, 7.36) P = 0.012] and lower weight [β: -266 g (95% CI: -527, -5) P = 0.045], length [β: -1.31 cm (95% CI: -2.32, -0.31) P = 0.010], and length-for-age Z scores [β: -0.59; (95% CI: -1.05, -0.13) P = 0.012] at age 6 mo. Spn carriage at age 4 mo did not affect growth. Carriage of invasive serotypes at age 2 mo was associated with decreases in mean weight [β: -289 g; (95% CI: -491, -106) P = 0.002] and length [β:-0.38 cm (95% CI: -1.49, -0.01) P = 0.047] at age 6 mo. Newborn vitamin A supplementation did not modify the association between Spn carriage and growth. Results suggest that pneumococcal carriage at age 2 mo is an independent risk factor for poor growth in young infants. Future studies need to clarify the role of Spn carriage on growth retardation in low-income countries.
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Affiliation(s)
- Christian L. Coles
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD,To whom correspondence should be addressed. E-mail:
| | | | - Reba Kanungo
- Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India; and
| | - Joanne Katz
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD
| | - Debora Sandiford
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD
| | - Sheela Devi
- Lions-Aravind Institute for Community Ophthalmology, Madurai, India
| | - R. D. Thulasiraj
- Lions-Aravind Institute for Community Ophthalmology, Madurai, India
| | - James M. Tielsch
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD
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Adetifa IMO, Antonio M, Okoromah CAN, Ebruke C, Inem V, Nsekpong D, Bojang A, Adegbola RA. Pre-vaccination nasopharyngeal pneumococcal carriage in a Nigerian population: epidemiology and population biology. PLoS One 2012; 7:e30548. [PMID: 22291984 PMCID: PMC3265474 DOI: 10.1371/journal.pone.0030548] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 12/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Introduction of pneumococcal vaccines in Nigeria is a priority as part of the Accelerated Vaccine Introduction Initiative (AVI) of the Global Alliance for Vaccines and Immunisation (GAVI). However, country data on the burden of pneumococcal disease (IPD) is limited and coverage by available conjugate vaccines is unknown. This study was carried out to describe the pre vaccination epidemiology and population biology of pneumococcal carriage in Nigeria. METHODS This was a cross sectional survey. Nasopharyngeal swabs (NPS) were obtained from a population sample in 14 contiguous peri-urban Nigerian communities. Data on demographic characteristics and risk factor for carriage were obtained from all study participants. Pneumococci isolated from NPS were characterised by serotyping, antimicrobial susceptibility and Multi Locus Sequencing Typing (MLST). RESULTS The prevalence of pneumococcal carriage was 52.5%. Carriage was higher in children compared to adults (67.4% vs. 26%), highest (≈90%) in infants aged <9 months and reduced significantly with increasing age (P<0.001). Serotypes 19F (18.6%) and 6A (14.4%) were most predominant. Potential vaccine coverage was 43.8%, 45.0% and 62% for PCV-7, PCV-10 and PCV-13 respectively. There were 16 novel alleles, 72 different sequence types (STs) from the isolates and 3 Sequence Types (280, 310 and 5543) were associated with isolates of more than one serotype indicative of serotype switching. Antimicrobial resistance was high for cotrimoxazole (93%) and tetracycline (84%), a third of isolates had intermediate resistance to penicillin. Young age was the only risk factor significantly associated with carriage. CONCLUSIONS Pneumococcal carriage and serotype diversity is highly prevalent in Nigeria especially in infants. Based on the coverage of serotypes in this study, PCV-13 is the obvious choice to reduce disease burden and prevalence of drug resistant pneumococci. However, its use will require careful monitoring. Our findings provide sound baseline data for impact assessment following vaccine introduction in Nigeria.
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Affiliation(s)
| | - Martin Antonio
- Medical Research Council (MRC) Unit, The Gambia, Fajara, The Gambia
| | - Christy A. N. Okoromah
- Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Chinelo Ebruke
- Medical Research Council (MRC) Unit, The Gambia, Fajara, The Gambia
| | - Victor Inem
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - David Nsekpong
- Medical Research Council (MRC) Unit, The Gambia, Fajara, The Gambia
| | - Abdoulie Bojang
- Medical Research Council (MRC) Unit, The Gambia, Fajara, The Gambia
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Go EJ, Kim HJ, Han SB, Lee H, Kim KH, Kang JH. Nasopharyngeal Colonization of Moraxella catarrhalisin Young Korean Children. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Ji Go
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunju Lee
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Abstract
Bacterial super-infections contribute to the significant morbidity and mortality associated with influenza and other respiratory virus infections. There are robust animal model data, but only limited clinical information on the effectiveness of licensed antiviral agents for the treatment of bacterial complications of influenza. The association of secondary bacterial pathogens with fatal pneumonia during the recent H1N1 influenza pandemic highlights the need for new development in this area. Basic and clinical research into viral-bacterial interactions over the past decade has revealed several mechanisms that underlie this synergism. By applying these insights to antiviral drug development, the potential exists to improve outcomes by means other than direct inhibition of the virus.
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Affiliation(s)
- Jonathan A McCullers
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
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Association between nasopharyngeal load of Streptococcus pneumoniae, viral coinfection, and radiologically confirmed pneumonia in Vietnamese children. Pediatr Infect Dis J 2011; 30:11-8. [PMID: 20686433 DOI: 10.1097/inf.0b013e3181f111a2] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The interplay between nasopharyngeal bacterial carriage, viral coinfection, and lower respiratory tract infections (LRTIs) is poorly understood. We explored this association in Vietnamese children aged less than 5 years. METHODS A hospital-based case-control study of pediatric LRTIs was conducted in Nha Trang, Vietnam. A total of 550 hospitalized children (274 radiologically confirmed pneumonia [RCP] and 276 other LRTIs) were enrolled and 350 healthy controls were randomly selected from the community. Polymerase chain reaction-based methods were used to measure bacterial loads of Streptococcus pneumoniae (SP), Haemophilus influenzae, and Moraxella catarrhalis and to detect 13 respiratory viruses and bacterial serotypes in nasopharyngeal samples of study participants. RESULTS The median nasopharyngeal bacterial load of SP was substantially higher in children with RCP compared with healthy controls or children with other LRTIs (P < 0.001). SP load was 15-fold higher in pneumonia children with viral coinfection compared with those children without viral coinfection (1.4 x 10⁷/mL vs. 9.1 x 10⁵/mL; P 0.0001). SP load was over 200-fold higher in serotypeable SP compared with nontypeable SP (2.5 x 10⁶/mL vs. 1 x 10⁴/mL; P < 0.0001). These associations were independent of potential confounders in multiple regression models. No clear association was found between nasopharyngeal load of Haemophilus influenzae or Moraxella catarrhalis and viral coinfection in either RCP or other LRTIs groups. CONCLUSIONS An increased load of SP in the nasopharynx was associated with RCP, viral coinfection, and presence of pneumococcal capsule.
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Mackenzie GA, Leach AJ, Carapetis JR, Fisher J, Morris PS. Epidemiology of nasopharyngeal carriage of respiratory bacterial pathogens in children and adults: cross-sectional surveys in a population with high rates of pneumococcal disease. BMC Infect Dis 2010; 10:304. [PMID: 20969800 PMCID: PMC2974682 DOI: 10.1186/1471-2334-10-304] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/23/2010] [Indexed: 11/10/2022] Open
Abstract
Background To determine the prevalence of carriage of respiratory bacterial pathogens, and the risk factors for and serotype distribution of pneumococcal carriage in an Australian Aboriginal population. Methods Surveys of nasopharyngeal carriage of Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis were conducted among adults (≥16 years) and children (2 to 15 years) in four rural communities in 2002 and 2004. Infant seven-valent pneumococcal conjugate vaccine (7PCV) with booster 23-valent pneumococcal polysaccharide vaccine was introduced in 2001. Standard microbiological methods were used. Results At the time of the 2002 survey, 94% of eligible children had received catch-up pneumococcal vaccination. 324 adults (538 examinations) and 218 children (350 examinations) were enrolled. Pneumococcal carriage prevalence was 26% (95% CI, 22-30) among adults and 67% (95% CI, 62-72) among children. Carriage of non-typeable H. influenzae among adults and children was 23% (95% CI, 19-27) and 57% (95% CI, 52-63) respectively and for M. catarrhalis, 17% (95% CI, 14-21) and 74% (95% CI, 69-78) respectively. Adult pneumococcal carriage was associated with increasing age (p = 0.0005 test of trend), concurrent carriage of non-typeable H. influenzae (Odds ratio [OR] 6.74; 95% CI, 4.06-11.2) or M. catarrhalis (OR 3.27; 95% CI, 1.97-5.45), male sex (OR 2.21; 95% CI, 1.31-3.73), rhinorrhoea (OR 1.66; 95% CI, 1.05-2.64), and frequent exposure to outside fires (OR 6.89; 95% CI, 1.87-25.4). Among children, pneumococcal carriage was associated with decreasing age (p < 0.0001 test of trend), and carriage of non-typeable H. influenzae (OR 9.34; 95% CI, 4.71-18.5) or M. catarrhalis (OR 2.67; 95% CI, 1.34-5.33). Excluding an outbreak of serotype 1 in children, the percentages of serotypes included in 7, 10, and 13PCV were 23%, 23%, and 29% (adults) and 22%, 24%, and 40% (2-15 years). Dominance of serotype 16F, and persistent 19F and 6B carriage three years after initiation of 7PCV is noteworthy. Conclusions Population-based carriage of S. pneumoniae, non-typeable H. influenzae, and M. catarrhalis was high in this Australian Aboriginal population. Reducing smoke exposure may reduce pneumococcal carriage. The indirect effects of 10 or 13PCV, above those of 7PCV, among adults in this population may be limited.
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Affiliation(s)
- Grant A Mackenzie
- Child Health Division, Menzies School of Health Research, Darwin, Australia.
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Danhauer JL, Johnson CE, Corbin NE, Bruccheri KG. Xylitol as a prophylaxis for acute otitis media: Systematic review. Int J Audiol 2010; 49:754-61. [DOI: 10.3109/14992027.2010.493897] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McCullers JA, McAuley JL, Browall S, Iverson AR, Boyd KL, Henriques Normark B. Influenza enhances susceptibility to natural acquisition of and disease due to Streptococcus pneumoniae in ferrets. J Infect Dis 2010; 202:1287-95. [PMID: 20822454 DOI: 10.1086/656333] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The role of respiratory viruses in the transmission of Streptococcus pneumoniae is poorly understood. Key questions, such as which serotypes are most fit for transmission and disease and whether influenza virus alters these parameters in a serotype-specific manner, have not been adequately studied. In a novel model of transmission in ferrets, we demonstrated that pneumococcal transmission and disease were enhanced if donors had previously been infected with influenza virus. Bacterial titers in nasal wash, the incidence of mucosal and invasive disease, and the percentage of contacts that were infected all increased. In contact ferrets, viral infection increased their susceptibility to S. pneumoniae acquisition both in terms of the percentage infected and the distance over which they could acquire infection. These influenza-mediated effects on colonization, transmission, and disease were dependent on the pneumococcal strain. Overall, these data argue that the relationship between respiratory viral infections, acquisition of pneumococci, and development of disease in humans needs further study to be better understood.
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Affiliation(s)
- Jonathan A McCullers
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Labout JAM, Duijts L, Lebon A, de Groot R, Hofman A, Jaddoe VVW, Verbrugh HA, Hermans PWM, Moll HA. Risk factors for otitis media in children with special emphasis on the role of colonization with bacterial airway pathogens: the Generation R study. Eur J Epidemiol 2010; 26:61-6. [PMID: 20821039 PMCID: PMC3018595 DOI: 10.1007/s10654-010-9500-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 08/23/2010] [Indexed: 11/30/2022]
Abstract
Acute otitis media is the most frequent diagnosis in children visiting physicians’ offices. Risk factors for otitis media have been widely studied. Yet, the correlation between bacterial carriage and the development of otitis media is not entirely clear. Our aim was to study in a population-based prospective cohort the risk factors for otitis media in the second year of life with special emphasis on the role of colonization with Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. The study was embedded in the Generation R Study. Data on risk factors and doctor-diagnosed otitis media were obtained by midwives, hospital registries and postal questionnaires in the whole cohort (n = 7,295). Nasopharyngeal swabs were obtained at the age of 1.5, 6 and 14 months in the focus cohort (n = 1,079). Of these children, 2,515 (47.2%) suffered at least one period of otitis media in their second year of life. The occurrence of otitis media during the follow-up period in the first 6 months of life and between 6 and 12 months of age was associated with the risk of otitis media in the second year of life (aOR, 1.83 95% CI 1.24–2.71 and aOR 2.72, 95% CI 2.18–3.38, respectively). Having siblings was associated with an increased risk for otitis media in the second year of life (aOR 1.42, 95% CI 1.13–1.79). No associations were found between bacterial carriage in the first year of life and otitis media in the second year of life. In our study, otitis media in the first year of life is an independent risk factor for otitis media in the second year of life. Surprisingly, bacterial carriage in the first year of life did not add to this risk. Moreover, no association was observed between bacterial carriage in the first year of life and otitis in the second year of life.
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Affiliation(s)
- Joost A M Labout
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
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Affiliation(s)
| | - Johann A. Sigurdsson
- Department of Family Medicine, University of Iceland and Centre of Prevention, Education, Research and Development Primary Health Care of the Capital Area Reykjavik, Iceland
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Revisiting pneumococcal carriage by use of broth enrichment and PCR techniques for enhanced detection of carriage and serotypes. J Clin Microbiol 2010; 48:1611-8. [PMID: 20220175 DOI: 10.1128/jcm.02243-09] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The measurement of pneumococcal carriage in the nasopharyngeal reservoir is subject to potential confounders that include low-density and multiple-strain colonization. To compare different methodologies, we picked a random sampling of 100 nasopharyngeal specimens recovered from infants less than 2 years of age who were previously assessed for pneumococcal carriage and serotypes by a conventional method that used direct plating from the transport/storage medium (50 specimens were culture negative and 50 specimens were culture positive for pneumococci). We used a broth enrichment approach and a conventional PCR approach (with and without broth enrichment) to determine pneumococcal carriage and serotypes, and the results were compared to the initial conventional culture-based results. Additionally, we used a lytA-targeted real-time PCR for pneumococcal detection. Broth enrichment for both the culture-based and the PCR-based methods enhanced the isolation of pneumococci and detection of serotype diversity, with the most effective serotype deduction method being one that used broth enrichment prior to sequential multiplex PCR. Similarly, we also found that broth enrichment followed by the lytA-specific real-time PCR was the most sensitive for the detection of apparent pneumococcal carriage. The broth enrichment, conventional multiplex PCR, and real-time PCR approaches used in this study were effective in detecting pneumococcal carriage in the 50 specimens that were negative by conventional direct plating from transport medium (range of numbers of positive specimens, 8/50 to 22/50 [16 to 44%]), and the three different serotyping approaches that used broth enrichment increased the number of serotype identifications from the 100 specimens (12 to 29 additional serotype identifications to be positive). A PCR-based approach that employed a broth enrichment step appeared to best enhance the detection of mixed serotypes and low-density pneumococcal carriage.
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Auranen K, Mehtälä J, Tanskanen A, S Kaltoft M. Between-strain competition in acquisition and clearance of pneumococcal carriage--epidemiologic evidence from a longitudinal study of day-care children. Am J Epidemiol 2010; 171:169-76. [PMID: 19969530 PMCID: PMC2800239 DOI: 10.1093/aje/kwp351] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The state of pneumococcal carriage-that is, pneumococcal colonization in the nasopharynx of healthy persons-represents a reservoir for the spread of pneumococci among individuals. In light of the introduction of new pneumococcal conjugate vaccines, further knowledge on the dynamics of pneumococcal carriage is important. Different serotypes (strains) of pneumococcus are known to compete with each other in colonizing human hosts. Understanding the strength and mode of between-serotype competition is important because of its implications for vaccine-induced changes in the ecology of pneumococcal carriage. Competition may work through reduced acquisition of new serotypes, due to concurrent carriage in the individual, or through enhanced clearance of serotypes in carriers who harbor more than 1 serotype simultaneously. The authors employed longitudinal data (1999-2001) on pneumococcal carriage in Danish day-care children to analyze between-serotype competition. The data included observations of carriage in children who had not been vaccinated against pneumococcus, and the level of pneumococcal antibiotic resistance and antibiotic usage in the community was very low. Clearance of any single serotype was not affected by simultaneous carriage of other serotypes. In contrast, acquisition of other serotypes in already-colonized hosts was weak (relative rate of acquisition = 0.09, 95% credible interval: 0.05, 0.15).
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Affiliation(s)
- Kari Auranen
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
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Coles CL, Sherchand JB, Khatry SK, Katz J, Leclerq SC, Mullany LC, Tielsch JM. Nasopharyngeal carriage of S. pneumoniae among young children in rural Nepal. Trop Med Int Health 2009; 14:1025-33. [PMID: 19563428 DOI: 10.1111/j.1365-3156.2009.02331.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide epidemiologic data on Streptococcus pneumoniae (Spn) carriage in Nepal. METHODS Prospective, population-based study among children in Sarlahi, Nepal to estimate carriage prevalence, identify risk factors, and determine antibiotic susceptibility patterns and serotype distribution. Between December 2003 and July 2004, NP specimens were collected from 604 children aged 1-36 months with acute lower respiratory infection (ALRI) and 604 healthy, age- and season-matched controls. RESULTS Of the 1100 specimens analysed, carriage prevalence was approximately 80% in both groups. In the multivariate analyses, significant risk factors for Spn carriage in controls were Muslim religion [adjusted odds ratio (AOR): 2.93] and no latrine in the household (AOR: 2.41). Those treated for a recent illness had lower carriage rates (AOR: 0.37). Results were similar for ALRI cases with the addition of age >or=12 months (AOR: 1.68), and symptomatic infection (AOR: 3.78) as risk factors. The antibiotics and proportions of isolates resistant to them were as follows: penicillin 4.5%, cotrimoxazole 89.2%, chloramphenicol 1.4%, erythromycin 1.5% and tetracycline 22.7%. The most prevalent serogroups/types were 6, 19, 23, 15, 9 and 10. CONCLUSIONS Young children in rural Nepal experience high rates of Spn carriage. Most isolates were resistant to cotrimoxazole. Current conjugate Spn vaccines may substantially reduce the risk of a severe pneumonia and other Spn infections.
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Affiliation(s)
- Christian L Coles
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Hoa M, Syamal M, Sachdeva L, Berk R, Coticchia J. Demonstration of Nasopharyngeal and Middle Ear Mucosal Biofilms in an Animal Model of Acute Otitis Media. Ann Otol Rhinol Laryngol 2009; 118:292-8. [DOI: 10.1177/000348940911800410] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We performed this study to determine the role of nasopharyngeal and middle ear (ME) biofilms in acute otitis media (AOM). Methods: Sixty female 6-month-old chinchillas, free of ME disease, were utilized. Experimental animals were inoculated with influenza A followed by Streptococcus pneumonia 7 days later. Control animals were inoculated with Sorensen's phosphate buffer. Daily otoscopy and tympanometry was performed, and the animals were painlessly sacrificed on days 1, 2, 5, 8, and 14. All mucosae were harvested and prepared for scanning electron microscopy. Results: The ME inflammation, initially detected on day 2 after bacterial inoculation, peaked on day 8. Eight percent of the dually inoculated chinchillas displayed type B tympanograms, and 40% displayed type C. Otoscopic evaluation of tympanic membrane inflammation was rated from 0 to 4 (0 = normal and 4 = severe drainage and/or inflammation) according to an otoscopic grading system. Ten percent of the experimental chinchillas had a grade 2 score, 20% had grade 3, and 6.7% had grade 4. The controls demonstrated no abnormal tympanometric or otoscopic findings. Scanning electron microscopic imaging showed dense biofilms on 83% of the nasopharynges and 67% of the MEs on day 8 in the experimental animals. All animals with ME biofilms had biofilms in the nasopharynx. The controls did not demonstrate biofilm formation. Conclusions: The study parallels the natural pathogenesis of AOM in humans. The demonstration of mucosal biofilms in both the nasopharynx (58%) and the ME (47%) of animals with ME inflammation and/or infection lends further support to the importance of mucosal biofilms in the pathogenesis of AOM.
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Antonio M, Hakeem I, Sankareh K, Cheung YB, Adegbola RA. Evaluation of sequential multiplex PCR for direct detection of multiple serotypes of Streptococcus pneumoniae from nasopharyngeal secretions. J Med Microbiol 2009; 58:296-302. [DOI: 10.1099/jmm.0.006031-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sequential multiplex PCR was evaluated for detection of multiple Streptococcus pneumoniae serotypes directly from nasopharyngeal secretions. A total of 279 nasopharyngeal swab samples were tested blindly. When limited to the 29 serotypes identifiable by the molecular method, the mean number of serotypes identified by the conventional latex/Quellung method was 0.85, which was significantly lower than that by the molecular method (P <0.0001). The multiplex PCR method identified significantly more serotypes than the latex/Quellung method if limited to the 29 serotypes (P=0.001 and P=0.014, respectively).
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Affiliation(s)
- Martin Antonio
- Bacterial Diseases Programme, Medical Research Council (MRC) Laboratories, Banjul, The Gambia
| | - Ishrat Hakeem
- Bacterial Diseases Programme, Medical Research Council (MRC) Laboratories, Banjul, The Gambia
| | - Kawsu Sankareh
- Bacterial Diseases Programme, Medical Research Council (MRC) Laboratories, Banjul, The Gambia
| | - Yin Bun Cheung
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard A. Adegbola
- Bacterial Diseases Programme, Medical Research Council (MRC) Laboratories, Banjul, The Gambia
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47
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Streptococcal Infections. BACTERIAL INFECTIONS OF HUMANS 2009. [PMCID: PMC7121349 DOI: 10.1007/978-0-387-09843-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The streptococci are a large heterogeneous group of gram-positive spherically shaped bacteria widely distributed in nature. They include some of the most important agents of human disease as well as members of the normal human flora. Some streptococci have been associated mainly with disease in animals, while others have been domesticated and used for the culture of buttermilk, yogurt, and certain cheeses. Those known to cause human disease comprise two broad categories: First are the pyogenic streptococci, including the familiar β-hemolytic streptococci and the pneumococcus. These organisms are not generally part of the normal flora but cause acute, often severe, infections in normal hosts. Second are the more diverse enteric and oral streptococci, which are nearly always part of the normal flora and which are more frequently associated with opportunistic infections.
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Leach AJ, Morris PS, Mathews JD. Compared to placebo, long-term antibiotics resolve otitis media with effusion (OME) and prevent acute otitis media with perforation (AOMwiP) in a high-risk population: a randomized controlled trial. BMC Pediatr 2008; 8:23. [PMID: 18513453 PMCID: PMC2443129 DOI: 10.1186/1471-2431-8-23] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 06/02/2008] [Indexed: 12/02/2022] Open
Abstract
Background For children at high risk of chronic suppurative otitis media (CSOM), strategies to prevent acute otitis media with perforation (AOMwiP) may reduce progression to CSOM. Methods In a double blind study in northern Australia, 103 Aboriginal infants with first detection of OME were randomised to receive either amoxicillin (50 mg/kg/d BD) or placebo for 24 weeks, or until bilateral aerated middle ears were diagnosed at two successive monthly examinations (success). Standardised clinical assessments and international standards for microbiology were used. Results Five of 52 infants in the amoxicillin group and none of 51 infants in the placebo group achieved success at the end of therapy (Risk Difference = 9.6% [95% confidence interval 1.6,17.6]). Amoxicillin significantly reduced the proportion of children with i) perforation at the end of therapy (27% to 12% RD = -16% [-31,-1]), ii) recurrent perforation during therapy (18% to 4% RD = -14% [-25,-2]), and iii) reduced the proportion of examinations with a diagnosis of perforation during therapy (20% to 8% adjusted risk ratio 0.36 [0.15,0.83] p = 0.017). During therapy, the proportion of examinations with penicillin non-susceptible (MIC > 0.1 microg/ml) pneumococci was not significantly different between the amoxicillin group (34%) and the placebo group (40%). Beta-lactamase positive non-capsular H. influenzae (NCHi) were uncommon during therapy but more frequent in the amoxicillin group (10%) than placebo (5%). Conclusion Aboriginal infants receiving continuous amoxicillin had more normal ears, fewer perforations, and less pneumococcal carriage. There was no statistically significant increase in resistant pneumococci or NCHi in amoxicillin children compared to placebo children who received regular paediatric care and antibiotic treatment for symptomatic illnesses.
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Affiliation(s)
- Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
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Revai K, Mamidi D, Chonmaitree T. Association of nasopharyngeal bacterial colonization during upper respiratory tract infection and the development of acute otitis media. Clin Infect Dis 2008; 46:e34-7. [PMID: 18205533 DOI: 10.1086/525856] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute otitis media occurs mostly after upper respiratory tract infection; the causative bacteria are those colonized in the nasopharynx. We studied 709 episodes of upper respiratory tract infection and found that children with no bacteria in the nasopharynx were at low risk for acute otitis media, whereas children with 3 pathogenic bacteria were at the greatest risk.
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Affiliation(s)
- Krystal Revai
- Department of Pediatrics, University of Texas, Medical Branch at Galveston, Galveston, TX 7555-0371, USA.
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Random colony selection versus colony morphology for detection of multiple pneumococcal serotypes in nasopharyngeal swabs. Pediatr Infect Dis J 2008; 27:178-80. [PMID: 18174871 DOI: 10.1097/inf.0b013e31815bb6c5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Detection of multiple serotype carriage is important in understanding pneumococcal epidemiology. We compared random selection of 4 pneumococcal colonies per swab with selection by colony morphology. Multiple serotypes were detected in 20% of 98 swabs; 14% by morphology and 17% by random selection. Selection by morphology was more efficient per colony, but underestimated the true rate of multiple carriage.
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