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Feng S, McLellan J, Pidduck N, Roberts N, Higgins JP, Choi Y, Izu A, Jit M, Madhi SA, Mulholland K, Pollard AJ, Procter S, Temple B, Voysey M. Immunogenicity and seroefficacy of pneumococcal conjugate vaccines: a systematic review and network meta-analysis. Health Technol Assess 2024; 28:1-109. [PMID: 39046101 DOI: 10.3310/ywha3079] [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] [Indexed: 07/25/2024] Open
Abstract
Background Vaccination of infants with pneumococcal conjugate vaccines is recommended by the World Health Organization. Evidence is mixed regarding the differences in immunogenicity and efficacy of the different pneumococcal vaccines. Objectives The primary objective was to compare the immunogenicity of pneumococcal conjugate vaccine-10 versus pneumococcal conjugate vaccine-13. The main secondary objective was to compare the seroefficacy of pneumococcal conjugate vaccine-10 versus pneumococcal conjugate vaccine-13. Methods We searched the Cochrane Library, EMBASE, Global Health, MEDLINE, ClinicalTrials.gov and trialsearch.who.int up to July 2022. Studies were eligible if they directly compared either pneumococcal conjugate vaccine-7, pneumococcal conjugate vaccine-10 or pneumococcal conjugate vaccine-13 in randomised trials of children under 2 years of age, and provided immunogenicity data for at least one time point. Individual participant data were requested and aggregate data used otherwise. Outcomes included the geometric mean ratio of serotype-specific immunoglobulin G and the relative risk of seroinfection. Seroinfection was defined for each individual as a rise in antibody between the post-primary vaccination series time point and the booster dose, evidence of presumed subclinical infection. Each trial was analysed to obtain the log of the ratio of geometric means and its standard error. The relative risk of seroinfection ('seroefficacy') was estimated by comparing the proportion of participants with seroinfection between vaccine groups. The log-geometric mean ratios, log-relative risks and their standard errors constituted the input data for evidence synthesis. For serotypes contained in all three vaccines, evidence could be synthesised using a network meta-analysis. For other serotypes, meta-analysis was used. Results from seroefficacy analyses were incorporated into a mathematical model of pneumococcal transmission dynamics to compare the differential impact of pneumococcal conjugate vaccine-10 and pneumococcal conjugate vaccine-13 introduction on invasive pneumococcal disease cases. The model estimated the impact of vaccine introduction over a 25-year time period and an economic evaluation was conducted. Results In total, 47 studies were eligible from 38 countries. Twenty-eight and 12 studies with data available were included in immunogenicity and seroefficacy analyses, respectively. Geometric mean ratios comparing pneumococcal conjugate vaccine-13 versus pneumococcal conjugate vaccine-10 favoured pneumococcal conjugate vaccine-13 for serotypes 4, 9V and 23F at 1 month after primary vaccination series, with 1.14- to 1.54-fold significantly higher immunoglobulin G responses with pneumococcal conjugate vaccine-13. Risk of seroinfection prior to the time of booster dose was lower for pneumococcal conjugate vaccine-13 for serotype 4, 6B, 9V, 18C and 23F than for pneumococcal conjugate vaccine-10. Significant heterogeneity and inconsistency were present for most serotypes and for both outcomes. Twofold higher antibody after primary vaccination was associated with a 54% decrease in risk of seroinfection (relative risk 0.46, 95% confidence interval 0.23 to 0.96). In modelled scenarios, pneumococcal conjugate vaccine-13 or pneumococcal conjugate vaccine-10 introduction in 2006 resulted in a reduction in cases that was less rapid for pneumococcal conjugate vaccine-10 than for pneumococcal conjugate vaccine-13. The pneumococcal conjugate vaccine-13 programme was predicted to avoid an additional 2808 (95% confidence interval 2690 to 2925) cases of invasive pneumococcal disease compared with pneumococcal conjugate vaccine-10 introduction between 2006 and 2030. Limitations Analyses used data from infant vaccine studies with blood samples taken prior to a booster dose. The impact of extrapolating pre-booster efficacy to post-booster time points is unknown. Network meta-analysis models contained significant heterogeneity which may lead to bias. Conclusions Serotype-specific differences were found in immunogenicity and seroefficacy between pneumococcal conjugate vaccine-13 and pneumococcal conjugate vaccine-10. Higher antibody response after vaccination was associated with a lower risk of subsequent infection. These methods can be used to compare the pneumococcal conjugate vaccines and optimise vaccination strategies. For future work, seroefficacy estimates can be determined for other pneumococcal vaccines, which could contribute to licensing or policy decisions for new pneumococcal vaccines. Study registration This study is registered as PROSPERO CRD42019124580. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/148/03) and is published in full in Health Technology Assessment; Vol. 28, No. 34. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Julian Pt Higgins
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoon Choi
- Modelling and Economics Unit, UK Health Security Agency, London, UK
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Beth Temple
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Leach AJ, Wilson N, Arrowsmith B, Beissbarth J, Mulholland K, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Skull SA, Oguoma VM, Chatfield MD, Lehmann D, Brennan-Jones CG, Binks MJ, Licciardi PV, Andrews RM, Snelling T, Krause V, Carapetis J, Chang AB, Morris PS. Hearing loss in Australian First Nations children at 6-monthly assessments from age 12 to 36 months: Secondary outcomes from randomised controlled trials of novel pneumococcal conjugate vaccine schedules. PLoS Med 2024; 21:e1004375. [PMID: 38829821 PMCID: PMC11146696 DOI: 10.1371/journal.pmed.1004375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations. METHODS AND FINDINGS In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size. CONCLUSIONS In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation. TRIAL REGISTRATION ClinicalTrials.gov NCT01735084 and NCT01174849.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nicole Wilson
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Beth Arrowsmith
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kim Mulholland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Mathuram Santosham
- Departments of International Health and Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Indigenous Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Paul John Torzillo
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Peter McIntyre
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sue A. Skull
- Division of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Victor M. Oguoma
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D. Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Deborah Lehmann
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher G. Brennan-Jones
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Michael J. Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Paul V. Licciardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross M. Andrews
- Office of the Chief Health Officer, Queensland Health, Brisbane, Queensland, Australia
| | - Tom Snelling
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Vicki Krause
- Centre for Disease Control (CDC)-Environmental Health, Northern Territory Health, Darwin, Northern Territory, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Anne B. Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Paediatrics Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Feng S, McLellan J, Pidduck N, Roberts N, Higgins JP, Choi Y, Izu A, Jit M, Madhi SA, Mulholland K, Pollard AJ, Temple B, Voysey M. Immunogenicity and seroefficacy of 10-valent and 13-valent pneumococcal conjugate vaccines: a systematic review and network meta-analysis of individual participant data. EClinicalMedicine 2023; 61:102073. [PMID: 37425373 PMCID: PMC10328810 DOI: 10.1016/j.eclinm.2023.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Vaccination of infants with pneumococcal conjugate vaccines (PCV) is recommended by the World Health Organization. Evidence is mixed regarding the differences in immunogenicity and efficacy of the different pneumococcal vaccines. Methods In this systematic-review and network meta-analysis, we searched the Cochrane Library, Embase, Global Health, Medline, clinicaltrials.gov and trialsearch.who.int up to February 17, 2023 with no language restrictions. Studies were eligible if they presented data comparing the immunogenicity of either PCV7, PCV10 or PCV13 in head-to-head randomised trials of young children under 2 years of age, and provided immunogenicity data for at least one time point after the primary vaccination series or the booster dose. Publication bias was assessed via Cochrane's Risk Of Bias due to Missing Evidence tool and comparison-adjusted funnel plots with Egger's test. Individual participant level data were requested from publication authors and/or relevant vaccine manufacturers. Outcomes included the geometric mean ratio (GMR) of serotype-specific IgG and the relative risk (RR) of seroinfection. Seroinfection was defined for each individual as a rise in antibody between the post-primary vaccination series time point and the booster dose, evidence of presumed subclinical infection. Seroefficacy was defined as the RR of seroinfection. We also estimated the relationship between the GMR of IgG one month after priming and the RR of seroinfection by the time of the booster dose. The protocol is registered with PROSPERO, ID CRD42019124580. Findings 47 studies were eligible from 38 countries across six continents. 28 and 12 studies with data available were included in immunogenicity and seroefficacy analyses, respectively. GMRs comparing PCV13 vs PCV10 favoured PCV13 for serotypes 4, 9V, and 23F at 1 month after primary vaccination series, with 1.14- to 1.54- fold significantly higher IgG responses with PCV13. Risk of seroinfection prior to the time of booster dose was lower for PCV13 for serotype 4, 6B, 9V, 18C and 23F than for PCV10. Significant heterogeneity and inconsistency were present for most serotypes and for both outcomes. Two-fold higher antibody after primary vaccination was associated with a 54% decrease in risk of seroinfection (RR 0.46, 95% CI 0.23-0.96). Interpretation Serotype-specific differences were found in immunogenicity and seroefficacy between PCV13 and PCV10. Higher antibody response after vaccination was associated with a lower risk of subsequent infection. These findings could be used to compare PCVs and optimise vaccination strategies. Funding The NIHR Health Technology Assessment Programme.
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Affiliation(s)
- Shuo Feng
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Julian P.T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoon Choi
- Modelling and Economics Unit, UK Health Security Agency, London, UK
| | - Alane Izu
- South African Medical Research Council MRC Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shabir A. Madhi
- South African Medical Research Council MRC Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Andrew J. Pollard
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Beth Temple
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Merryn Voysey
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Leach AJ. What does microbiology have to do with the Hearing for Learning Initiative (HfLI)? MICROBIOLOGY AUSTRALIA 2022. [DOI: 10.1071/ma22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Where would we be without microbiology in tackling the high prevalence of otitis media (OM; middle ear infection) and disabling hearing loss that disadvantage Australian First Nations children living in remote communities? Understanding the microbiology of OM in this population has been critical in directing innovative clinical trials research and developing appropriate evidence-based practice guidelines. While these processes are critical to reducing disadvantage associated with OM and disabling hearing loss, a remaining seemingly insurmountable gap has remained, threatening progress in improving the lives of children with ear and hearing problems. That gap is created by the crisis in primary health care workforce in remote communities. Short stay health professionals and fly-in fly-out specialist services are under-resourced to manage the complex needs of the community, including prevention and treatment of otitis media and hearing loss rehabilitation. Hence the rationale for the Hearing for Learning Initiative – a workforce enhancement model to improve sustainability, cultural appropriateness, and effectiveness of evidence-based ear and hearing health care for young children in remote settings. This paper summarises the role of microbiology in the pathway to the Hearing for Learning Initiative.
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Leach AJ, Wilson N, Arrowsmith B, Beissbarth J, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Chatfield MD, Lehmann D, Binks M, Chang AB, Carapetis J, Krause V, Andrews R, Snelling T, Skull SA, Licciardi PV, Oguoma VM, Morris PS. Immunogenicity, otitis media, hearing impairment, and nasopharyngeal carriage 6-months after 13-valent or ten-valent booster pneumococcal conjugate vaccines, stratified by mixed priming schedules: PREVIX_COMBO and PREVIX_BOOST randomised controlled trials. THE LANCET. INFECTIOUS DISEASES 2022; 22:1374-1387. [PMID: 35772449 DOI: 10.1016/s1473-3099(22)00272-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Australian First Nations children are at very high risk of early, recurrent, and persistent bacterial otitis media and respiratory tract infection. With the PREVIX randomised controlled trials, we aimed to evaluate the immunogenicity of novel pneumococcal conjugate vaccine (PCV) schedules. METHODS PREVIX_BOOST was a parallel, open-label, outcome-assessor-blinded, randomised controlled trial. Aboriginal children living in remote communities of the Northern Territory of Australia were eligible if they had previously completed the three-arm PREVIX_COMBO randomised controlled trial of the following vaccine schedules: three doses of a 13-valent PCV (PCV13; PPP) or a ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; SSS) given at 2, 4, and 6 months, or SSS given at 1, 2, and 4 months followed by PCV13 at 6 months (SSSP). At age 12 months, eligible children were randomly assigned by a computer-generated random sequence (1:1, stratified by primary group allocation) to receive either a PCV13 booster or a PHiD-CV10 booster. Analyses used intention-to-treat principles. Co-primary outcomes were immunogenicity against protein D and serotypes 3, 6A, and 19A. Immunogenicity measures were geometric mean concentrations (GMC) and proportion of children with IgG concentrations of 0·35 μg/mL or higher (threshold for invasive pneumococcal disease), and GMCs and proportion of children with antibody levels of 100 EU/mL or higher against protein D. Standardised assessments of otitis media, hearing impairment, nasopharyngeal carriage, and developmental outcomes are reported. These trials are registered with ClinicalTrials.gov (NCT01735084 and NCT01174849). FINDINGS Between April 10, 2013, and Sept 4, 2018, 261 children were randomly allocated to receive a PCV13 booster (n=131) or PHiD-CV10 booster (n=130). Adequate serum samples for pneumococcal serology were obtained from 127 (95%) children in the PCV13 booster group and 126 (97%) in the PHiD-CV10 booster group; for protein D, adequate samples were obtained from 126 (96%) children in the PCV13 booster group and 123 (95%) in the PHiD-CV10 booster group. The proportions of children with IgG concentrations above standard thresholds in PCV13 booster versus PHiD-CV10 booster groups were the following: 71 (56%) of 126 versus 81 (66%) of 123 against protein D (difference 10%, 95% CI -2 to 22), 85 (67%) of 127 versus 59 (47%) of 126 against serotype 3 (-20%, -32 to -8), 119 (94%) of 127 versus 91 (72%) of 126 against serotype 6A (-22%, -31 to -13), and 116 (91%) of 127 versus 108 (86%) of 126 against serotype 19A (-5%, -13 to 3). Infant PCV13 priming mitigated differences between PCV13 and PHiD-CV10 boosters. In both groups, we observed a high prevalence of otitis media (about 90%), hearing impairment (about 75%), nasopharyngeal carriage of pneumococcus (about 66%), and non-typeable H influenzae (about 57%). Of 66 serious adverse events, none were vaccine related. INTERPRETATION Low antibody concentrations 6 months post-booster might indicate increased risk of pneumococcal infection. The preferred booster was PCV13 if priming did not have PCV13, otherwise either PCV13 or PHiD-CV10 boosters provided similar immunogenicity. Mixed schedules offer flexibility to regional priorities. Non-PCV13 serotypes and non-typeable H influenzae continue to cause substantial disease and disability in Australian First Nation's children. FUNDING National Health and Medical Research Council (NHMRC).
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Affiliation(s)
- Amanda Jane Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Nicole Wilson
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Beth Arrowsmith
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Edward Kim Mulholland
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mathuram Santosham
- Departments of International Health and Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for American Indian Health, Baltimore, MD, USA
| | - Paul John Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Department of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Peter McIntyre
- University of Otago, Department of Women's and Children's Health, Dunedin, New Zealand
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Deborah Lehmann
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Michael Binks
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia
| | - Vicki Krause
- Centre for Disease Control, Northern Territory Health, Darwin, NT, Australia
| | - Ross Andrews
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Tom Snelling
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sue A Skull
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia
| | - Paul V Licciardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD, Australia
| | - Peter Stanley Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Royal Darwin Hospital, Paediatrics Department, Darwin, NT, Australia
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Beissbarth J, Smith-Vaughan HC, Cheng AC, Morris PS, Leach AJ. BIGDATA: A Protocol to Create and Extend a 25-Year Clinical Trial and Observational Data Asset to Address Key Knowledge Gaps in Otitis Media and Hearing Loss in Australian Aboriginal and Non-Aboriginal Children. Front Pediatr 2022; 10:804373. [PMID: 35498792 PMCID: PMC9047683 DOI: 10.3389/fped.2022.804373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/18/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Otitis media (OM) is a common childhood illness, often resolving without intervention and acute and long-term complications are rare. However, Australian Aboriginal and Torres Strait Islander infants and children experience a high burden of OM and are at high risk of complications (tympanic membrane perforation and chronic infections). Bacterial OM is commonly associated with Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis. BIGDATA is a data asset combining over 25 years of microbiology and OM surveillance research from the Ear Health Research Program at Menzies School of Health Research (Northern Territory, Australia), including 11 randomized controlled trials, four cohort studies, eight surveys in over 30 remote communities (including data from Western Australia), and five surveys of urban childcare centers including Aboriginal and Torres Strait Islander and non-Indigenous children. Outcome measures include clinical examinations (focusing on OM), antibiotic prescriptions, pneumococcal vaccination, modifiable risk factors such as smoking and household crowding, and nasopharyngeal and ear discharge microbiology including antimicrobial resistance testing. METHODS AND ANALYSIS The initial series of projects are planned to address the following key knowledge gaps: (i) otitis media prevalence and severity over pre pneumococcal conjugate vaccines (PCVs) and three eras of increasing PCV valency; (ii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics of pneumococcal serotypes, and antimicrobial resistance; (iii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics and antimicrobial resistance of other otopathogens; and (iv) serotype specific differences between children with acute OM and OM with effusion or without OM. These data will be utilized to identify research gaps, providing evidence-based prioritization for ongoing research. ETHICS AND DISSEMINATION Data asset creation and priority analyses were approved by the Human Research Ethics Committee of Northern Territory Department of Health and Menzies School of Health Research (EC00153, 18-3281), the Child and Adolescent Health Service Human Research Ethics Committee and Western Australian Aboriginal Health Ethics Committee. Dissemination will be through peer review publication and conference presentations.
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Affiliation(s)
- Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Toh ZQ, Quang C, Tooma JA, Garland SM, Mulholland K, Licciardi PV. Australia's Role in Pneumococcal and Human Papillomavirus Vaccine Evaluation in Asia-Pacific. Vaccines (Basel) 2021; 9:vaccines9080921. [PMID: 34452046 PMCID: PMC8402478 DOI: 10.3390/vaccines9080921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Australian researchers have made substantial contributions to the field of vaccinology over many decades. Two examples of this contribution relate to pneumococcal vaccines and the human papillomavirus (HPV) vaccine, with a focus on improving access to these vaccines in low- and lower-middle-income countries (LLMICs). Many LLMICs considering introducing one or both of these vaccines into their National Immunisation Programs face significant barriers such as cost, logistics associated with vaccine delivery. These countries also often lack the resources and expertise to undertake the necessary studies to evaluate vaccine performance. This review summarizes the role of Australia in the development and/or evaluation of pneumococcal vaccines and the HPV vaccine, including the use of alternative vaccine strategies among countries situated in the Asia-Pacific region. The outcomes of these research programs have had significant global health impacts, highlighting the importance of these vaccines in preventing pneumococcal disease as well as HPV-associated diseases.
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Affiliation(s)
- Zheng Quan Toh
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Chau Quang
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Joseph A. Tooma
- Australia Cervical Cancer Foundation, Fortitude Valley, QLD 4006, Australia;
| | - Suzanne M. Garland
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3052, Australia
- Regional WHO HPV Reference Laboratory, Centre Women’s Infectious Diseases Research, The Royal Women’s Hospital, Parkville, VIC 3052, Australia
| | - Kim Mulholland
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Paul V. Licciardi
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence:
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Beissbarth J, Wilson N, Arrowsmith B, Binks MJ, Oguoma VM, Lawrence K, Llewellyn A, Mulholland EK, Santosham M, Morris PS, Smith-Vaughan HC, Cheng AC, Leach AJ. Nasopharyngeal carriage of otitis media pathogens in infants receiving 10-valent non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10), 13-valent pneumococcal conjugate vaccine (PCV13) or a mixed primary schedule of both vaccines: A randomised controlled trial. Vaccine 2021; 39:2264-2273. [PMID: 33766422 DOI: 10.1016/j.vaccine.2021.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aboriginal children in Northern Australia have a high burden of otitis media, driven by early and persistent nasopharyngeal carriage of otopathogens, including non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae (Spn). In this context, does a combined mixed primary series of Synflorix and Prevenar13 provide better protection against nasopharyngeal carriage of NTHi and Spn serotypes 3, 6A and 19A than either vaccine alone? METHODS Aboriginal infants (n = 425) were randomised to receive Synflorix™ (S, PHiD-CV10) or Prevenar13™ (P, PCV13) at 2, 4 and 6 months (_SSS or _PPP, respectively), or a 4-dose early mixed primary series of PHiD-CV10 at 1, 2 and 4 months and PCV13 at 6 months of age (SSSP). Nasopharyngeal swabs were collected at 1, 2, 4, 6 and 7 months of age. Swabs of ear discharge were collected from tympanic membrane perforations. FINDINGS At the primary endpoint at 7 months of age, the proportion of nasopharyngeal (Np) swabs positive for PCV13-only serotypes 3, 6A, or 19A was 0%, 0.8%, and 1.5% in the _PPP, _SSS, and SSSP groups respectively, and NTHi 55%, 52%, and 52% respectively, and no statistically significant vaccine group differences in other otopathogens at any age. The most common serotypes (in order) were 16F, 11A, 10A, 7B, 15A, 6C, 35B, 23B, 13, and 15B, accounting for 65% of carriage. Ear discharge swabs (n = 108) were culture positive for NTHi (52%), S. aureus (32%), and pneumococcus (20%). CONCLUSIONS Aboriginal infants experience nasopharyngeal colonisation and tympanic membrane perforations associated with NTHi, non-PCV13 pneumococcal serotypes and S. aureus in the first months of life. Nasopharyngeal carriage of pneumococcus or NTHi was not significantly reduced in the early 4-dose combined SSSP group compared to standard _PPP or _SSS schedules at any time point. Current pneumococcal conjugate vaccine formulations do not offer protection from early onset NTHi and pneumococcal colonisation in this high-risk population.
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Affiliation(s)
- J Beissbarth
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - N Wilson
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia
| | - B Arrowsmith
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - M J Binks
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - V M Oguoma
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.
| | - K Lawrence
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - A Llewellyn
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - E K Mulholland
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Australia; London School of Hygiene and Tropical Medicine, UK.
| | - M Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - P S Morris
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
| | - H C Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - A C Cheng
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Victoria, Australia.
| | - A J Leach
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
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Leach AJ, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Wilson N, Arrowsmith B, Beissbarth J, Chatfield MD, Oguoma VM, Licciardi P, Skull S, Andrews R, Carapetis J, McDonnell J, Krause V, Morris PS. Interchangeability, immunogenicity and safety of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (Synflorix) and 13-valent-PCV (Prevenar13) schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial. Vaccine X 2021; 7:100086. [PMID: 33681756 PMCID: PMC7930582 DOI: 10.1016/j.jvacx.2021.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
A mix of SynflorixTM (S) and Prevenar13TM (P) at 1–2-4–6 months (SSSP) is safe. At 7 months the SSSP schedule is immunogenic against 13 serotypes* and protein D. One-month dose of Synflorix is immunogenic* (8 of 10 serotypes) Two-month dose of Prevenar13 is poorly immunogenic** (8 of 13 serotypes) Two-month dose of Synflorix is superior (8 serotypes) or similar (4) to Prevenar13 *GMC ≥ 0·35 µg/mL **GMC ≤ 0·35 µg/mL. A 4-dose schedule is superior to either 3-dose schedule, particularly against 6B, 19F, and 23F.
Background Aboriginal children living in remote communities are at high risk of early and persistent otitis media. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are primary pathogens. Vaccines with potential to prevent early OM have not been evaluated in this population. We compared immunogenicity (ELISA and opsonophagocytic activity) of a combination of Synflorix™ (PHiD-CV10, 10 serotypes and protein D of NTHi) and Prevenar13™ (PCV13, 10 serotypes plus 3, 6A, and 19A), with recommended schedules. Methods This open-label superiority trial randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to PCV13 (P) at 2–4-6 months (_PPP), PHiD-CV10 (S) at 2–4-6 months (_SSS), or PHiD-CV10 at 1–2–4 plus PCV13 at −6 months (SSSP). Primary outcomes (blinded) were immunogenicity against PCV13-only serotypes 3, 6A, 19A, and PHiD-CV10-only protein D at 7 months. Secondary outcomes include immunogenicity against all serotypes at 2, 4 and 7 months. Findings Between 2011 and 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(1 4 1). An intention to treat approach including all available data was used. The SSSP group had superior immunogenicity against serotypes 3, 6A, and 19A compared to _SSS (OPA GMT ratios 8.1 to 59.5, p < 0.001), and against protein D compared to _PPP (GMC ratio 11.9 (95%CI 9.7 to 14.6)). Immune responses to protein D and 3, 6A, and 19A in SSSP were not significantly lower (i.e. no harm) than either _SSS or _PPP. For ten common serotypes responses at 2, 4 and 7 months were superior for SSSP (following 1-, 2-, and 4- doses) than _SSS and _PPP (following 0-, 1-, and 3- doses). At 4 months, _SSS was superior to _PPP. Reactogenicity and hospitalisations were rare and unrelated to the intervention. Interpretation From two months, the 1–2–4–6-month combined schedule (SSSP) was safe and significantly more immunogenic than 2–4–6-month schedules. The earlier responses may be beneficial in high-risk populations.
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Affiliation(s)
- Amanda Jane Leach
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Corresponding author at: Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - Edward Kim Mulholland
- Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Australia
- London School of Hygiene and Tropical Medicine, UK
| | | | - Paul John Torzillo
- Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Peter McIntyre
- National Centre for Immunization Research and Surveillance, Sydney, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Nicole Wilson
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Beth Arrowsmith
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Victor M. Oguoma
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Paul Licciardi
- Murdoch Children’s Research Institute, Dept of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sue Skull
- Dept of Child Health Research, Perth Children’s Hospital, University of Western Australia, Perth, Australia
| | - Ross Andrews
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Australian National University, Canberra, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Australia
- Perth Children’s Hospital, Perth, Australia
| | | | - Vicki Krause
- Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia
| | - Peter Stanley Morris
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin Northern Territory, Australia
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Leach AJ, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Wilson N, Arrowsmith B, Beissbarth J, Chatfield MD, Oguoma VM, Morris PS. Otitis media outcomes of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine and 13-valent pneumococcal conjugate vaccine schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial. BMC Pediatr 2021; 21:117. [PMID: 33685411 PMCID: PMC7938290 DOI: 10.1186/s12887-021-02552-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal children living in Australian remote communities are at high risk of early and persistent otitis media, hearing loss, and social disadvantage. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are the primary pathogens. We compared otitis media outcomes in infants randomised to either a combination of Synflorix™ (PHiD-CV10, with protein D of NTHi) and Prevenar13™ (PCV13, with 3, 6A, and 19A), with recommended schedules for each vaccine alone. We previously reported superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months. METHODS In an open-label superiority trial, we randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to either Prevenar13™ (P) at 2-4-6 months (_PPP), Synflorix™ (S) at 2-4-6 months (_SSS), or Synflorix™ at 1-2-4 months plus Prevenar13™ at 6 months (SSSP). Ears were assessed using tympanometry at 1 and 2 months, combined with otoscopy at 4, 6, and 7 months. A worst ear diagnosis was made for each child visit according to a severity hierarchy of normal, otitis media with effusion (OME), acute otitis media without perforation (AOMwoP), AOM with perforation (AOMwiP), and chronic suppurative otitis media (CSOM). RESULTS Between September 2011 and September 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(141). Ear assessments were successful in 96% scheduled visits. At 7 months prevalence of any OM was 91, 86, and 90% in the _PPP, _SSS, and SSSP groups, respectively. There were no significant differences in prevalence of any form of otitis media between vaccine groups at any age. Combined group prevalence of any OM was 43, 57, 82, 87, and 89% at 1, 2, 4, 6, and 7 months of age, respectively. Of 388 infants with ear assessments at 4, 6 and 7 months, 277 (71.4%) had OM that met criteria for specialist referral; rAOM, pOME, or CSOM. CONCLUSIONS Despite superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months, there were no significant differences in prevalence of otitis media nor healthy ears throughout the first months of life. TRIAL REGISTRATION ACTRN12610000544077 registered 06/07/2010 and ClinicalTrials.gov NCT01174849 registered 04/08/2010.
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Affiliation(s)
- Amanda Jane Leach
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Edward Kim Mulholland
- Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Paul John Torzillo
- Prince Alfred Hospital, Sydney, NSW Australia
- University of Sydney, NSW, Australia
| | - Peter McIntyre
- National Centre for Immunization Research and Surveillance, Sydney, NSW Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Nicole Wilson
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Beth Arrowsmith
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Centre for Health Services Research Faculty of Medicine, University of Queensland, Brisbane QLD, Australia
| | - Victor M. Oguoma
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Health Research Institute University of Canberra, Canberra, ACT Australia
| | - Peter Stanley Morris
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Department of Paediatrics , Royal Darwin Hospital, Darwin, Northern Territory Australia
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Chan K, Carosone-Link P, Bautista MTG, Sanvictores D, Uhler K, Tallo V, Lucero MG, De Jesus J, Simoes EAF. Population-based otoscopic and audiometric assessment of a birth cohort recruited for a pneumococcal vaccine trial 15-18 years earlier: a protocol. BMJ Open 2021; 11:e042363. [PMID: 33597137 PMCID: PMC7893663 DOI: 10.1136/bmjopen-2020-042363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A cohort of 12 000 children in the Philippines who had enrolled in a 2000-2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort's current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis. METHODS AND ANALYSIS Reliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data. ETHICS AND DISSEMINATION The study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers. TRIAL REGISTRATION NUMBER ISRCTN 62323832; Post-results.
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Affiliation(s)
- Kenny Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary Thatcher G Bautista
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Diozele Sanvictores
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Kristin Uhler
- Department of Audiology, Speech-Pathology, and Learning, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Veronica Tallo
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Marilla G Lucero
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Joanne De Jesus
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Eric A F Simoes
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Oguoma VM, Wilson N, Mulholland K, Santosham M, Torzillo P, McIntyre P, Smith-Vaughan H, Balloch A, Chatfield M, Lehmann D, Binks MJ, Chang A, Carapetis J, Krause V, Andrews R, Snelling T, Licciardi P, Morris P, Leach AJ. 10-Valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine (PHiD-CV10) versus 13-valent pneumococcal conjugate vaccine (PCV13) as a booster dose to broaden and strengthen protection from otitis media (PREVIX_BOOST) in Australian Aboriginal children: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033511. [PMID: 32448790 PMCID: PMC7252982 DOI: 10.1136/bmjopen-2019-033511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/06/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major otitis media pathogens that densely co-colonise the nasopharynx and infect the middle ear of Australian Aboriginal infants from very early in life. Our co-primary hypotheses are that at 18 months of age infants receiving 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) compared with those receiving 13-valent pneumococcal conjugate vaccine (PCV13) as a booster at 12 months of age will have higher antibody levels to Haemophilus influenzae protein D and that infants receiving PCV13 will have higher antibody levels to PCV13-only serotypes 3, 6A and 19A. METHODS AND ANALYSES Our randomised controlled trial will enrol 270 Aboriginal children at 12 months of age to a booster dose of either PHiD-CV10 or PCV13. Children who completed the three-dose primary course schedules of PHiD-CV10 at 2, 4, 6 months of age; PCV13 at 2, 4, 6 months of age; or a combination schedule of PHiD-CV10 at 1, 2, 4 months of age plus PCV13 at 6 months of age are eligible. The co-primary assessor-blinded outcomes when the infants are 18 months of age are as follows: (a) IgG geometric mean concentration (GMC) and proportion with IgG ≥100 EU/mL for protein D, and (b) IgG GMC and the proportion with IgG ≥0.35 µg/mL for pneumococcal serotypes 3, 6A and 19A. Secondary immunogenicity comparisons of six primary and booster dose schedules of 10 shared serotypes at 18 months of age, nasopharyngeal carriage, all forms of otitis media, hearing loss and developmental milestones at 18, 24, 30 and 36 months of age will be reported. ETHICS AND DISSEMINATION Ethics committees of NT Department of Health, Menzies, WA Department of Health and WA Aboriginal Health approved the study. Results will be presented to communities, at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT01735084.
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Affiliation(s)
- Victor M Oguoma
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nicole Wilson
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kim Mulholland
- Infection and Immunity: Pneumococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Mathuram Santosham
- Center American Indian Health, John Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Paul Torzillo
- Respiratory Medicine, Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter McIntyre
- Director, National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Balloch
- Pneumococcal Immunology, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Mark Chatfield
- Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Deborah Lehmann
- Division of Population Sciences, Telethon Institute for Child Health Research, West Perth, Western Australia, Australia
| | - Michael J Binks
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Chang
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Vicki Krause
- Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
| | - Ross Andrews
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tom Snelling
- Infectious Disease Implementation Research Team, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Paul Licciardi
- Infections and Immunity: Pneumococcal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Morris
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Amanda Jane Leach
- Child Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
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Alderson MR, Murphy T, Pelton SI, Novotny LA, Hammitt LL, Kurabi A, Li JD, Thornton RB, Kirkham LAS. Panel 8: Vaccines and immunology. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109839. [PMID: 31948716 PMCID: PMC7153269 DOI: 10.1016/j.ijporl.2019.109839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review and highlight significant advances made towards vaccine development and understanding of the immunology of otitis media (OM) since the 19th International Symposium on Recent Advances in Otitis Media (ISOM) in 2015, as well as identify future research directions and knowledge gaps. DATA SOURCES PubMed database, National Library of Medicine. REVIEW METHODS Key topics were assigned to each panel member for detailed review. Draft reviews were collated, circulated, and thoroughly discussed when the panel met at the 20th ISOM in June 2019. The final manuscript was prepared with input from all panel members. CONCLUSIONS Since 2015 there have been a number of studies assessing the impact of licensed pneumococcal vaccines on OM. While these studies have confirmed that these vaccines are effective in preventing carriage and/or disease caused by vaccine serotypes, OM caused by non-vaccine serotype pneumococci and other otopathogens remains a significant health care burden globally. Development of multi-species vaccines is challenging but essential to reducing the global burden of OM. Influenza vaccination has been shown to prevent acute OM, and with novel vaccines against nontypeable Haemophilus influenzae (NTHi), Moraxella catarrhalis and Respiratory Syncytial Virus (RSV) in clinical trials, the potential to significantly prevent OM is within reach. Research into alternative vaccine delivery strategies has demonstrated the power of maternal and mucosal vaccination for OM prevention. Future OM vaccine trials must include molecular diagnostics of middle ear effusion, for detection of viruses and bacteria that are persisting in biofilms and to enable accurate assessment of vaccine impact on OM etiology. Understanding population differences in natural and vaccine-induced immune responses to otopathogens is also important for development of the most effective OM vaccines. Improved understanding of the interaction between otopathogens will also advance development of effective therapies and encourage the assessment of the indirect benefits of vaccination. IMPLICATIONS FOR PRACTICE While NTHi and M. catarrhalis are the predominant otopathogens, funding opportunities to drive vaccine development for these species are limited due to a focus on prevention of childhood mortality rather than morbidity. Delivery of a comprehensive report on the high financial and social costs of OM, including the potential for OM vaccines to reduce antibiotic use and subsequent development of antimicrobial resistance (AMR), would likely assist in engaging stakeholders to recognize the value of prevention of OM and increase support for efforts on OM vaccine development. Vaccine trials with OM prevention as a clinical end-point are challenging, however a focus on developing assays that measure functional correlates of protection would facilitate OM vaccine development.
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Affiliation(s)
| | - Tim Murphy
- Clinical and Translational Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Stephen I Pelton
- Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Laura A Novotny
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arwa Kurabi
- Division of Otolaryngology, Department of Surgery, University of California, San Diego, CA, USA
| | - Jian-Dong Li
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, GA, USA
| | - Ruth B Thornton
- School of Biomedical Sciences, University of Western Australia, Australia and Wesfarmers Centre for Vaccines and Infectious Diseases Research, Telethon Kids Institute, Perth, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre for Vaccines and Infectious Diseases Research, Telethon Kids Institute, Australia and Centre for Child Health Research, University of Western Australia, Perth, Australia
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De Wals P, Lemeur JB, Ayukawa H, Proulx JF. Middle ear abnormalities at age 5 years in relation with early onset otitis media and number of episodes, in the Inuit population of Nunavik, Quebec, Canada. Int J Circumpolar Health 2019; 78:1599269. [PMID: 30924406 PMCID: PMC6442088 DOI: 10.1080/22423982.2019.1599269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 11/02/2022] Open
Abstract
Otitis media (OM) and their sequelae are a major health issue in the Inuit population of Nunavik, Quebec. Hypotheses of the study were: (i) early onset OM leads to repeated OM; (ii) repeated OM episodes leads to middle ear abnormalities (MEA) at age 5 years, (iii) pneumococcal conjugate vaccines (PCVs) may reduce multiple OM and MEA. Immunisation cards, medical records and audiology screening tests at age 5 years in a sample of 610 children born in 1994-2010 in 3 communities were reviewed. Children were classified into three categories using a score based on audiology screening tests: no abnormality, minor, or major MEA. The average number of OM episodes before age 5 years was 5.0 and 30% had minor and 17% major MEA at age 5 years. Community residency predicted both frequent (≥ 8) OM episodes and MEA. Early onset OM (age <6 months) was a predictor of frequent OM (RR = 1.71; 95%CI: 1.50-1.95) whereas PCV (≥1 dose ≥ age 2 months) has no significant effect. Frequent OM episodes were associated with major MEA (RR = 2.16; 95%CI: 1.20-3.85). Although associations were not statistically significant, there was a trend towards a protective effect of PCV administration on frequent OM and minor MEA, but not major MEA. In conclusion, results support an association between early onset OM, frequent OM and MEA that could represent a causal pathway.
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Affiliation(s)
- P De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec, Canada
- Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec, Canada
- Quebec University Hospital Research Centre, Quebec, Canada
| | - JB Lemeur
- Department of Social and Preventive Medicine, Laval University, Quebec, Canada
- Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec, Canada
| | - H Ayukawa
- Ungava Tulattavik Health Centre, Kuujjuaq, Canada
| | - JF Proulx
- Public Health Directorate, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Canada
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Beissbarth J, Smith-Vaughan HC, Harris TM, Binks MJ, Leach AJ. Use of the 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in an Australian Indigenous paediatric population does not alter the prevalence of nontypeable Haemophilus influenzae without the protein D gene. Vaccine 2019; 37:4089-4093. [PMID: 31164306 DOI: 10.1016/j.vaccine.2019.05.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/03/2019] [Accepted: 05/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nontypeable Haemophilus influenzae (NTHi) is one of the main respiratory pathogens associated with otitis media and lung infections in Australian Indigenous children. PHiD-CV10, the 10-valent pneumococcal conjugate vaccine containing H. influenzae protein D was used in the Northern Territory infant vaccination schedule for two years from October 2009. METHODS NTHi isolates from nasopharyngeal and ear discharge samples collected before, during and after the PHiD-CV10 era were screened for the hpd gene by PCR. Target amplicon sequence, extracted from available genomic sequence data, was analysed to identify variability in this region. RESULTS There was no statistically significant difference in the proportion of hpd#3-PCR negative isolates from each era; overall 7% and 6% of nasopharyngeal and ear discharge isolates were negative, respectively. The nucleotide sequence data supported the hpd-PCR findings; truncations of the hpd gene precluding amplification and presumably expression of protein D were observed in approximately 7% of available genomes. CONCLUSIONS In the Northern Territory of Australia, a population at high risk of NTHi-associated infection, PHiD-CV10 use did not select for hpd-PCR negative isolates.
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Affiliation(s)
- Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | | | - Tegan Maree Harris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Michael John Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Beissbarth J, Binks MJ, Marsh RL, Chang AB, Leach AJ, Smith-Vaughan HC. Recommendations for application of Haemophilus influenzae PCR diagnostics to respiratory specimens for children living in northern Australia: a retrospective re-analysis. BMC Res Notes 2018; 11:323. [PMID: 29784027 PMCID: PMC5963172 DOI: 10.1186/s13104-018-3429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/10/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Haemophilus haemolyticus can be misidentified as nontypeable Haemophilus influenzae (NTHi) due to their phenotypic similarities in microbiological culture. This study aimed to determine the prevalence of misidentified NTHi in respiratory specimens from children living in northern Australia. RESULTS Among respiratory specimens collected in studies between 2010 and 2013, retrospective PCR analysis found that routine culture misidentified H. haemolyticus as NTHi in 0.3% (3/879) of nasal specimens, 25% (14/55) of bronchoalveolar lavage and 40% (12/30) of throat specimens. Therefore, in this population, PCR-based NTHi diagnostics are indicated for throat and bronchoalveolar specimens, but not for nasal specimens.
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Affiliation(s)
- Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Robyn L Marsh
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, PO Box 3474, South Brisbane, QLD, 4101, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Heidi C Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
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Vojtek I, Nordgren M, Hoet B. Impact of pneumococcal conjugate vaccines on otitis media: A review of measurement and interpretation challenges. Int J Pediatr Otorhinolaryngol 2017; 100:174-182. [PMID: 28802367 DOI: 10.1016/j.ijporl.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 01/22/2023]
Abstract
Acute otitis media (AOM) is among the most frequent childhood diseases and is caused by various bacterial and viral etiological agents. In this article, we provide an overview of published studies assessing the impact of higher-valent pneumococcal conjugate vaccines (PCVs) on AOM. In some instances, reports of PCV impact on complications of AOM have been included. While randomized controlled trials (RCTs) allow for the most precise assessment of vaccine efficacy against AOM, observational studies provide answers to questions regarding the public health value of these vaccines in real-life settings. We discuss the challenges that arise when measuring PCV impact on AOM in observational studies: the local variability of viral and bacterial etiology, differences in case ascertainment, care-seeking behavior, standards of care and diagnosis of AOM (e.g. use of incisions), as well as declining baseline AOM incidence that can already be in place before PCV introduction, and how these factors can impact the results and their interpretation.
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Chen JJ, Yuan L, Huang Z, Shi NM, Zhao YL, Xia SL, Li GH, Li RC, Li YP, Yang SY, Xia JL. Safety and immunogenicity of a new 13-valent pneumococcal conjugate vaccine versus a licensed 7-valent pneumococcal conjugate vaccine: a study protocol of a randomised non-inferiority trial in China. BMJ Open 2016; 6:e012488. [PMID: 27798013 PMCID: PMC5073664 DOI: 10.1136/bmjopen-2016-012488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The invasive pneumococcal diseases (IPDs) caused by Streptococcus pneumoniae pose an enormous threat to children under 5 years of age. However, routine use of pneumococcal conjugate vaccines could aid in reducing the incidence of IPDs. The purpose of this clinical trial is to assess the non-inferiority of the investigational 13-valent pneumococcal conjugate vaccine (PCV13) to the currently licensed 7-valent pneumococcal conjugate vaccine (PCV7). METHODS AND ANALYSIS 1040 infants will receive a three-dose series of either PCV13 or PCV7 at ages 3, 4 and 5 months, respectively, and a booster dose at 12-15 months. Primary end points are the percentage of participants reaching a serotype-specific IgG concentration of ≥0.35 µg/mL and the IgG antibody geometric mean concentrations (GMCs) measured 30 days after the primary immunisation. Secondary end points include the percentage of vaccine recipients reaching a serotype-specific IgG concentration threshold of 1.0 µg/mL, the percentage of participants reaching the pneumococcal opsonophagocytic assay (OPA) titre threshold of 1:8, and the geometric mean titres (GMTs) of OPA measured 30 days after primary and booster doses. The number of standard IgG responders and IgG GMCs measured 30 days after the booster immunisation will also be determined. To evaluate differences between two groups, the sequential testing of the non-inferiority of PCV13 for the seven common serotypes and its effectiveness in treating the six additional serotypes will be performed. ETHICS AND DISSEMINATION Ethics approvals have been granted by the Ethics Committees at the three provinces involved in this study: Shanxi, Henan and Hebei. The trial will be reported in accordance with the CONSORT guidance. TRIAL REGISTRATION NUMBER NCT02736240.
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Affiliation(s)
- Jing Jing Chen
- Department of Health Statistics of Fourth Military Medical University, Xi'an, China
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Lin Yuan
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Zhen Huang
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Nian Min Shi
- Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing, China
| | - Yu Liang Zhao
- Heibei Province Centre for Disease Control and Prevention, Shijiazhuang, China
| | - Sheng Li Xia
- Henan Province Centre for Disease Control and Prevention, Zhengzhou, China
| | - Guo Hua Li
- Shanxi Province Centre for Disease Control and Prevention, Taiyuan, China
| | - Rong Cheng Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Yan Ping Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Shu Yuan Yang
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Jie Lai Xia
- Department of Health Statistics of Fourth Military Medical University, Xi'an, China
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Best EJ, Walls T, Souter M, Neeff M, Anderson T, Salkeld L, Ahmad Z, Mahadevan M, Walker C, Murdoch D, Mills N. Pneumococcal vaccine impact on otitis media microbiology: A New Zealand cohort study before and after the introduction of PHiD-CV10 vaccine. Vaccine 2016; 34:3840-7. [DOI: 10.1016/j.vaccine.2016.05.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022]
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Nicholls TR, Leach AJ, Morris PS. The short-term impact of each primary dose of pneumococcal conjugate vaccine on nasopharyngeal carriage: Systematic review and meta-analyses of randomised controlled trials. Vaccine 2015; 34:703-13. [PMID: 26742947 DOI: 10.1016/j.vaccine.2015.12.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Early onset of persistent otitis media is a priority issue for Australian Indigenous populations. The objective is to determine the direct and short-term impact of one, two and three doses of any pneumococcal conjugate vaccine (PCV) formulation on nasopharyngeal (NP) carriage of Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi), the otopathogens targeted by current PCVs. METHODS We searched MEDLINE (PubMed) and CENTRAL (Cochrane Library) to 29 September 2015. We also scanned reference lists of recent reviews and contacted authors. We included randomised controlled trials (RCTs) with a PCV schedule commencing ≤3 months of age that reported controlled non-cumulative group-specific prevalence data for carriage of Spn or NTHi at age<12 months. We performed a standard risk of bias assessment. We estimated the pooled relative risk (RR) and 95% confidence interval (95%CI) for each vaccine dose on NP carriage by meta-analysis. RESULTS We included 16 RCTs involving 14,776 participants. The PCVs were conjugated to diphtheria toxin CRM197, diphtheria toxoid, tetanus toxoid or NTHi protein D and varied in valency (4-13). Controls were non-PCVs, placebo or no vaccine. The earliest carriage outcome was from 2 to 9 months of age. Compared to controls, there were no significant differences between one or two doses of PCV on vaccine-type (VT) pneumococcal carriage at ∼4 and ∼6 months respectively. However, VT carriage was significantly lower at ∼7 months RR 0.67 95%CI 0.56-0.81 from 9 studies and 7613 infants and non-vaccine type (NVT) carriage was higher RR 1.23 95%CI 1.09-1.40 from 8 studies and 5861 infants. No impact on overall pneumococcal or NTHi carriage was found. CONCLUSIONS The primary PCV schedule had no significant short-term impact on overall pneumococcal or NTHi NP carriage and a limited impact on VT pneumococcal carriage before the third dose.
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Affiliation(s)
- Thomas Rodger Nicholls
- Menzies School of Health Research, Charles Darwin University, John Matthews Building (58), Royal Darwin Hospital Campus, Darwin 0810, NT, Australia
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, John Matthews Building (58), Royal Darwin Hospital Campus, Darwin 0810, NT, Australia.
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, John Matthews Building (58), Royal Darwin Hospital Campus, Darwin 0810, NT, Australia
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