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Chu K, Hu Y, Pan H, Wu J, Zhu D, Young MM, Luo L, Yi Z, Giardina PC, Gruber WC, Scott DA, Watson W. A randomized, open-label, phase 3 study evaluating safety and immunogenicity of 13-valent pneumococcal conjugate vaccine in Chinese infants and children under 6 years of age. Hum Vaccin Immunother 2023; 19:2235926. [PMID: 37549923 PMCID: PMC10408693 DOI: 10.1080/21645515.2023.2235926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023] Open
Abstract
Streptococcus pneumoniae causes a considerable disease burden among children in China. Many isolates exhibit antimicrobial resistance but are often serotypes covered by the 13-valent pneumococcal conjugate vaccine (PCV13). Because the approved infant immunization schedule in China allows PCV13 vaccination only for those 6 weeks to 15 months of age, this phase 3 study was conducted to evaluate PCV13 immunogenicity and safety in unvaccinated older infants and children. Eligible participants were stratified by age into four cohorts: Cohort 1 (n = 125), 6 weeks-2 months; Cohort 2 (n = 354), 7-<12 months; Cohort 3 (n = 250), 1 -<2 years; Cohort 4 (n = 207), 2-<6 years. Cohort 1 received PCV13 at ages 2, 4, and 6 months; older cohorts were randomized 2:1 to PCV13 or Haemophilus influenzae type b (Hib) vaccine using age-appropriate schedules. Within-group immune responses were assessed by immunoglobulin G (IgG) concentrations and opsonophagocytic activity (OPA) titers. Safety evaluations included solicited reactogenicity events and adverse events (AEs). IgG geometric mean concentrations and OPA geometric mean titers for all 13 PCV13 serotypes increased for all participants vaccinated with PCV13, but not those vaccinated with Hib. Immune responses in Cohorts 2-4 were generally comparable with those in Cohort 1 (the infant series) for most serotypes. PCV13 was well tolerated across cohorts, with reported AEs consistent with expectations in these age groups; no new safety signals were identified. These results suggest that PCV13 administered as a catch-up regimen to infants and children 7 months-<6 years of age in China will effectively reduce vaccine-type pneumococcal disease in this population. NCT03574389.
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Affiliation(s)
- Kai Chu
- Department of Vaccine Clinical Evaluation, Jiangsu Center for Disease Control and Prevention, Nanjing, JS, P. R. China
| | - Yuemei Hu
- Department of Vaccine Clinical Evaluation, Jiangsu Center for Disease Control and Prevention, Nanjing, JS, P. R. China
| | - Hongxing Pan
- Department of Vaccine Clinical Evaluation, Jiangsu Center for Disease Control and Prevention, Nanjing, JS, P. R. China
| | - Jingliang Wu
- Department of Infectious Disease, Huaiyin Center for Disease Control and Prevention, Huai’an, JS, P. R. China
| | - Dandan Zhu
- Department of Infectious Disease, Huaiyin Center for Disease Control and Prevention, Huai’an, JS, P. R. China
| | - Mariano M. Young
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Li Luo
- Clinical Development, Pfizer Vaccine Research, Beijing, P. R. China
| | - Zhuobiao Yi
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
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Hullegie S, Venekamp RP, van Dongen TMA, Hay AD, Moore MV, Little P, Schilder AGM, Damoiseaux RAMJ. Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review. Pediatr Infect Dis J 2021; 40:756-762. [PMID: 34166300 PMCID: PMC8274581 DOI: 10.1097/inf.0000000000003134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Of children with acute otitis media (AOM), 15%-20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era. METHODS Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist. RESULTS Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%-47.9%), Haemophilus influenzae (median 18.8%, range 3.9%-55.3%), Staphylococcus aureus (median 12.3%, range 2.3%-34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%-30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%-100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time. CONCLUSIONS In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children's PCV status.
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Affiliation(s)
- Saskia Hullegie
- From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Thijs M. A. van Dongen
- From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alastair D. Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Michael V. Moore
- Primary Care and Population Sciences Unit, Aldermoor Health Centre, University of Southampton, Southampton
| | - Paul Little
- Primary Care and Population Sciences Unit, Aldermoor Health Centre, University of Southampton, Southampton
| | - Anne G. M. Schilder
- From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- NIHR UCLH BRC, evidENT, Ear Institute, University College London, London, United Kingdom
| | - Roger A. M. J. Damoiseaux
- From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Liu Y, Li W, Dong Q, Chen M, Li W, Wang X, Fu J, Ye X. Non-linear relationships between children age and pneumococcal vaccine coverage: Important implications for vaccine prevention strategies. Vaccine 2021; 39:1392-1401. [PMID: 33531198 DOI: 10.1016/j.vaccine.2021.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) is an important pathogen causing both invasive and non-invasive infections in children, with significant morbidity and mortality worldwide. This study aimed to determine the potential relationships between age and vaccine coverage and between multiple phenotype-genotype characteristics of S. pneumoniae isolated from children. METHODS All S. pneumoniae isolates were tested for antimicrobial susceptibility, virulence genes, serotypes, and sequence types. The restricted cubic spline models were used to reveal potential relationships between children age and pneumococcal vaccine coverage. RESULTS For capsular-based vaccines, we observed a high coverage rate of 13-valent pneumococcal conjugate vaccine (PCV13, 85.8%) and a significantly non-linear relationship between children age and vaccine coverage (including PCV7, PCV10, and PCV13), with marked fluctuations in children aged < 2 years. For protein-based and pilus-based vaccine candidates, we demonstrated dynamic non-linear relationships between age and vaccine coverage, maintaining a stable and high coverage rate of ply and lytA for all age groups. Moreover, there were significantly high-dimensional corresponding relationships among multiple phenotype-genotype characteristics of S. pneumoniae isolates (such as ST271 associated with serotype 19F, PI-2, and extensively drug-resistance). CONCLUSIONS Our findings suggest that the age for high PCV coverage being children aged ≥ 2 years and also provide important evidence for supporting ply and lytA as priority candidate targets for the development of new-generation protein vaccines.
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Affiliation(s)
- Yanling Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenhui Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qian Dong
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Minqi Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenyu Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xulin Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jinjian Fu
- Department of Prevention and Health Care, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China.
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
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Early clinical predictors for the prognosis of invasive pneumococcal disease. BMC Infect Dis 2020; 20:651. [PMID: 32887563 PMCID: PMC7650274 DOI: 10.1186/s12879-020-05382-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Risk factors related to mortality due to invasive pneumococcal disease (IPD) have been unveiled previously, but early clinical manifestations of IPD based on prognosis remain uncovered. Methods The demographic characteristics, clinical features, serotype, antibiotic susceptibility, and outcomes of 97 hospitalized children with laboratory-confirmed IPD from Suzhou, China, were collected and analyzed retrospectively. Results The median age was 0.69 (0.49–1.55) years in the non-survivor group compared with 2.39 (0.90–3.81) years in the survivor group. The mortality of 97 children with laboratory-confirmed IPD was 17.5% (17/97), and 53.6% of them were aged less than 2 years. Pathogens were mainly from the blood and cerebrospinal fluid, and sepsis was the most frequent type. Statistically significant differences were found in hyperpyrexia, vomiting, anorexia, lethargy, poor perfusion of extremities, Hb level, and Plt count between the nonsurvival and survival groups. Further, the multivariate regression analysis showed that early signs, including hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities, were independent risk factors for the in-hospital mortality of children with laboratory-confirmed IPD. The mortality was also associated with antimicrobial sensitivity in pneumococcal isolates. The microbes in 1/17 (5.9%) children who were prescribed an antibiotic showed antimicrobial sensitivity in the nonsurvival group, compared with 21/80 (26.3%) children who survived. The most common serotypes identified were 6B (35.3%, 6/17), 14 (23.5%, 4/17), 19F (23.5%, 4/17), 19A (5.9%, 1/17), 23F (5.9%, 1/17), and 20 (5.9%, 1/17) in the nonsurvival group. The coverage of IPD serotypes of the 7-valent pneumococcal conjugate vaccine (PCV7) was 88.2% (15/17), while that of the 13-valent S. pneumoniae vaccine (PCV13) was 94.1% (16/17) of the coverage in the nonsurvival group. Conclusions Recurrent hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities in the early stage were independent predictors for the in-hospital mortality of children with laboratory-confirmed IPD. Appropriate use of antibiotics and PCV immunization were the keys to improve the outcome of IPD.
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Xu J, Du Q, Shu Y, Ji J, Dai C. Bacteriological Profile of Chronic Suppurative Otitis Media and Antibiotic Susceptibility in a Tertiary Care Hospital in Shanghai, China. EAR, NOSE & THROAT JOURNAL 2020; 100:NP391-NP396. [PMID: 32352873 DOI: 10.1177/0145561320923823] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Chronic suppurative otitis media (CSOM) is mostly caused by bacterial infection of the middle ear and antibiotics are generally used empirically, which may lead to the emergence of resistant bacterial strains. The objective of the study is to assess the bacteriological profile of and evaluate the antibiotic susceptibility of strains isolated in a tertiary care hospital in Shanghai, China. METHODS This study included 289 individuals with clinical diagnosis of CSOM. Middle ear purulent discharge was obtained with sterile swabs and cultured for bacterial pathogens. The susceptibility of the isolated microorganisms to antibiotics was assessed by a microdilution method. RESULTS Bacterial pathogens were found in 223 (77.2%) of the 289 cases. A total of 236 strains were isolated. Staphylococcus aureus was the commonest bacteria (44.9%) followed by Pseudomonas aeruginosa (16.9%) and coagulase-negative Staphylococcus (8.5%). There were 18.9% methicillin-resistant S aureus (MRSA) among the obtained S aureus organisms. Multidrug-resistant P aeruginosa was found in 4 patients, making up 10% of all detected P aeruginosa. Staphylococcus aureus showed highest susceptibility to vancomycin (100%), then gentamicin (98.1%) and rifampicin (97.2%) and was most resistant to penicillin (61.3%) and erythromycin (50%). All isolated P aeruginosa showed susceptibility to piperacillin, piperacillin/tazobactam, and meropenem. High degree of resistance in P aeruginosa was observed toward levofloxacin (42.5%), ciprofloxacin (40%), and ceftriaxone (30%). CONCLUSION The high prevalence of MRSA and fluoroquinolone-resistant P aeruginosa indicated cephalosporins and fluoroquinolone as primary empirical antibiotic drugs in CSOM to be cautiously used. In order to reduce the incidence of resistant strains and promote effective usage of antibiotics, all aural discharges should be cultured to determine antibacterial susceptibility patterns before treatment.
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Affiliation(s)
- Jianghong Xu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, China
| | - Qiang Du
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, China
| | - Yilai Shu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, China
| | - Jian Ji
- Clinical Laboratory, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Chunfu Dai
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, China
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Leach AJ, Homøe P, Chidziva C, Gunasekera H, Kong K, Bhutta MF, Jensen R, Tamir SO, Das SK, Morris P. Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109857. [PMID: 32057518 PMCID: PMC7259423 DOI: 10.1016/j.ijporl.2019.109857] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: Summarise the published evidence on otitis media and associated hearing loss in low to middle-income countries (LMIC) and disadvantaged populations. DATA SOURCES: PubMed and other databases. REVIEW METHODS: Firstly, sensitive search strategy using ‘otitis media’, combined with specific key words for each topic of the review, from January 2015 to June 2019. Then, restriction to LMIC and disadvantaged populations. Topics covered included prevention, epidemiology, risk factors, microbiology, prognosis, diagnosis, and treatment. CONCLUSIONS: There was a high degree of methodological heterogeneity and high risk of bias. The majority of studies were school-based. In Africa, Asia and Oceania (e.g., Australian Aboriginal populations) the prevalence of OM was respectively 8% (range 3–16%), 14% (range 7–22%) and 50% (4–95%). Prevalence of any hearing loss in these regions was 12% (range 8–17%), 12% (range 3–24%), and 26% (range 25–28%) respectively. Risk factors in LMIC and disadvantaged populations included age, gender, exposure to smoke and pollution. Microbiology was reported for otitis media with effusion at time of surgery or ear discharge (acute otitis media with perforation or chronic suppurative otitis media). Specimen handling and processing in hospital laboratories was associated with low detection of S. pneumoniae and H. influenzae. Case series described complicated cases of OM due to M. tuberculosis, multidrug resistance and HIV. QOL studies identified discrimination of persons with OM and hearing loss. Diagnostic methods varied greatly, from naked eye to tympanometry. Treatment interventions were reported from four RCTs. Non-RCTs included evaluations of guidelines, surgery outcomes, access to ENTs. IMPLICATIONS FOR CLINICAL PRACTICE: Chronic suppurative otitis media, otitis media with effusion and conductive hearing loss are common in LMIC and disadvantaged populations. Paucity of research, poor regional representation, non-standardised methods and low-quality reporting preclude accurate assessment of disease burden in LMIC and disadvantaged populations. Awareness and adherence to reporting Guidelines should be promoted.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Preben Homøe
- Køge University Hospital, Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Clemence Chidziva
- University of Zimbabwe, Department of Surgery, 630 Churchill Avenue, Harare, Zimbabwe.
| | - Hasantha Gunasekera
- University of Sydney, Australia; The Children's Hospital at Westmead, Cnr Hawkesbury Rd &, Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Kelvin Kong
- John Hunter Children's Hospital, Newcastle, Australia; Hunter ENT, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Mahmood F Bhutta
- Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
| | - Ramon Jensen
- Dept of Oto-rhino-laryngology and Audiology, F 2071 Rigshospitalet, Blegdamsvej 9, DK, 2100, Denmark; Department of Clinical Medicine, Blegdamsvej 3, 2200, København, Denmark.
| | - Sharon Ovnat Tamir
- Dept of OTO-HNS, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Department of Otolaryngology-Head and Neck Surgery, Assuta University Hospital, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel.
| | - Sumon Kumar Das
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Peter Morris
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia; Royal Darwin Hospital, Rocklands Dr, Tiwi, NT, 0810, Australia.
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Fu J, Yi R, Jiang Y, Xu S, Qin P, Liang Z, Chen J. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis. BMC Pediatr 2019; 19:424. [PMID: 31711442 PMCID: PMC6844036 DOI: 10.1186/s12887-019-1722-1] [Citation(s) in RCA: 15] [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: 08/04/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background To summarize information about invasive pneumococcal disease (IPD) among children in mainland China. Methods Sixteen eligible studies were included in this systematic review and the random effect model was used to estimate the pool prevalence of IPD. Results The most predominant serotypes circulating in children were 19F (27.7, 95% confidence interval (95% CI): 17.7–37.6%), 19A (21.2%, 16.4–26.1%), 14 (16.5%, 12.8–20.1%), 6B (8.6%, 5.2–10.8%) and 23F (7.3%, 5.2–9.5%). The serotype coverage of the available pneumococcal conjugate vaccines PCV7, PCV10, and PCV13 was 60.8% (52.5–69.4%), 65.1% (57.7–72.4%), and 90.0% (87.1–92.8%), respectively. The pooled antibiotic resistance rates of Streptococcus pneumoniae revealed a resistance to penicillin prevalence rate of 32.0% (12.1–51.9%). Approximately 94.4% (90.7–98.1%) and 92.3% (87.4–97.3%) of isolates were resistant to erythromycin and clindamycin. eBURST analysis revealed great diversity among isolates, with 102 sequence types (STs) for 365 isolates. The major predominant clonal complexes (CCs) were CC271 (43.6%, 159/365), CC876 (13.4%, 49/365), CC81 (5.2%, 19/365), and CC90 (4.1%, 15/365). Long-term and regional surveillance of S. pneumoniae is necessary. Conclusions Based on our pooled results showing that PCV13 coverage of the reported serotypes was 90% and that most serotypes contributed to the distribution of antibiotic-resistant isolates, implementation of PCV13 into the Chinese Expanded Program on Immunizations (EPI) would achieve health benefits in Chinese children.
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Affiliation(s)
- Jinjian Fu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.,Department of Laboratory Medicine, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Rongsong Yi
- Department of Pediatric, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Yongjiang Jiang
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Shaolin Xu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Peixu Qin
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Zhuoxin Liang
- Department of Pediatric Intensive Care Unit, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China. .,Department of Pediatric, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
| | - Jichang Chen
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
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Negash AA, Asrat D, Abebe W, Hailemariam T, Gebre M, Aseffa A, Vaneechoutte M. Pneumococcal serotype 19A is the major cause of pediatric acute otitis media with ruptured tympanic membrane in Addis Ababa, Ethiopia, 5 years after the introduction of the ten-valent pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2019; 126:109638. [PMID: 31442868 DOI: 10.1016/j.ijporl.2019.109638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In Ethiopia, there is a lack of data on pneumococcal serotypes causing acute otitis media (AOM) in children. We aimed to study the etiology, pneumococcal serotypes and antimicrobial resistance patterns of isolates from children with AOM with spontaneous perforation of the tympanic membrane (SPTM). METHODS We carried out a prospective observational study in children with AOM with SPTM, aged 0-15 years in Addis Ababa, Ethiopia. Middle ear fluid was collected using sterile swabs, cultured and antibiotic susceptibility testing was performed. Serotypes of Streptococcus pneumoniae were determined by sequencing the cpsB gene and by the Quellung reaction. RESULTS A total of 55 children were enrolled. Out of 55 samples that were cultured, 52 (94.5%) were culture positive for a total of 66 bacterial species, and 56.4% (31/55) samples were positive for 41 (62.1%) known pathogenic bacterial species. The most common pathogenic bacterial isolates were S. pneumoniae (36.6%), Staphylococcus aureus (19.5%), Streptococcus pyogenes (14.6%) and Haemophilus influenzae (12.2%). Serotype 19A (73.3%) was the predominant pneumococcal serotype. There was a high rate of non-susceptibility to penicillin (86.6%) and trimethoprim/sulfamethoxazole (80%) among pneumococcal isolates. Out of 21 different isolates tested for amoxicillin susceptibility, 15 (71.4%) were resistant. CONCLUSIONS Pneumococcal serotype 19A was the predominant cause of AOM with SPTM in children in Addis Ababa, Ethiopia, 5 years after introduction of PCV10. There was a high rate of resistance to commonly prescribed antibiotics. The study highlights the need for wide scale surveillance of the etiology and antimicrobial susceptibility of AOM in Ethiopian children.
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Affiliation(s)
- Abel Abera Negash
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia; Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Hailemariam
- Department of Pediatrics and Child Health, Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Meseret Gebre
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
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Mather MW, Drinnan M, Perry JD, Powell S, Wilson JA, Powell J. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int J Pediatr Otorhinolaryngol 2019; 123:102-109. [PMID: 31085462 DOI: 10.1016/j.ijporl.2019.04.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/16/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE OF REVIEW Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria. TYPE OF REVIEW & SEARCH STRATEGY We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library. RESULTS From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63-0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27-0.32), Haemophilus influenza 0.23 (CI 0.20-0.26), and Moraxella catarrhalis 0.05 (CI 0.04-0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76-0.94), erythromycin was 0.64 (0.48-0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85-0.98). CONCLUSION We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.
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Affiliation(s)
- Michael W Mather
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Michael Drinnan
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - John D Perry
- Department of Microbiology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Steven Powell
- Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Janet A Wilson
- Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK
| | - Jason Powell
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
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Fu J, Li L, Liang Z, Xu S, Lin N, Qin P, Ye X, McGrath E. Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China. BMC Infect Dis 2019; 19:168. [PMID: 30770718 PMCID: PMC6377742 DOI: 10.1186/s12879-019-3795-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children. Methods A retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types. Results The dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates. Conclusion The high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.
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Affiliation(s)
- Jinjian Fu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Ling Li
- School of Public Health, Guangdong Pharmaceutical University, 283# Jianghai Dadao, Haizhu District, Guangzhou, 510310, China
| | - Zhuoxin Liang
- Department of Pediatric, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, Guangxi, China
| | - Shaolin Xu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Nan Lin
- Department of Otolaryngology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, Guangxi, China
| | - Peixu Qin
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University, 283# Jianghai Dadao, Haizhu District, Guangzhou, 510310, China.
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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Ding YL, Fu J, Chen J, Mo SF, Xu S, Lin N, Qin P, McGrath E. Molecular characterization and antimicrobial susceptibility of Staphylococcus aureus isolated from children with acute otitis media in Liuzhou, China. BMC Pediatr 2018; 18:388. [PMID: 30553272 PMCID: PMC6295064 DOI: 10.1186/s12887-018-1366-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There have been few studies focused on the prevalence, bacterial etiology, antibiotic resistance, and genetic background of Staphylococcus aureus (S. aureus) in children with acute otitis media (AOM) in China. METHODS A retrospective study was conducted in Liuzhou Maternity and Child Healthcare Hospital. Patients younger than 18 years diagnosed with AOM were enrolled in the study. Middle ear fluid specimens were collected and cultured for bacterial pathogens. The antibiotic susceptibility, virulence genes, macrolide resistant genes and sequence types of S. aureus were identified. RESULTS From January 1, 2013 to December 31, 2015, a total of 228 cases of AOM were identified. Pathogenic bacteria were positive in 181 (79.4%) of 228 specimens. Streptococcus pneumoniae was the most common bacteria (36.4%), followed by S. aureus (16.2%). Among the 37 S. aureus isolates, 12 (23.5%) were methicillin-resistant S. aureus (MRSA), and 25 (77.5%) were methicillin-susceptible S. aureus (MSSA). A total of 23 isolates (62.2%) were resistant to erythromycin, 40.5% of isolates were resistant to clindamycin, and 37.8% isolates were resistant to tetracycline. Twenty-three isolates were multi-drug resistant (MDR) S. aureus. Eighteen isolates carried the pvl gene. Up to 22 (59.4%) isolates expressed ermA gene, 8 (21.6%) isolates expressed both ermA and ermC genes, and only 8.1% expressed ermB. Among all S.aureus isolates, 7 sequence types (STs) were identified by multilocus sequence typing (MLST). The most common ST was ST59 (16/37, 43.2%), followed by ST45 (7/37, 18.9%) and ST30 (7/37, 18.9%). The predominant MSSA isolates were ST59-t437-MSSA (5/25, 20.0%), the prevailing MRSA isolates were Taiwan related strains ST59-SCCmec-IVa/V (5/12, 41.6%). CONCLUSIONS S. aureus was the second most common cause for AOM in children in Liuzhou. Most of the S. aureus was MDR which carried a high proportion of ermA and ermC gene. CA-MRSA (ST59-SCCmec-IV/V-t437) is circulating in children with AOM. These findings support continued surveillance of S. aureus infections in children with AOM in both communities and hospitals.
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Affiliation(s)
- Yan Ling Ding
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, China
| | - Jinjian Fu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, China
| | - Jichang Chen
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, China
| | - Sheng Fu Mo
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, China
| | - Shaolin Xu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, China
| | - Nan Lin
- Department of Otolaryngology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Peixu Qin
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, China
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA. .,Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
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Choffor-Nchinda E, Atanga LC, Nansseu JR, Djomou F. Effectiveness of amoxicillin alone in the treatment of uncomplicated acute otitis media: a systematic review protocol. BMJ Open 2018; 8:e021133. [PMID: 29884697 PMCID: PMC6009545 DOI: 10.1136/bmjopen-2017-021133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Amoxicillin is the first-line antibiotic recommended by most scientific societies for the treatment of uncomplicated acute otitis media (AOM) in children and adults. In low-income and middle-income countries however, absence of setting-specific recommendations and antibiotic resistance, promoted by higher population density and over-the-counter antibiotic availability, could hamper the effectiveness of amoxicillin. We aim to provide updated information to enable evidence-based decisions for first-line therapy of uncomplicated AOM in our setting. METHODS AND ANALYSIS We will conduct a systematic review of all randomised controlled trials on the clinical effectiveness of amoxicillin for the treatment of uncomplicated AOM in children above 6 months and adults. The search will include studies published from the generation of the included databases to 31 December 2017. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed by the Risk of Bias Assessment Tool from the Cochrane Handbook for randomised trials. A meta-analysis will be conducted for homogeneous studies, eventually, using the fixed-effect model. Subgroup analysis will include age groups, amoxicillin dosage, treatment duration, effectiveness criteria, time of trial realisation, study quality and region of the world involved. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and presented at scientific meetings. PROSPERO REGISTRATION NUMBER CRD42017080029.
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Affiliation(s)
- Emmanuel Choffor-Nchinda
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Leonel Christophe Atanga
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - François Djomou
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
- Otolaryngology- Head and Neck Surgery unit, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
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Chen K, Zhang X, Shan W, Zhao G, Zhang T. Serotype distribution of Streptococcus pneumoniae and potential impact of pneumococcal conjugate vaccines in China: A systematic review and meta-analysis. Hum Vaccin Immunother 2018; 14:1453-1463. [PMID: 29451838 PMCID: PMC6037451 DOI: 10.1080/21645515.2018.1435224] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Thirteen-valent pneumococcal conjugate vaccines (PCV13) was licensed for optional use in mainland China since 2017, but the uptake is low. To update the research evidence for the pneumococcal serotype distribution of pre-PCV era and to estimate the potential impact of PCVs, we performed a meta-analysis on the relevant publications concerning the Chinese population. METHODS This systematic review and meta-analysis were conducted on the pneumococcal serotype distribution publications in mainland China from 2000 to 2016. The literature was searched in PubMed, Ovid-EMBASE, Web of Science, CNKI and Wanfang. Heterogeneity and publication bias were tested by I2, meta-regression, Egger's and Begg's test. The pneumococcal serotype and vaccine serotype coverage rates were pooled using the random-effects model in Stata SE 12.0. RESULTS In total, 85 publications were included. Of all 16,945 included pneumococcal isolates, the most common serotypes/serogroups were 19F, 19A, 23F, 14, and 6B, that from children were the same as above, that from adults≥18 years were 19, 3, 6, 23, and 14. Among isolates from children <18 years, the pooled coverage for PCV10 serotypes was 52.3%, that for PCV13 was 68.4% and that for PPSV23 was 65.5%. Regarding individuals ≥18 years, the pooled coverage for PCV10 serotypes was 29.7%, that for PCV13 was 49.5% and that for PPSV23 was 50.7%. Serotype prevalence and vaccine serotype coverage varied by age group, source, and region. CONCLUSIONS The most common pneumococcal serotype in mainland China was 19F. The serotype coverage rates of PCV13 and PPSV23 were 50%-68% in mainland China.
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Affiliation(s)
- Kaile Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xiyan Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wei Shan
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Fong IW, Shlaes D, Drlica K. Antimicrobial Resistance Among Streptococcus pneumoniae. ANTIMICROBIAL RESISTANCE IN THE 21ST CENTURY 2018:13-38. [PMCID: PMC7122384 DOI: 10.1007/978-3-319-78538-7_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Antibiotic resistance in Streptococcus pneumoniae (pneumococcus), the main pathogen responsible for community-acquired pneumonia (CAP), meningitis, bacteremia, and otitis media, is a major concern for clinicians. This pathogen is associated with high rates of morbidity and mortality, especially among children under 2 years old, immunocompromised persons, and the elderly population. The major anti-pneumococcus agents are β-lactams and macrolides, with fluoroquinolones ranking third. The emergence of antibiotic-resistant pneumococcus due to overuse of antibiotics is a global concern. While the discovery of novel classes of antibiotics for the pneumococcus is at a standstill, significant progress in reducing the problem of resistance is associated with antibacterial vaccines. Nevertheless, the World Health Organization recently considered drug-resistant S. pneumoniae as ranking among the 12 bacteria, for which there is an urgent need for new treatments. A challenge is to slow the evolution of new strains that are resistant to the vaccines.
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Affiliation(s)
- I. W. Fong
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - David Shlaes
- Anti-infectives Consulting, LLC, Stonington, CT USA
| | - Karl Drlica
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ USA
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15
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Phenotypic and molecular characterization of Streptococcus pneumoniae in pre-conjugate vaccine era: A Chinese hospital-based retrospective study. Vaccine 2017; 36:599-605. [PMID: 29289385 DOI: 10.1016/j.vaccine.2017.12.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) is an important pathogen in causing global morbidity and mortality among children. This study aimed to determine phenotypic and molecular characteristics of S. pneumoniae causing infections in children under five years in China. METHODS A hospital-based retrospective study was conducted. All 537 S. pneumoniae isolates were tested for antimicrobial susceptibility by E-test method, molecular characteristics including resistance genes, virulence genes and serotypes by multiplex polymerase chain reaction (PCR) method, and sequence types (STs) by sequencing seven housekeeping genes. Minimum spanning tree and correspondence analysis were used to reveal the potential relationship between serotypes and STs. RESULTS Most of S. pneumoniae isolates were resistant to erythromycin (93.9%) and tetracycline (86.4%), with the predominant resistance genes being erm(B) (92.6%) and tet(M) (95.5%). The prevalent serotypes were 19F, 6B, 19A, 23F and 14, the coverage rate of PCV13 was high in 85.8%, and the predominant STs were ST271, ST320, ST3173, ST81 and ST876. A significant correlation existed between STs and serotypes, with ST271/19F and ST320/19A as the most prevalent clones. Notably, ST271/19F and ST320/19A isolates were associated with resistance to specific antibiotics and carrying of mef(A/E), rlrA and sipA genes. CONCLUSIONS Our findings suggest the introduction of PCV13 vaccine to Chinese children, and underscore the value of monitoring multiple characteristics to detect new epidemiologic trends and provide implications for the formulation of multivalent pneumococcal vaccines.
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Ovnat Tamir S, Shemesh S, Oron Y, Marom T. Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity. Arch Dis Child 2017; 102:450-457. [PMID: 27601361 DOI: 10.1136/archdischild-2016-310729] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease, with an enormous economic and healthcare-related burden. Guidelines and consensus papers for AOM diagnosis and management were published in many countries. Our objective was to study the differences and similarities between these protocols in developing and developed countries. METHODS The keywords: 'acute otitis media' AND 'children' AND ['treatment' or 'management'] AND ['guideline' or 'consensus'] were used in various electronic databases between 1 January 1989 through 31 December 2015. Overall, 99 sources from 62 countries were retrieved: 53 from 22 developed countries, and 46 from 40 developing countries. Representative guidelines from America (the USA, Argentina), Europe (Italy, Moldova), Africa (South Africa, Tanzania, Ethiopia), Asia (Japan, Afghanistan, Sri Lanka),and Oceania (South Australia, Fiji) were compared. RESULTS Paediatric societies publish guidelines in most developed countries; in developing countries, the Ministry of Health usually initiates guideline formulation. Most guidelines use the same diagnostic criteria and offer watchful waiting in mild-moderate scenarios. Amoxicillin is the suggested first-line antibiotic, whereas options for second-line and third-line therapies vary. Duration of therapy varies and is usually age dependent: 5-7 days for children <2 years and 10 days for children >2 years in developed countries, while duration and age groups vary greatly in developing countries. Reduction of AOM risk factors is encouraged in developed countries, but rarely in developing countries. CONCLUSIONS Guidelines for AOM from developing and developed countries are similar in many aspects, with variation in specific recommendations, due to local epidemiology and healthcare accessibility. Formulation of regional guidelines may help reduce AOM burden.
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Affiliation(s)
- Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - Shay Shemesh
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler Faculty of Medicine, Zerifin, Israel
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Tamir SO, Sibbald A, Rupa V, Marchisio P, Homøe P, Daniel SJ, Enoksson F, Marom T. Guidelines for the Treatment of Acute Otitis Media: Why Are There Worldwide Differences? CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0149-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Huang Y, Wang Z, Jin C, Wang L, Zhang X, Xu W, Xiang Y, Wang W, He X, Yin Y, He Y. TLR2 promotes macrophage recruitment and Streptococcus pneumoniae clearance during mouse otitis media. Pediatr Res 2016; 80:886-893. [PMID: 27463737 DOI: 10.1038/pr.2016.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The natural course of otitis media (OM) in most children is acute and self-limiting; however, approximately 10-20% of children can experience persistent or recurrent OM. Determining the host factors that influence outcome of OM will help us design better therapies. This study focused on the role of Toll-like receptor 2 (TLR2) in a pneumococcal OM mouse model. METHODS The middle ears (MEs) of wild-type (WT) and TLR2-/- mice were inoculated with Streptococcus pneumoniae (Spn) serotype 19F via transbullar injection. ME TLR2 expression in WT mice was determined by qRT-PCR and immunofluorescence. ME pathological manifestations, inflammatory response, and pneumococcal clearance between WT and TLR2-/- mice were compared after Spn inoculation. RESULTS TLR2 expression in ME mucosa was markedly enhanced following infection with Spn in WT mice. In contrast to WT mice, TLR2-/- mice exhibited unaffected early ME inflammatory response. During late stage of ME infection, however, the absence of TLR2 can lead to reduced macrophage recruitment, impaired Spn clearance, and prolonged ME inflammation. CONCLUSION Our results demonstrate that TLR2 signaling is critical for bacterial clearance and timely resolution of inflammation in OM induced by Spn.
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Affiliation(s)
- Yifei Huang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China.,Department of Laboratory Medicine, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Zimeng Wang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Chunfang Jin
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Lei Wang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Wenchun Xu
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Yun Xiang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Wei Wang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiujing He
- Department of Laboratory Medicine, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Yujuan He
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
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Li R, Fang KX, Young M, Zhou X, Chen Z, Liang JZ, Giardina PC, Scott DA. Long-term antibody persistence study (3 years after last dose) of the 7-valent pneumococcal conjugate vaccine in young children in China. Vaccine 2016; 34:5359-5365. [PMID: 27616471 DOI: 10.1016/j.vaccine.2016.08.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/18/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a previous study, Chinese infants were vaccinated with 7-valent pneumococcal conjugate vaccine (PCV7) ⩾7days before routine diphtheria, tetanus, and acellular pertussis vaccine (DTaP); PCV7 administered concomitantly with DTaP (PCV7+DTaP); or DTaP alone. This study examined antibody persistence at a single time point 3years after the last vaccination. METHODS Children who participated in the prior PCV7 study were eligible to participate. A single blood sample was drawn at enrollment. Immunoglobulin G (IgG) geometric mean concentrations (GMCs) specific to the PCV7 serotypes and percentages of subjects with IgG ⩾0.35μg/mL were compared for subjects receiving PCV7 versus PCV7+DTaP (concomitant) and for PCV7 or PCV7+DTaP (concomitant) versus DTaP alone. IgG concentrations at 3years after the last vaccination were also compared with those after the infant series and toddler dose. RESULTS Three years after the last vaccination with PCV7 or PCV7+DTaP (concomitant), IgG GMCs for most PCV7 serotypes were lower than after the infant series or toddler dose but remained above prevaccination concentrations. IgG GMC were similar between the PCV7 and PCV7+DTaP (concomitant) groups for 5 out of 7 serotypes but serotypes 4 and 19F were significantly lower in the PCV7+DTaP (concomitant) recipients. Three years after the last vaccination, IgG GMCs were significantly higher for 6 of 7 PCV7 serotypes among those receiving PCV7 or PCV7+DTaP (concomitant) compared with recipients of DTaP alone. Among subjects receiving DTaP alone, serotype-specific antibody concentrations were significantly higher for all serotypes 3years after the last vaccination compared with after the infant series. CONCLUSION Three years after PCV7 vaccination, serotype-specific antibodies were lower than after the primary infant series but higher than prevaccination levels and higher among subjects who received PCV7 compared with those who did not. The immune response was comparable in children who received PCV7 with and without concomitant DTaP. CLINICAL TRIAL REGISTRATION NCT01298544.
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Affiliation(s)
- Rongcheng Li
- Guangxi Center for Disease Control and Prevention, Center for Vaccine Clinical Research, Guangxi, China.
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Principi N, Marchisio P, Rosazza C, Sciarrabba CS, Esposito S. Acute otitis media with spontaneous tympanic membrane perforation. Eur J Clin Microbiol Infect Dis 2016; 36:11-18. [PMID: 27677281 DOI: 10.1007/s10096-016-2783-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
The principal aim of this review is to present the current knowledge regarding acute otitis media (AOM) with spontaneous tympanic membrane perforation (STMP) and to address the question of whether AOM with STMP is a disease with specific characteristics or a severe case of AOM. PubMed was used to search for all studies published over the past 15 years using the key words "acute otitis media" and "othorrea" or "spontaneous tympanic membrane perforation". More than 250 articles were found, but only those published in English and providing data on aspects related to perforation of infectious origin were considered. Early Streptococcus pneumoniae infection due to invasive pneumococcal strains, in addition to coinfections and biofilm production due mainly to non-typeable Haemophilus influenzae, seem to be precursors of STMP. However, it is unclear why some children have several STMP episodes during the first years of life that resolve without complications in adulthood, whereas other children develop chronic suppurative otitis media. Although specific aetiological agents appear to be associated with an increased risk of AOM with STMP, further studies are needed to determine whether AOM with STMP is a distinct disease with specific aetiological, clinical and prognostic characteristics or a more severe case of AOM than the cases that occur without STMP. Finally, it is important to identify preventive methods that are useful not only in otitis-prone children with uncomplicated AOM, but also in children with recurrent AOM and those who experience several episodes with STMP.
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Affiliation(s)
- N Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy
| | - P Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy
| | - C Rosazza
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy
| | - C S Sciarrabba
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy
| | - S Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy.
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DeAntonio R, Yarzabal JP, Cruz JP, Schmidt JE, Kleijnen J. Epidemiology of otitis media in children from developing countries: A systematic review. Int J Pediatr Otorhinolaryngol 2016; 85:65-74. [PMID: 27240499 DOI: 10.1016/j.ijporl.2016.03.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review examined the epidemiology of otitis media (OM) in children <6 years within 90 developing and newly industrialised countries. METHODS Literature searches (1992-2011), based on MEDLINE, EMBASE, WHO, Index Medicus, country-specific websites, conferences, and the reference lists of included studies, yielded 11,413 records; 59 of 344 studies analysed were included in this review. RESULTS The majority of the identified studies provided only a single timepoint for OM. In children <6 years of age, OM prevalence was found to be 9.2% in Nigeria, 10% in Egypt, 6.7% in China, 9.2% in India, 9.1% in Iran and 5.1-7.8% in Russia. Few studies examined the etiology of OM and the antibacterial resistance. The most common bacterial pathogens were S. pneumoniae, H. influenzae and S. aureus. A high resistance to penicillin was reported in Nigeria and Turkey. CONCLUSIONS Despite the variability between the identified studies, this review indicates that OM and its various sub-types remain a significant burden in different settings. However, the heterogeneity of studies and a general lack of reliable data made generalisation very difficult.
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Affiliation(s)
| | | | | | | | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Kleijnen Systematic Reviews Ltd, York, United Kingdom.
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