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Ricci Conesa H, Skröder H, Norton N, Bencina G, Tsoumani E. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence. PLoS One 2024; 19:e0297098. [PMID: 38564583 PMCID: PMC10986968 DOI: 10.1371/journal.pone.0297098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. METHODS This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. RESULTS In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. CONCLUSIONS Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.
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Affiliation(s)
| | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Marom T, Gluck O, Ovnat Tamir S. Treatment failure in pediatric acute otitis media: How do you define? Int J Pediatr Otorhinolaryngol 2021; 150:110888. [PMID: 34416438 DOI: 10.1016/j.ijporl.2021.110888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/26/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Reaching the point of treatment failure in the management of pediatric acute otitis media (AOM) is decision-changing, and is often associated with switching to a broader coverage antibiotic with/without middle ear surgical drainage. Yet, still there is no consensus on the definition of what is treatment failure, which may lead to confusion for clinical decision-making purposes. We sought to review the heterogeneity of treatment failure definitions in AOM. METHODS We searched for relevant English language manuscripts using the following key-words: ['otitis media' (OM) or (AOM)] AND ['treatment failure' or 'failure' or 'response failure' or 'response'] AND 'human' in various electronic databases from 1/1/2005 through 10/31/2020. RESULTS In the 60 retrieved papers, treatment failure was considered only when antibiotics had been prescribed beforehand, but not when watchful waiting had been adopted. We categorized the manuscripts into 5 major treatment failure definition subgroups, which occasionally overlapped: unimprovement or worsening of symptoms or signs of failure in otoscopy (n = 36), specialist(s) referral or hospital admission (n = 12), changing or adding antibiotic treatment (n = 22), failure to eradicate causative bacteria (n = 7) and failure as perceived by parents (n = 4). CONCLUSIONS We suggest a broader definition of AOM treatment failure including physical examination findings and degree of initial treatment response, which will enable an unbiased, uniform comparison of treatments for pediatric AOM.
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Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel.
| | - Ofer Gluck
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
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Design and Characterization of Protein E-PilA, a Candidate Fusion Antigen for Nontypeable Haemophilus influenzae Vaccine. Infect Immun 2019; 87:IAI.00022-19. [PMID: 31085711 PMCID: PMC6652776 DOI: 10.1128/iai.00022-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/26/2019] [Indexed: 01/17/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is a pathogen known for being a frequent cause of acute otitis media in children and respiratory tract infections in adults with chronic obstructive pulmonary disease. In the present study, a vaccine antigen based on the fusion of two known NTHi adhesive proteins, protein E (PE) and a pilin subunit (PilA), was developed. The quality of the combined antigen was investigated through functional, biophysical, and structural analyses. Nontypeable Haemophilus influenzae (NTHi) is a pathogen known for being a frequent cause of acute otitis media in children and respiratory tract infections in adults with chronic obstructive pulmonary disease. In the present study, a vaccine antigen based on the fusion of two known NTHi adhesive proteins, protein E (PE) and a pilin subunit (PilA), was developed. The quality of the combined antigen was investigated through functional, biophysical, and structural analyses. It was shown that the PE and PilA individual structures are not modified in the PE-PilA fusion and that PE-PilA assembles as a dimer in solution, reflecting PE dimerization. PE-PilA was found to bind vitronectin by enzyme-linked immunosorbent assay, as isolated PE does. Disulfide bridges were conserved and homogeneous, which was determined by peptide mapping and top-down analysis of PE, PilA, and PE-PilA molecules. Finally, the PE-PilA crystal showed a PE entity with a three-dimensional (3D) structure similar to that of the recently published isolated PE, while the structure of the PilA entity was similar to that of a 3D model elaborated from two other type 4 pilin subunits. Taken together, our observations suggest that the two tethered proteins behave independently within the chimeric molecule and display structures similar to those of the respective isolated antigens, which are important characteristics for eliciting optimal antibody-mediated immunity. PE and PilA can thus be further developed as a single fusion protein in a vaccine perspective, in the knowledge that tethering the two antigens does not perceptibly compromise the structural attributes offered by the individual antigens.
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A Protein E-PilA Fusion Protein Shows Vaccine Potential against Nontypeable Haemophilus influenzae in Mice and Chinchillas. Infect Immun 2019; 87:IAI.00345-19. [PMID: 31109946 PMCID: PMC6652774 DOI: 10.1128/iai.00345-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 11/21/2022] Open
Abstract
PE-PilA is a fusion protein composed of immunologically relevant parts of protein E (PE) and the majority subunit of the type IV pilus (PilA), two major antigens of nontypeable Haemophilus influenzae (NTHi). Here we report on the preclinical evaluation of PE-PilA as a vaccine antigen. The immunogenic potential of the PE and PilA within the fusion was compared with that of isolated PE and PilA antigens. PE-PilA is a fusion protein composed of immunologically relevant parts of protein E (PE) and the majority subunit of the type IV pilus (PilA), two major antigens of nontypeable Haemophilus influenzae (NTHi). Here we report on the preclinical evaluation of PE-PilA as a vaccine antigen. The immunogenic potential of the PE and PilA within the fusion was compared with that of isolated PE and PilA antigens. When injected intramuscularly into mice, the immunogenicity of PE within the fusion was equivalent to that of isolated PE, except when it was formulated with alum. In contrast, in our murine models PilA was consistently found to be more immunogenic as a subentity of the PE-PilA fusion protein than when it was injected as an isolated antigen. Following immunization with PE-PilA, anti-PE antibodies demonstrated the same capacity to inhibit the binding of PE to vitronectin as those induced after PE immunization. Likewise, PE-PilA-induced anti-PilA antibodies inhibited the formation of NTHi biofilms and disrupted established biofilms in vitro. These experiments support the immunogenic equivalence between fused PE-PilA and isolated PE and PilA. Further, the potential of PE-PilA immunization against NTHi-induced disease was evaluated. After intranasal NTHi challenge, colonization of the murine nasopharynx significantly dropped in animals formerly immunized with PE-PilA, and in chinchillas, signs of otitis media were significantly reduced in animals that had received anti-PE-PilA antibodies. Taken together, our data support the use of PE-PilA as an NTHi vaccine antigen.
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Vermee Q, Cohen R, Hays C, Varon E, Bonacorsi S, Bechet S, Thollot F, Corrard F, Poyart C, Levy C, Raymond J. Biofilm production by Haemophilus influenzae and Streptococcus pneumoniae isolated from the nasopharynx of children with acute otitis media. BMC Infect Dis 2019; 19:44. [PMID: 30634919 PMCID: PMC6329076 DOI: 10.1186/s12879-018-3657-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background Biofilm production by Haemophilus influenzae and Streptococcus pneumoniae has been implicated in the pathogenesis of otitis media, mainly in chronic and recurrent cases. We studied the “in vitro” biofilm production by these 2 species isolated alone or together from the nasopharynx of children with acute otitis media. Methods The studied strains were from 3 pneumococcal conjugate vaccine (PCV) periods: pre-PCV7, post-PCV7/pre-PCV13 and post-PCV13. A modified microtiter plate assay with crystal violet stain was used to study the biofilm production of 182 H. influenzae and 191 S. pneumoniae strains. Results Overall, 117/181 (64.6%) H. influenzae and 128/191 (66.8%) S. pneumoniae strains produced biofilm. The proportion of biofilm-producing H. influenzae strains was greater with than without the isolation of S. pneumoniae in the same sample (75.5% vs 52.3%, p = 0.001). Conversely, the proportion of biofilm-producing S. pneumoniae strains was not affected by the presence or not of H. influenzae (66.3% vs 67.4%). S. pneumoniae serotypes 6B, 15B/C, 19A, 35F and 35B were the better biofilm producers (80%). Serotypes 11A, 14, 15A, 19F and 19A were more associated with H. influenzae biofilm-producing strains. Overall, 89/94 (94.6%) of cases with combined isolation showed biofilm production by S. pneumoniae or H. influenzae. Conclusion This study emphasizes the high proportion of biofilm production by H. influenzae and S. pneumoniae strains isolated from the nasopharynx of children with acute otitis media, which reinforces the results of studies suggesting the importance of biofilm in the pathogenesis of acute otitis media. Electronic supplementary material The online version of this article (10.1186/s12879-018-3657-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Quentin Vermee
- Bactériologie, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris Cedex 14, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94 Saint-Maur des Fossés, France.,IMRB- GRC GEMINI, Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.,Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Constantin Hays
- Bactériologie, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris Cedex 14, France
| | - Emmanuelle Varon
- Bactériologie, Hôpital Georges Pompidou, Université Paris Descartes, Paris, France
| | | | - Stephane Bechet
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94 Saint-Maur des Fossés, France
| | | | - François Corrard
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94 Saint-Maur des Fossés, France
| | - Claire Poyart
- Bactériologie, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris Cedex 14, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94 Saint-Maur des Fossés, France.,IMRB- GRC GEMINI, Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Josette Raymond
- Bactériologie, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris Cedex 14, France.
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Lewnard JA, Givon-Lavi N, Weinberger DM, Lipsitch M, Dagan R. Pan-serotype Reduction in Progression of Streptococcus pneumoniae to Otitis Media After Rollout of Pneumococcal Conjugate Vaccines. Clin Infect Dis 2018; 65:1853-1861. [PMID: 29020218 DOI: 10.1093/cid/cix673] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 01/10/2023] Open
Abstract
Background Reductions in otitis media (OM) burden following rollout of pneumococcal conjugate vaccines (PCVs) have exceeded predictions of vaccine impact. In settings with active surveillance, reductions in OM caused by vaccine-targeted pneumococcal serotypes have co-occurred with reductions in OM caused by other pathogens carried in the upper-respiratory tract of children. To understand these changes, we investigated the progression of vaccine-targeted and non-vaccine pneumococcal serotypes from carriage to OM before and after vaccine rollout. Methods Nasopharyngeal carriage prevalence of pneumococcus was monitored in prospective studies of Bedouin and Jewish children <3 years old in southern Israel between 2004 and 2016. Incidence of OM necessitating middle-ear fluid culture (predominantly complex OM including recurrent, spontaneously-draining, non-responsive, and chronic cases) was monitored via prospective, population-based active surveillance. We estimated rates of pneumococcal serotype-specific progression from carriage to disease before and after rollout of PCV7/13, measured as OM incidence per carrier. We pooled serotype-specific estimates using Bayesian random-effects models. Results On average, rates of progression declined 92% (95% credible interval: 79-97%) and 80% (46-93%) for PCV7/13 serotypes among Bedouin and Jewish children <12 months old, respectively, and 32% (-58-71%) and 61% (-5-86%) among children aged 12-35m. For non-vaccine serotypes, rates of progression among Bedouin and Jewish children aged <12m declined 74% (55-85%) and 43% (4-68%), respectively. Conclusions Vaccine-targeted and non-vaccine pneumococcal serotypes showed lower rates of progression to complex OM after rollout of PCV7/13. Early-life OM episodes historically associated with vaccine-serotype pneumococci may impact the susceptibility of children to OM progression.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Noga Givon-Lavi
- Pediatric Infectious Diseases Unit, Soroka University Medical Center.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Wouters I, Van Heirstraeten L, Desmet S, Blaizot S, Verhaegen J, Goossens H, Van Damme P, Malhotra-Kumar S, Theeten H. Nasopharyngeal s. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme. Vaccine 2017; 36:15-22. [PMID: 29180027 DOI: 10.1016/j.vaccine.2017.11.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. MATERIALS/METHODS Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. RESULTS Culture-based (DCC: 462/760; 60.8% - AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 × 106 copies/µl (95%CI = 3.9-9.2 × 106, median = 3.5 × 105); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture-based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively. CONCLUSION Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.
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Affiliation(s)
- Ine Wouters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Stefanie Desmet
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Stéphanie Blaizot
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Verhaegen
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Van Dyke MK, Pirçon JY, Cohen R, Madhi SA, Rosenblüt A, Macias Parra M, Al-Mazrou K, Grevers G, Lopez P, Naranjo L, Pumarola F, Sonsuwan N, Hausdorff WP. Etiology of Acute Otitis Media in Children Less Than 5 Years of Age: A Pooled Analysis of 10 Similarly Designed Observational Studies. Pediatr Infect Dis J 2017; 36:274-281. [PMID: 27918383 PMCID: PMC5312727 DOI: 10.1097/inf.0000000000001420] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is an important cause of childhood morbidity and antibiotic prescriptions. However, the relative importance of the well-known otopathogens, Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hflu), remains unclear because of a limited number of tympanocentesis-based studies that vary significantly in populations sampled, case definitions and heptavalent pneumococcal conjugate vaccine use. METHODS We conducted a pooled analysis of results from 10 AOM etiology studies of similar design, the protocols of which were derived from a common protocol and conducted in children 3 months to 5 years of age in different countries. Generalized estimating equations were used to account for within-study correlations. RESULTS The majority, 55.5% (95% confidence interval: 47.0%-65.7%) of 1124 AOM episodes, were bacterial pathogen positive: 29.1% (24.8%-34.1%) yielded Hflu and 23.6% (19.0%-29.2%) Spn. Proportions of Hflu and Spn were higher and lower, respectively, in heptavalent pneumococcal conjugate vaccine-vaccinated children. Hflu and Spn were each isolated from 20% to 35% of children in every 1-year age range. Hflu was less likely to be isolated from first (vs. subsequent) episodes [relative risk (RR): 0.71 (0.60-0.84)]. Spn was more often isolated from sporadic (vs. recurrent) cases [RR: 0.76 (0.61-0.97)]; the opposite was true for Hflu [RR: 1.4 (1.00-1.96)]. Spn cases were more likely to present with severe (vs. mild) symptoms [RR: 1.42 (1.01-2.01)] and Hflu cases with severe tympanic membrane inflammation [RR: 1.35 (1.06-1.71)]. CONCLUSIONS Spn and Hflu remain the leading otopathogens in all populations examined. While associated with overlapping symptoms and severity, they exhibit some differences in their likelihood to cause disease in specific subpopulations.
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Affiliation(s)
- Melissa K. Van Dyke
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Jean-Yves Pirçon
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Robert Cohen
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Shabir A. Madhi
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Andrés Rosenblüt
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Mercedes Macias Parra
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Khalid Al-Mazrou
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Gerhard Grevers
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Pio Lopez
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Laura Naranjo
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Felix Pumarola
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Nuntigar Sonsuwan
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - William P. Hausdorff
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
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9
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Cohen R, Biscardi S, Levy C. The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014. Hum Vaccin Immunother 2016; 12:277-84. [PMID: 26905678 DOI: 10.1080/21645515.2015.1116654] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In 2003, France was the first European country to recommend 7-valent pneumococcal conjugate vaccine (PCV7) for a large proportion of healthy children. With complicated recommendations, the vaccine coverage during the first 4 y of implementation was low, then progressively increased to reach 90% in 2008. The aim of this review was to describe the particular impact of PCVs in a country where the vaccine coverage was initially suboptimal. After PCV7 implementation, the PCV7 serotypes nearly disappeared among pneumococci isolated from meningitis (-73%), other invasive pneumococcal disease (IPD; -90%) and pneumococcal carriage (-97%). Consequently, the rates of penicillin-resistant strains declined. However, because of important serotype replacement, the global effect on the incidence of meningitis (-31%) or other IPD (-14%) was modest and observed only in young children < 2 y old. After PCV13 transition, with immediate high vaccine coverage, the vaccine had an important impact on all pneumococcal disease: reduction of -20% for pneumococcal meningitis, -36% for non-meningitis IPD, -32% for community acquired pneumonia and -15% for S. pneumoniae carriage. These findings underline the complexity of pneumococcal epidemiology and the importance of high and fast vaccination coverage to obtain the optimal effect of PCVs.
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Affiliation(s)
- Robert Cohen
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,d Unité Court Séjour; Petits Nourrissons ; Service de Néonatologie; Centre Hospitalier Intercommunal de Créteil ; France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
| | - Sandra Biscardi
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France.,f Service des urgences pédiatriques ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France
| | - Corinne Levy
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
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10
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Dagan R, Pelton S, Bakaletz L, Cohen R. Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:480-92. [PMID: 27036355 DOI: 10.1016/s1473-3099(15)00549-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/22/2022]
Abstract
Otitis media is a common childhood infection of the middle ear and a major cause of morbidity. This multifactorial disease manifests as a spectrum of clinical syndromes from uncomplicated acute otitis media to more complex recurrent and chronic cases (frequently polymicrobial), with the major pathogens involved being Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Pneumococcal conjugate vaccines (PCVs) target only a few serotypes that cause otitis media; however, results from studies suggest that existing PCVs can prevent early episodes of disease associated with vaccine serotypes, resulting in a reduction of subsequent complex cases caused by non-vaccine serotypes and other otopathogens, which contribute considerably to the disease burden. In this Review, we discuss the role of pneumococcus in the disease continuum and assess clinical evidence showing the effect of prevention of early episodes on the complex interplay between bacterial species implicated in otitis media.
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Affiliation(s)
- Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Lauren Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, and Unité Court Séjour, Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Paris, France
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11
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Petraitiene S, Alasevicius T, Staceviciene I, Vaiciuniene D, Kacergius T, Usonis V. The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children. BMC Infect Dis 2015; 15:403. [PMID: 26423571 PMCID: PMC4589981 DOI: 10.1186/s12879-015-1149-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/25/2015] [Indexed: 12/05/2022] Open
Abstract
Background Streptococcus pneumoniae (SPn) is an important pathogen causing a variety of clinical manifestations. The effects of SPn nasopharyngeal colonization on respiratory tract infections are poorly studied. We evaluated the association of SPn colonization with features of respiratory tract infections. Methods Children under the age of 6 years who visited a primary care physician because of respiratory tract infections were enrolled in the study. History was taken, children were clinically assessed by the physician, and nasopharyngeal swabs were obtained and cultured for SPn. Positive samples were serotyped. Associations of SPn colonization with clinical signs and symptoms, recovery duration, absence from day care centre, frequencies of specific diagnoses, and treatment with antimicrobials were evaluated. Results In total 900 children were enrolled. The prevalence of SPn colonization was 40.8 % (n = 367). There were minor differences between male and female subjects (199 of 492, 40.4 % vs 168 of 408, 41.2 %, p = 0.825). Children with and without siblings had similar colonization rates (145 of 334, 43.4 % vs 219 of 562, 39.0 %, p = 0.187). Clinical signs and symptoms were not associated with SPn colonization. Children colonized with SPn had longer recovery duration compared to non-colonized children (114 of 367, 31.1 % vs 98 of 533, 18.4 %, p < 0.001) and were longer absent from day care (270 of 608, 44.4 % vs 94 of 284, 33.1 %, p = 0.001). Pneumonia, sinusitis, and acute otitis media were more frequently diagnosed in children colonized with SPn. Children attending day care centres had significantly higher prevalence of SPn colonization (270 of 367, 44.4 % vs 338 of 533, 33.1 %, p = 0.001). Children with pneumonia, sinusitis and acute otitis media were more frequently treated with antimicrobials than children with other diagnoses. Conclusions SPn nasopharyngeal colonization has a negative impact on the course of respiratory tract infection, likely because of SPn being the cause of the disease or a complicating factor. It is also associated with and may be responsible for higher frequencies of bronchitis, pneumonia, acute otitis media, sinusitis and the need of antimicrobial treatment.
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Affiliation(s)
- Sigita Petraitiene
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Tomas Alasevicius
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Indre Staceviciene
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Daiva Vaiciuniene
- Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Tomas Kacergius
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Vytautas Usonis
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
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12
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Angoulvant F, Cohen R, Doit C, Elbez A, Werner A, Béchet S, Bonacorsi S, Varon E, Levy C. Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction. BMC Infect Dis 2015; 15:236. [PMID: 26093673 PMCID: PMC4475293 DOI: 10.1186/s12879-015-0978-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After the implementation of pneumococcal conjugate vaccines (PCVs), the marked shift in Streptococcus pneumoniae (Pnc) serotype distribution led to a modification in pneumococcal antibiotic susceptibility. In 2011, the pattern of antibiotic prescription in France for acute otitis media in infants was greatly modified, with decreased use of third-generation cephalosporins and amoxicillin-clavulanate replaced by amoxicillin alone. To assess antibiotic strategies, here we measured the antibiotic susceptibility of Pnc and Haemophilus influenzae (Hi) isolated from nasopharyngeal flora in infants with acute otitis media in the 13-valent PCV (PCV13) era in France. METHODS From November 2006 to June 2013, 77 pediatricians obtained nasopharyngeal swabs from infants (6 to 24 months old) with acute otitis media. The swabs were sent for analysis to the national reference centre for pneumococci in France. Demographics, medical history, and physical examination findings were recorded. RESULTS We examined data for 7200 children, 3498 in the pre-PCV13 period (2006-2009) and 3702 in the post-PCV13 period (2010-2013). The Pnc carriage rate decreased from 57.9% to 54.2% between the 2 periods, and the proportion of pneumococcal strains with reduced susceptibility to penicillin or resistant to penicillin decreased from 47.1% to 39% (P < 0.0001). The Hi carriage rate increased from 48.2% to 52.4%, with the proportion of ß-lactamase-producing strains decreasing from 17.1% to 11.9% and the proportion of ß-lactamase-nonproducing, ampicillin-resistant strains remaining stable, from 7.7% to 8.2%. We did not identify any risk factor associated with carriage of ß-lactamase-producing Hi strains (such as daycare center attendance, otitis-prone condition or recent antibiotic use). CONCLUSION In France, the nasopharyngeal carriage rate of reduced-susceptibility pneumococcal strains and ß-lactamase-producing Hi strains decreased in children with acute otitis media after 2010, the year the PCV13 was introduced. Accordingly, amoxicillin as the first-line drug for acute otitis media requiring antibiotics remains a valid choice.
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Affiliation(s)
- François Angoulvant
- Service d'Accueil des Urgences Pédiatriques, AP-HP, Hôpital Necker-Enfants-Malades, Université Paris Descartes Sorbonne Paris Cité, ECEVE - INSERM UMR1123, Paris, France.
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France. .,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
| | - Catherine Doit
- Université Paris Diderot Sorbonne Paris Cité, Paris, France. .,Service de Microbiologie, AP-HP, Hôpital Robert-Debré, 75019, Paris, France.
| | - Annie Elbez
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France.
| | - Andreas Werner
- AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France.
| | - Stéphane Bonacorsi
- Université Paris Diderot Sorbonne Paris Cité, Paris, France. .,Service de Microbiologie, AP-HP, Hôpital Robert-Debré, 75019, Paris, France.
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, AP-HP, Hopital Européen Georges-Pompidou, Paris, France.
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France. .,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
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13
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Etiology and epidemiology of children with acute otitis media and spontaneous otorrhea in Suzhou, China. Pediatr Infect Dis J 2015; 34:e102-6. [PMID: 25379833 DOI: 10.1097/inf.0000000000000617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are scare data about bacterial etiology and the antibiotic susceptibility, serotype distribution and molecular characteristics of pneumococci in children with acute otitis media (AOM) in China. METHODS A prospective study was conducted in Suzhou University Affiliated Children's Hospital. All children under 18 years of age diagnosed as AOM and with spontaneous otorrhea were offered enrollment, and collection of middle ear fluid was then cultured for bacterial pathogens. The antibiotic susceptibility, serotypes, macrolide resistance genes and sequence types of Streptococcus pneumoniae strains were identified. RESULTS From January 2011 to December 2013, a total of 229 cases of AOM with spontaneous otorrhea were identified; of these, 159 (69.4%) middle ear fluid specimens were tested positive for bacterial pathogens. The leading cause was S. pneumoniae (47.2%), followed by Staphylococcus aureus (18.8%) and Haemophilus influenzae (7.4%). The antibiotic resistance rates of S. pneumoniae isolates to erythromycin were 99.1%, and the nonsusceptible rate to penicillin was 54.6%. The most common serotypes identified were 19A (45.1%) and 19F (35.4%). The coverage against PCV7 serotypes for this outcome was 56.1% and of PCV13 was 97.6%. The macrolide resistance was mainly mediated by both ermB and mefA/E genes (88.6%). The CC271 was the major clonal complex identified. CONCLUSIONS S. pneumoniae was a leading cause for AOM in children in Suzhou, China. Antibiotics resistance rates of S. pneumoniae were high and mainly due to the spread of CC271 clonal complex.
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14
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Abdelnour A, Arguedas A, Dagan R, Soley C, Porat N, Mercedes Castrejon M, Ortega-Barria E, Colindres R, Pirçon JY, DeAntonio R, Van Dyke MK. Etiology and antimicrobial susceptibility of middle ear fluid pathogens in Costa Rican children with otitis media before and after the introduction of the 7-valent pneumococcal conjugate vaccine in the National Immunization Program: acute otitis media microbiology in Costa Rican children. Medicine (Baltimore) 2015; 94:e320. [PMID: 25590837 PMCID: PMC4602541 DOI: 10.1097/md.0000000000000320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acute otitis media (AOM) microbiology was evaluated in children after 7-valent pneumococcal conjugate vaccine (PCV7) introduction in Costa Rica (private sector, 2004; National Immunization Program, 2009). This was a combined prospective and retrospective study conducted in a routine clinical setting in San José, Costa Rica. In the prospective part of the study, which was conducted post-PCV7 introduction (2010-2012), standard bacteriological procedures were used to evaluate the etiology and serotype distribution of middle ear fluid samples collected by tympanocentesis or otorrhea from children aged 3-59 months diagnosed with AOM. E-tests were used to evaluate antimicrobial susceptibility in culture-positive samples. Retrospective data recorded between 1999 and 2004 were used for comparison of bacterial etiology and serotype distribution before and after PCV7 introduction. Statistical significance was evaluated in bivariate analyses at the P-value < 0.05 level (without multiplicity correction). Post-PCV7 introduction, Haemophilus influenzae was detected in 118/456 and Streptococcus pneumoniae in 87/456 AOM episodes. Most H. influenzae isolates (113/118) were non-typeable. H. influenzae was more (27.4% vs 20.8%) and S. pneumoniae less (17.1% vs 25.5%) frequently observed in vaccinated (≥ 2 PCV7 doses or ≥ 1 PCV7 dose at >1 year of age) versus unvaccinated children. S. pneumoniae non-susceptibility rates were 1.1%, 34.5%, 31.7%, and 50.6% for penicillin, erythromycin, azithromycin, and trimethoprim/sulfamethoxazole (TMP-SMX), respectively. H. influenzae non-susceptibility rate was 66.9% for TMP-SMX. Between pre- and post-PCV7 introduction, H. influenzae became more (20.5% vs 25.9%; P-value < 0.001) and S. pneumoniae less (27.7% vs 19.1%; P-value = 0.002) prevalent, and PCV7 serotype proportions decreased among pneumococcal isolates (65.8% vs 43.7%; P-value = 0.0005). Frequently identified pneumococcal serotypes were 19F (34.2%), 3 (9.7%), 6B (9.7%), and 14 (9.7%) pre-PCV7 introduction, and 19F (27.6%), 14 (8.0%), and 35B (8.0%) post-PCV7 introduction. Following PCV7 introduction, a change in the distribution of AOM episodes caused by H. influenzae and pneumococcal serotypes included in PCV7 was observed in Costa Rican children. Pneumococcal vaccines impact should be further evaluated following broader vaccination coverage.
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Affiliation(s)
- Arturo Abdelnour
- From the Instituto de Atención Pediátrica, San José, Costa Rica (AAb, AAr, CS); Universidad Autónoma de Ciencias Médicas, San José, Costa Rica (AAr); Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel (RDa, NP); GlaxoSmithKline Vaccines, Panama City, Panama (MMC, EO-B, RDA) GlaxoSmithKline Vaccines, Wavre, Belgium (RC, J-YP, RD, MVD)
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15
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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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