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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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Cohen R, Madhi F, Thollot F, Hau I, Vie le Sage F, Lemaître C, Magendie C, Werner A, Gelbert N, Cohen JF, Couloigner V. Antimicrobial treatment of ENT infections. Infect Dis Now 2023; 53:104785. [PMID: 37730165 DOI: 10.1016/j.idnow.2023.104785] [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: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
Ear, nose and throat (ENT) or upper respiratory tract infections (URTI) are the most common infections in children and the leading causes of antibiotic prescriptions. In most cases, these infections are due to (or are triggered by) viruses and even when bacterial species are implicated, recovery is usually spontaneous. The first imperative is to refrain from prescribing antibiotics in a large number of URTIs: common cold, most cases of sore throat, laryngitis, congestive otitis, and otitis media with effusion. On the contrary, a decision to treat sore throats with antibiotics is based primarily on the positivity of the Group A Streptococcus (GAS) rapid antigen diagnostic tests. For ear infections, only (a) purulent acute otitis media in children under 2 years of age and (b) complicated or symptomatic forms of purulent acute otitis media (PAOM) in older children should be treated with antibiotics. Amoxicillin is the first-line treatment in the most cases of ambulatory ENT justifying antibiotics. Severe ENT infections (mastoiditis, epiglottitis, retro- and parapharyngeal abscesses, ethmoiditis) are therapeutic emergencies necessitating hospitalization and initial intravenous antibiotic therapy.
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Affiliation(s)
- R Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France.
| | - F Madhi
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service de Pédiatrie Centre Hospitalier Intercommunal de Créteil, France
| | - F Thollot
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - I Hau
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service de Pédiatrie Centre Hospitalier Intercommunal de Créteil, France
| | - F Vie le Sage
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - C Lemaître
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - C Magendie
- Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - A Werner
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - N Gelbert
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Primary Care Paediatrician, Association Française de Pédiatrie Ambulatoire, France
| | - Jeremie F Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Créteil, France
| | - V Couloigner
- Service d'ORL Pédiatrique - Hôpital Necker - Enfants Malades, AP-HP, Université Paris Descartes, France; Secrétaire Général de la Société Française d'ORL - General Secretary of the French ENT Society, France; Head of the Education Commission of the European Society of Pediatric Otorhinolaryngology, France
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Rybak A, Levy C, Ouldali N, Bonacorsi S, Béchet S, Delobbe JF, Batard C, Donikian I, Goldrey M, Assouline J, Cohen R, Varon E. Dynamics of Antibiotic Resistance of Streptococcus pneumoniae in France: A Pediatric Prospective Nasopharyngeal Carriage Study from 2001 to 2022. Antibiotics (Basel) 2023; 12:1020. [PMID: 37370339 DOI: 10.3390/antibiotics12061020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Epidemiological surveillance of nasopharyngeal pneumococcal carriage is important for monitoring serotype distribution and antibiotic resistance, particularly before and after the implementation of pneumococcal conjugate vaccines (PCVs). With a prospective surveillance study in France, we aimed to analyze the dynamics of pneumococcal carriage, antibiotic susceptibility and serotype distribution in children aged 6 to 24 months who had acute otitis media between 2001 and 2022 with a focus on the late PCV13 period from May 2014 to July 2022. Trends were analyzed with segmented linear regression with autoregressive error. For the 17,136 children enrolled, overall pneumococcal carriage was stable during the study. During the late PCV13 period, the five most frequent serotypes were all non-PCV13 serotypes: 15B/C (14.3%), 23B (11.0%), 11A (9.6%), 15A (7.4%) and 35B (6.5%). During the same period, we observed a rebound of penicillin non-susceptibility (+0.15% per month, 95% confidence interval, +0.08 to 0.22, p < 0.001). Five serotypes accounted for 64.4% of the penicillin non-susceptible strains: 11A (17.5%), 35B (14.9%), 15A (13.9%), 15B/C (9.9%) and 19F (8.2%); non-PCV13/PCV15 accounted for <1%, and non-PCV15/PCV20 accounted for 28%. The next generation PCVs, particularly PCV20, may disrupt nasopharyngeal carriage and contribute to decreasing the rate of antibiotic resistance among pneumococci.
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Affiliation(s)
- Alexis Rybak
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- Pediatric Emergency Department, Trousseau Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
- Clinical Epidemiology Unit, Eceve Inserm UMR-S 1123, Robert Debré University Hospital, Université de Paris, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Corinne Levy
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, 06200 Nice, France
- CRC, Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Naïm Ouldali
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
- IAME, Infection, Antimicrobials, Modelling, Evolution, Inserm UMR 1137, Paris University, 75018 Paris, France
| | - Stéphane Bonacorsi
- Microbiology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75019 Paris, France
| | - Stéphane Béchet
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
| | | | - Christophe Batard
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Isabelle Donikian
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Marie Goldrey
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Jessica Assouline
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Robert Cohen
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, 06200 Nice, France
- CRC, Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Emmanuelle Varon
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, 94000 Créteil, France
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Dagan R, van der Beek BA, Ben-Shimol S, Greenberg D, Shemer-Avni Y, Weinberger DM, Danino D. The COVID-19 pandemic as an opportunity for unravelling the causative association between respiratory viruses and pneumococcus-associated disease in young children: a prospective study. EBioMedicine 2023; 90:104493. [PMID: 36857965 PMCID: PMC9970381 DOI: 10.1016/j.ebiom.2023.104493] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In young children, rates of lower respiratory infections (LRI) and invasive pneumococcal disease (IPD) have been associated with respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza (flu), and parainfluenza (PIV) (collectively termed here as pneumonia and pneumococcal disease-associated viruses [PDA-viruses]). However, their contribution to the pathogenesis of these disease endpoints has not yet been elucidated. The COVID-19 pandemic provided a unique opportunity to examine the question. METHODS This prospective study comprised all children <5 years, living in southern Israel, during 2016 through 2021. The data were previously collected in multiple ongoing prospective surveillance programs and include: hospital visits for community-acquired alveolar pneumonia (CAAP), non-CAAP LRI; nasopharyngeal pneumococcal carriage (<3 years of age); respiratory virus activity; and nationwide, all-ages COVID-19 episodes and IPD in children <5 years. A hierarchical statistical model was developed to estimate the proportion of the different clinical endpoints attributable to each virus from monthly time series data, stratified by age and ethnicity. A separate model was fit for each endpoint, with covariates that included a linear time trend, 12-month harmonic variables to capture unexplained seasonal variations, and the proportion of tests positive for each virus in that month. FINDINGS During 2016 through 2021, 3,204, 26,695, 257, and 619 episodes of CAAP, non-CAAP LRI, pneumococcal bacteremic pneumonia and non-pneumonia IPD, respectively, were reported. Compared to 2016-2019, broad declines in the disease endpoints were observed shortly after the pandemic surge, coincident with a complete disappearance of all PDA-viruses and continued circulation of rhinovirus (RhV) and adenovirus (AdV). From April 2021, off-season and abrupt surges of all disease endpoints occurred, associated with similar dynamics among the PDA-viruses, which re-emerged sequentially. Using our model fit to the entire 2016-2021 period, 82% (95% CI, 75-88%) of CAAP episodes in 2021 were attributable to the common respiratory viruses, as were 22%-31% of the other disease endpoints. Virus-specific contributions to CAAP were: RSV, 49% (95% CI, 43-55%); hMPV, 13% (10-17%); PIV, 11% (7-15%); flu, 7% (1-13%). RhV and AdV did not contribute. RSV was the main contributor in all endpoints, especially in infants. Pneumococcal carriage prevalence remained largely stable throughout the study. INTERPRETATION RSV and hMPV play a critical role in the burden of CAAP and pneumococcal disease in children. Interventions targeting these viruses could have a secondary effect on the burden of disease typically attributed to bacteria. FUNDING There was no funding for this study.
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Affiliation(s)
- Ron Dagan
- The Shraga Segal Deptartment of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Bart Adriaan van der Beek
- The Shraga Segal Deptartment of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Yonat Shemer-Avni
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; Clinical Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Dana Danino
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
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Isolation and Identification of Pathogenic Bacteria Causing Otitis Media in Misan Governorate. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study examined 150 ear swab samples from patients with otitis media who consulted at Al-Sadr Teaching Hospital from January to April 2021 in Misan, Iraq. The participants were aged 14–50 years, among which the infection rate was highest in participants aged 14–22 years and lowest in those aged 40–50 years. Subsequently, bacterial isolates were identified based on their morphology in various culture media and using biochemical tests. Six bacterial species were identified, namely Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Staphylococcus epidermidis. Staphylococcus aureus had the highest infection rate (30%), whereas Staphylococcus epidermidis had the lowest infection rate (8.55%). When the sensitivity of each isolate to antibiotics was determined, Escherichia coli was the most sensitive to trimethoprim (TMP), whereas Pseudomonas aeruginosa was the most resistant to 75% of the tested antibiotics.
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6
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Rybak A, Levy C, Angoulvant F, Auvrignon A, Gembara P, Danis K, Vaux S, Levy-Bruhl D, van der Werf S, Béchet S, Bonacorsi S, Assad Z, Lazzati A, Michel M, Kaguelidou F, Faye A, Cohen R, Varon E, Ouldali N. Association of Nonpharmaceutical Interventions During the COVID-19 Pandemic With Invasive Pneumococcal Disease, Pneumococcal Carriage, and Respiratory Viral Infections Among Children in France. JAMA Netw Open 2022; 5:e2218959. [PMID: 35763298 PMCID: PMC9240903 DOI: 10.1001/jamanetworkopen.2022.18959] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE An association between pneumococcal nasopharyngeal carriage and invasive pneumococcal disease (IPD) has been previously established. However, it is unclear whether the decrease in IPD incidence observed after implementation of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic was associated with concomitant changes in pneumococcal carriage and respiratory viral infections. OBJECTIVE To assess changes in IPD incidence after the implementation of NPIs during the COVID-19 pandemic and examine their temporal association with changes in pneumococcal carriage rate and respiratory viral infections (specifically respiratory syncytial virus [RSV] and influenza cases) among children in France. DESIGN, SETTING, AND PARTICIPANTS This cohort study used interrupted time series analysis of data from ambulatory and hospital-based national continuous surveillance systems of pneumococcal carriage, RSV and influenza-related diseases, and IPD between January 1, 2007, and March 31, 2021. Participants included 11 944 children younger than 15 years in France. EXPOSURES Implementation of NPIs during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES The estimated fraction of IPD change after implementation of NPIs and the association of this change with concomitant changes in pneumococcal carriage rate and RSV and influenza cases among children younger than 15 years. The estimated fraction of change was analyzed using a quasi-Poisson regression model. RESULTS During the study period, 5113 children (median [IQR] age, 1.0 [0.6-4.0] years; 2959 boys [57.9%]) had IPD, and 6831 healthy children (median [IQR] age, 1.5 [0.9-3.9] years; 3534 boys [51.7%]) received a swab test. Data on race and ethnicity were not collected. After NPI implementation, IPD incidence decreased by 63% (95% CI, -82% to -43%; P < .001) and was similar for non-13-valent pneumococcal conjugate vaccine serotypes with both high disease potential (-63%; 95% CI, -77% to -48%; P < .001) and low disease potential (-53%; 95% CI, -70% to -35%; P < .001). The overall pneumococcal carriage rate did not significantly change after NPI implementation (-12%; 95% CI, -37% to 12%; P = .32), nor did the carriage rate for non-PCV13 serotypes with high disease potential (-26%; 95% CI, -100% to 52%; P = .50) or low disease potential (-7%; 95% CI, -34% to 20%; P = .61). After NPI implementation, the estimated number of influenza cases decreased by 91% (95% CI, -74% to -97%; P < .001), and the estimated number of RSV cases decreased by 74% (95% CI, -55% to -85%; P < .001). Overall, the decrease in influenza and RSV cases accounted for 53% (95% CI, -28% to -78%; P < .001) and 40% (95% CI, -15% to -65%; P = .002) of the decrease in IPD incidence during the NPI period, respectively. The decrease in IPD incidence was not associated with pneumococcal carriage, with carriage accounting for only 4% (95% CI, -7% to 15%; P = .49) of the decrease. CONCLUSIONS AND RELEVANCE In this cohort study of data from multiple national continuous surveillance systems, a decrease in pediatric IPD incidence occurred after the implementation of NPIs in France; this decrease was associated with a decrease in viral infection cases rather than pneumococcal carriage rate. The association between pneumococcal carriage and IPD was potentially modified by changes in the number of RSV and influenza cases, suggesting that interventions targeting respiratory viruses, such as immunoprophylaxis or vaccines for RSV and influenza, may be able to prevent a large proportion of pediatric IPD cases.
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Affiliation(s)
- Alexis Rybak
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Assistance Publique–Hôpitaux de Paris, Service d'Accueil des Urgences Pédiatriques, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - François Angoulvant
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Unité Mixte de Recherche Scientifique 1138, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Anne Auvrignon
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Piotr Gembara
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Kostas Danis
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Sophie Vaux
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Daniel Levy-Bruhl
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Sylvie van der Werf
- Centre National de Référence des Infections Respiratoires, Institut Pasteur, Paris, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Stéphane Bonacorsi
- Assistance Publique–Hôpitaux de Paris, Service de Microbiologie, Robert Debré University Hospital, Université de Paris, Paris, France
- Infection Antimicrobials Modelling Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université de Paris, Paris, France
| | - Zein Assad
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Caen-Normandie, Caen, France
| | - Andréa Lazzati
- Chirurgie Générale, Digestive et de l'Obésité, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale, L’Institut Mondor de Recherche Biomédicale, Unité 955, Université Paris-Est Créteil, Créteil, France
| | - Morgane Michel
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
| | - Florentia Kaguelidou
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Centre d’Investigation Clinique 1426, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Albert Faye
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Néonatalogie et Réanimation Néonatale, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Microbiologie et Centre National de Référence du Pneumocoque, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Naïm Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
- Service des Maladies Infectieuses Pédiatriques, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Québec, Canada
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Perdrizet J, Farkouh RA, Horn EK, Hayford K, Sings HL, Wasserman MD. The broader impacts of otitis media and sequelae for informing economic evaluations of pneumococcal conjugate vaccines. Expert Rev Vaccines 2022; 21:499-511. [PMID: 35191368 DOI: 10.1080/14760584.2022.2040989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Otitis media (OM) is a common childhood infection. Pneumococcal conjugate vaccines (PCVs) prevent OM episodes, thereby reducing short- and long-term clinical, economic, humanistic, and societal consequences. Most economic evaluations of PCVs focus on direct health gains and cost savings from prevented acute episodes but do not fully account for the broader societal impacts of OM prevention. AREAS COVERED This review explores the broader burden of OM on children, caregivers, and society to better inform future economic evaluations of PCVs. EXPERT OPINION OM causes a substantial burden to society through long-term sequelae, productivity losses, reduced quality of life for children and caregivers, and contribution to antimicrobial resistance from inappropriate antibiotic use. The effect of PCVs on acute OM has been recognized globally, yet the broader impact has not been consistently quantified, studied, or communicated. Economic evaluations of PCVs must evolve to include broader effects for patients, caregivers, and society from OM prevention. Future PCVs with broader coverage may further reduce OM incidence and antimicrobial resistance, but optimal uptake will depend on increasing the recognition and use of novel frameworks that include broader benefits. Communicating the full value of PCVs to decision makers may result in wider access and positive societal returns.
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Affiliation(s)
- Johnna Perdrizet
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Raymond A Farkouh
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Emily K Horn
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kyla Hayford
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Toronto, Canada
| | - Heather L Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Collegeville, PA, USA
| | - Matt D Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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8
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Rybak A, Varon E, Masson E, Etchevers A, Levy-Brühl D, Ouldali N, Levy C, Cohen R. Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center. Front Pediatr 2022; 10:945767. [PMID: 35928689 PMCID: PMC9344131 DOI: 10.3389/fped.2022.945767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4-2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.
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Affiliation(s)
- Alexis Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Assistance Publique-Hôpitaux de Paris, Clinical Epidemiology Unit, Robert Debré University Hospital, ECEVE INSERM UMR 1123, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Emmanuelle Varon
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France
| | - Elodie Masson
- Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Bicêtre University Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Anne Etchevers
- The National Public Health institute, Saint-Maurice, France
| | | | - Naïm Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Clinical Epidemiology Unit, Robert Debré University Hospital, ECEVE INSERM UMR 1123, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, QC, Canada
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Neonates Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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9
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Dynamic changes in otopathogens colonizing the nasopharynx and causing acute otitis media in children after 13-valent (PCV13) pneumococcal conjugate vaccination during 2015-2019. Eur J Clin Microbiol Infect Dis 2021; 41:37-44. [PMID: 34432166 DOI: 10.1007/s10096-021-04324-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
The otopathogens colonizing the nasopharynx (NP) and causing acute otitis media (AOM) have shown dynamic changes following introduction of pneumococcal conjugate vaccines. Five hundred eighty-nine children were prospectively enrolled, 2015-2019. Two thousand fifty-nine visits (1528 healthy, 393 AOM, and 138 AOM follow-up) were studied. Two thousand forty-two NP and 495 middle ear fluid (MEF) samples by tympanocentesis from 319 AOM cases were cultured for bacterial identification and antibiotic susceptibility. Streptococcus pneumoniae (Spn) isolates were serotyped by Quellung, and multi-locus sequence type (ST) determined by genomic analysis. Haemophilus influenzae (Hi) was the most common otopathogen cultured from MEF during AOM (34% in MEF) followed by Spn (24% in MEF), then Moraxella catarrhalis (Mcat) (15% in MEF). NP isolates during healthy visit were Mcat (39%), Spn (32%), Hi (12%). 48.6% of Hi isolates from MEF were beta-lactamase-producing. Spn non-susceptibility to penicillin and other antibiotics was high. The most common Spn serotypes associated with AOM (and colonizing the NP during healthy visits) were 35B, 23B, and 15B/C. ST558 and ST199 were the most common sequence types. During 2015-2019, Hi was the most common otopathogen cultured from MEF during AOM among young children. Pneumococcal AOM was most commonly caused by non-PCV13 serotypes of Spn, predominantly 35B, 23B, and 15B/C. Resistance to common antibiotics among Spn strains showed an increasing trend.
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10
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Ben-Shimol S, Givon-Lavi N, Greenberg D, van der Beek BA, Leibovitz E, Dagan R. Substantial reduction of antibiotic-non-susceptible pneumococcal otitis media following PCV7/PCV13 sequential introduction. J Antimicrob Chemother 2020; 75:3038-3045. [PMID: 32946586 DOI: 10.1093/jac/dkaa263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the pre-pneumococcal conjugated vaccines (PCVs) era, serotypes included in the 7/13-valent PCVs (PCV7/PCV13) caused most pneumococcal otitis media (OM) and antibiotic-non-susceptible pneumococcal OM (ANSP-OM) episodes. In southern Israel, sequential PCV7/PCV13 introduction resulted in >90% reduction of vaccine-serotype OM. OBJECTIVES We assessed the dynamics of ANSP-OM necessitating middle ear fluid culture following PCV7/PCV13 sequential introduction in young children. METHODS This was a prospective, population-based, active surveillance. All episodes in children <3 years old, during 2004-16, were included. Two subperiods were defined: (i) pre-PCV: 2004-08; and (ii) PCV13: 2014-16. ANSP was defined for the following antibiotics: penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone, trimethoprim/sulfamethoxazole and chloramphenicol. MDR was defined as ANSP for ≥3 classes. RESULTS Overall, 2270 pneumococcal OM episodes were identified. Annual overall pneumococcal, PCV13 and non-PCV13 serotype OM incidence declined by 86%, 97% and 33%, respectively, comparing pre-PCV with the PCV13 period. During 2004-08, 95% of ANSP was observed in vaccine serotypes. Incidence of penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone and multidrug ANSP-OM declined by >90% in the PCV13 period. Rates of trimethoprim/sulfamethoxazole and chloramphenicol ANSP-OM declined by 85% and 79%, respectively. The proportions of ANSP of all pneumococcal isolates declined by ∼70% for penicillin, ceftriaxone and erythromycin; 53% for tetracycline; and 55% for MDR, versus no significant reductions observed for chloramphenicol, trimethoprim/sulfamethoxazole and clindamycin. CONCLUSIONS PCV7/PCV13 sequential introduction resulted in rapid and substantial ANSP-OM reduction, in parallel with the near disappearance of PCV13-serotype OM and no increase in replacement disease.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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11
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Ouldali N, Cohen R, Levy C, Gelbert-Baudino N, Seror E, Corrard F, Vie Le Sage F, Michot AS, Romain O, Bechet S, Bonacorsi S, Angoulvant F, Varon E. Pneumococcal susceptibility to antibiotics in carriage: a 17 year time series analysis of the adaptive evolution of non-vaccine emerging serotypes to a new selective pressure environment. J Antimicrob Chemother 2020; 74:3077-3086. [PMID: 31280295 DOI: 10.1093/jac/dkz281] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccine (PCV) implementations led to major changes in serotype distribution and antibiotic resistance in carriage, accompanied by changes in antibiotic consumption. OBJECTIVES To assess the dynamic patterns of antimicrobial non-susceptibility across non-PCV13 serotypes following PCV implementations. METHODS We conducted a quasi-experimental interrupted time series analysis based on a 17 year French nationwide prospective cohort. From 2001 to 2018, 121 paediatricians obtained nasopharyngeal swabs from children with acute otitis media who were aged 6 months to 2 years. The main outcome was the rate of penicillin-non-susceptible pneumococci (PNSP), analysed by segmented regression. RESULTS We enrolled 10 204 children. After PCV13 implementation, the PNSP rate decreased (-0.5% per month; 95% CI -0.9 to -0.1), then, after 2014, the rate slightly increased (+0.7% per month; 95% CI +0.2 to +1.2). Global antibiotic use within the previous 3 months decreased over the study period (-22.2%; 95% CI -33.0 to -11.3), but aminopenicillin use remained high. Among the main non-PCV13 serotypes, four dynamic patterns of penicillin susceptibility evolution were observed, including unexpected patterns of serotypes emerging while remaining or even becoming penicillin susceptible. In contrast to PNSP strains, for these latter patterns, the rate of co-colonization with Haemophilus influenzae increased concomitant with their emergence. CONCLUSIONS In a context of continuing high antibiotic selective pressure, a progressive increase in PNSP rate was observed after 2014. However, we highlighted an unexpected variability in dynamic patterns of penicillin susceptibility among emerging non-PCV13 serotypes. Antibiotic resistance may not be the only adaptive mechanism to antimicrobial selective pressure, and co-colonization with H. influenzae may be involved.
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Affiliation(s)
- Naim Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France.,Urgences pédiatriques, hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, Créteil, France.,Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, Créteil, France
| | - Nathalie Gelbert-Baudino
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Elisa Seror
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,Hématologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - François Corrard
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - François Vie Le Sage
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Anne-Sylvestre Michot
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
| | - Olivier Romain
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Réanimation et pédiatrie néonatales, Hôpitaux Universitaires Paris-Sud, Hôpital Antoine Béclère, Clamart, France
| | - Stéphane Bechet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - François Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Urgences pédiatriques, hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France.,Centre de recherche des Cordeliers, INSERM UMR 1138, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Abstract
INTRODUCTION Otitis media (OM) is a spectrum of infectious and inflammatory diseases that involve the middle ear. It includes acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (CSOM). AREAS COVERED This manuscript discusses some of the emerging and unsolved problems regarding OM, and some of the newly developed prophylactic and therapeutic medical measures. EXPERT OPINION In recent years, considerable progress in the knowledge of OM physiopathology has been made. However, although extremely common, diseases included under OM have not been adequately studied, and many areas of development, evolution and possible treatments of these pathologies are not defined. It is necessary that these deficiencies be quickly overcome if we want to reduce the total burden of a group of diseases that still have extremely high medical, social and economic relevance.
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Affiliation(s)
- Nicola Principi
- Emeritus of Pediatrics, Università Degli Studi Di Milano , Milan, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma , Parma, Italy
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13
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Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention. Pediatr Infect Dis J 2019; 38:S22-S36. [PMID: 31876602 DOI: 10.1097/inf.0000000000002430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010. METHODS The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. RESULTS The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended. CONCLUSIONS The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.
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14
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Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment. Pediatr Infect Dis J 2019; 38:S10-S21. [PMID: 31876601 DOI: 10.1097/inf.0000000000002452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines. METHODS A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts. RESULTS Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics. CONCLUSIONS AOM should be managed on a case-by-case basis that takes account of the child's age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.
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15
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Tin Tin Htar M, van Den Biggelaar AHJ, Sings H, Ferreira G, Moffatt M, Hall-Murray C, Verstraeten T, Gessner BD, Schmitt HJ, Jodar L. The impact of routine childhood immunization with higher-valent pneumococcal conjugate vaccines on antimicrobial-resistant pneumococcal diseases and carriage: a systematic literature review. Expert Rev Vaccines 2019; 18:1069-1089. [PMID: 31585049 DOI: 10.1080/14760584.2019.1676155] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: The introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in childhood immunization programs reduced antimicrobial-resistant pneumococcal infections by vaccine serotypes. However, emerging antimicrobial-resistant non-vaccine serotypes, particularly serotype 19A, attenuated the overall effect. In 2010, higher-valent PCVs became available containing serotypes that are prone to become antimicrobial-resistant, like serotype 7F in PCV10 and PCV13, and serotype 19A in PCV13.Areas covered: This review evaluated literature published between June 1, 2008 and June 1, 2017 reporting on the effect of PCV10 or PCV13 implementation in routine infant immunization schedules on antimicrobial-resistant invasive pneumococcal disease (IPD), otitis media (OM), and nasopharyngeal carriage (NPC) in children and adults.Expert opinion: In countries with relatively high prior pneumococcal antimicrobial resistance (AMR), PCV13 childhood vaccination programs have reduced antimicrobial-resistant IPD, OM, and NPC in children and IPD in adults. The effectiveness of PCV13 against serotype 19A is likely an important contributing factor. Only few studies have documented the impact of PCV10 on AMR. Multiple factors may influence observed decreases in pneumococcal AMR including antimicrobial stewardship, case definition, time since PCV10/13 introduction, and pre-PCV10/13 AMR levels. This review emphasizes the importance of including impact on AMR when evaluating the full public health of pneumococcal vaccination programs.
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Affiliation(s)
| | | | - Heather Sings
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Germano Ferreira
- Department of Epidemiology, P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Margaret Moffatt
- Department of Health Economic & Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Cassandra Hall-Murray
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Thomas Verstraeten
- Department of Epidemiology, P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Bradford D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Heinz-Josef Schmitt
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Paris, France
| | - Luis Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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16
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Levy C, Ouldali N, Caeymaex L, Angoulvant F, Varon E, Cohen R. Diversity of Serotype Replacement After Pneumococcal Conjugate Vaccine Implementation in Europe. J Pediatr 2019; 213:252-253.e3. [PMID: 31561776 DOI: 10.1016/j.jpeds.2019.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Corinne Levy
- Université Paris Est, Mondor Institute of Biomedical Research-Groupement de Recherche Clinique (IMRB-GRC) Groupe d'étude de Maladies Infectieuses Néonatales et Infantiles (GEMINI), Créteil, France; Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France.
| | - Naim Ouldali
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France
| | - Laurence Caeymaex
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France
| | - François Angoulvant
- Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emmanuelle Varon
- Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- Université Paris Est, Mondor Institute of Biomedical Research-Groupement de Recherche Clinique (IMRB-GRC) Groupe d'étude de Maladies Infectieuses Néonatales et Infantiles (GEMINI), Créteil, France; Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France
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17
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Kruk SK, Pacheco SE, Koenig MK, Bergerson JRE, Gordon-Lipkin E, McGuire PJ. Vulnerability of pediatric patients with mitochondrial disease to vaccine-preventable diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2415-2418.e3. [PMID: 30954647 DOI: 10.1016/j.jaip.2019.03.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Shannon K Kruk
- Metabolism, Infection and Immunity Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Susan E Pacheco
- Department of Pediatrics, The University of Texas Health Science Center, Houston, Texas
| | - Mary Kay Koenig
- Department of Pediatrics, The University of Texas Health Science Center, Houston, Texas
| | - Jenna R E Bergerson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Eliza Gordon-Lipkin
- Metabolism, Infection and Immunity Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Peter J McGuire
- Metabolism, Infection and Immunity Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md.
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18
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Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine. PLoS One 2019; 14:e0211712. [PMID: 30707730 PMCID: PMC6358092 DOI: 10.1371/journal.pone.0211712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022] Open
Abstract
After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were β-lactamase-producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of β-lactamase-producing NTHi did not exceed 16%.
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19
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Mittal R, Parrish JM, Soni M, Mittal J, Mathee K. Microbial otitis media: recent advancements in treatment, current challenges and opportunities. J Med Microbiol 2018; 67:1417-1425. [PMID: 30084766 DOI: 10.1099/jmm.0.000810] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Otitis media (OM) is a common disease affecting humans, especially paediatric populations. OM refers to inflammation of the middle ear and can be broadly classified into two types, acute and chronic. Bacterial infection is one of the most common causes of OM. Despite the introduction of vaccines, the incidence of OM remains significantly high worldwide. In this mini-review article, we discuss the recent treatment modalities for OM, such as suspension gel, transcutaneous immunization, and intranasal and transtympanic drug delivery, including therapies that are currently undergoing clinical trials. We provide an overview of how these recent advancements in therapeutic strategies can facilitate the circumvention of current treatment challenges involving preadolescence soft palate dysfunction, biofilm formation, tympanic membrane (ear drum) barrier and the attainment of efficacious drug concentrations in the middle ear. While traditional first-line immunization strategies are generally not very efficacious against biofilms, new technologies that use transdermal or intranasal drug delivery via chitosan-PsaA nanoparticles have shown promising results in experimental animal models of OM. Sustained drug delivery systems such as penta-block copolymer poloxamer 407-polybutylphosphoester (P407-PBP) or poloxamer 407 (e.g. OTO-201, with the brand name 'OTIPRIO') have demonstrated that treatments can be reduced to a single topical application. The emergence of effective new treatment modalities opens up promising new avenues for the treatment of OM that could lead to improved quality of life for many children and their families.
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Affiliation(s)
- Rahul Mittal
- 1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James M Parrish
- 1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manasi Soni
- 1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeenu Mittal
- 1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kalai Mathee
- 2Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.,3Biomolecular Sciences Institute, Florida International University, Miami, FL, USA
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