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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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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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Ngo CC, Massa HM, McMonagle BA, Perry CF, Nissen MD, Sloots TP, Thornton RB, Cripps AW. Predominant Bacterial and Viral Otopathogens Identified Within the Respiratory Tract and Middle Ear of Urban Australian Children Experiencing Otitis Media Are Diversely Distributed. Front Cell Infect Microbiol 2022; 12:775535. [PMID: 35360096 PMCID: PMC8963760 DOI: 10.3389/fcimb.2022.775535] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Otitis media (OM) is one of the most common infections in young children, arising from bacterial and/or viral infection of the middle ear. Globally, Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are the predominant bacterial otopathogens. Importantly, common upper respiratory viruses are increasingly recognized contributors to the polymicrobial pathogenesis of OM. This study aimed to identify predominant bacteria and viruses in the nasopharynx, adenoids and middle ears of peri-urban/urban South-East Queensland Australian children, with and without clinical history of chronic otitis media with effusion (COME) and/or recurrent acute otitis media (RAOM). Methods Sixty children, 43 diagnosed with OM and 17 controls with no clinical history of OM from peri-urban/urban South-East Queensland community were recruited to the study. Respiratory tract bacterial and viral presence were examined within nasopharyngeal swabs (NPS), middle ear effusions (MEE) and adenoids, using real-time polymerase chain reaction (RT-PCR) and bacterial culture. Results At least one otopathogen present was observed in all adenoid samples, 86.1% and 82.4% of NPS for children with and without OM, respectively, and 47.1% of the MEE from the children with OM. NTHi was the most commonly detected bacteria in both the OM and control cohorts within the adenoids (90.0% vs 93.8%), nasopharynx (67.4% vs 58.8%) respectively, and in the MEE (OM cohort 25.9%). Viruses were detected in all adenoid samples, 67.4% vs 47.1% of the NPS from the OM and control cohorts, respectively, and 37% of the MEE. Rhinovirus was the predominant virus identified in the adenoids (85.0% vs 68.8%) and nasopharynx (37.2% vs 41.2%) from the OM and control cohorts, respectively, and the MEE (19.8%). Conclusions NTHi and rhinovirus are predominant otopathogens within the upper respiratory tract of children with and without OM from peri-urban and urban South-East Queensland, Australia. The presence of bacterial otopathogens within the middle ear is more predictive of concurrent URT infection than was observed for viruses, and the high otopathogen carriage within adenoid tissues confirms the complex polymicrobial environment in children, regardless of OM history.
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Affiliation(s)
- Chinh C. Ngo
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Helen M. Massa
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- *Correspondence: Helen M. Massa,
| | - Brent A. McMonagle
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Pindara Private Hospital, Ramsay Health Care, Gold Coast, QLD, Australia
| | - Christopher F. Perry
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Otolaryngology, Head and Neck Surgery Department, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Michael D. Nissen
- Child Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Theo P. Sloots
- Child Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Ruth B. Thornton
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth, WA, Australia
| | - Allan W. Cripps
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, 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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Rahman T, de Gier C, Orami T, Seppanen EJ, Granland CM, Francis JP, Michael A, Yoannes M, Corscadden KJ, Ford RL, Martinovich KM, Jacoby P, van den Biggelaar AHJ, Lehmann D, Richmond PC, Pomat WS, Thornton RB, Kirkham LAS. PCV10 elicits Protein D IgG responses in Papua New Guinean children but has no impact on NTHi carriage in the first two years of life. Vaccine 2021; 39:3486-3492. [PMID: 34024658 DOI: 10.1016/j.vaccine.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nasopharyngeal colonisation with nontypeable Haemophilus influenzae (NTHi) is associated with development of infections including pneumonia and otitis media. The 10-valent pneumococcal conjugate vaccine (PCV10) uses NTHi Protein D (PD) as a carrier. Papua New Guinean children have exceptionally early and dense NTHi carriage, and high rates of NTHi-associated disease. Vaccination with PCV10 could potentially reduce NTHi carriage and disease in this population by inducing a NTHi PD immune response. METHODS Serum and nasopharyngeal swabs were collected from 101 Papua New Guinean children at 1, 4, 9, 10, 23 and 24 months of age. Children received PCV10 (n = 55) or PCV13 (not containing NTHi PD) (n = 46) at 1, 2 and 3 months of age. NTHi carriage density was measured in swabs by qPCR. Serum PD-IgG levels were measured by bead-based immunoassay. RESULTS Papua New Guinean children did naturally develop PD-IgG antibodies whose levels were increased at 4 months of age with PCV10 vaccination at 1-2-3 months. Despite this, most children were colonised with NTHi by 4 months of age (~95%) regardless of being vaccinated with PCV10 or PCV13, and PCV10 had no impact on NTHi carriage density. CONCLUSION Early vaccination of infants with PCV10 elicited a robust PD antibody response but this had no impact on NTHi carriage. TRIAL REGISTRATION ClinicalTrials.gov CTN NCT01619462.
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Affiliation(s)
- Tasmina Rahman
- Division of Paediatrics, University of Western Australia, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Camilla de Gier
- Division of Paediatrics, University of Western Australia, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Elke J Seppanen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Jacinta P Francis
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Audrey Michael
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Mition Yoannes
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Karli J Corscadden
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Rebecca L Ford
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Kelly M Martinovich
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Peter Jacoby
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Peter C Richmond
- Division of Paediatrics, University of Western Australia, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - William S Pomat
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Ruth B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia.
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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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Wang BC, Chaiyakunapruk N, Zhu S, Babigumira JB, Furnback W, Chitale R, Gamil A, Zhao K, Wasserman M. A systematic literature review of economic evaluations of pneumococcal conjugate vaccines in east and southeast Asia (2006-2019). Expert Rev Vaccines 2021; 21:885-898. [PMID: 33682584 DOI: 10.1080/14760584.2021.1894933] [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: 10/22/2022]
Abstract
INTRODUCTION Pneumococcal infections can lead to serious invasive diseases such as meningitis, septicemia and pneumonia, as well as milder but more common illnesses such as sinusitis and otitis media. The World Health Organization (WHO) recommends the inclusion of pneumococcal conjugate vaccines (PCVs) in infant National Immunization Program (NIP) programs worldwide. Decision-makers in Asian countries planning to introduce PCVs in their respective NIP will need a comprehensive evidence of effectiveness of PCVs at the population level and economic evidence including cost-effectiveness. AREAS COVERED A systematic literature review (from 1/1/2016 to 10/11/2019) of PCVs in East and Southeast Asia to understand (1) the contributing factors to cost-effectiveness results of PCVs and (2) whether gaps in evidence exist suggesting why the region may have yet to implement full NIPs. EXPERT OPINION In East and Southeast Asia, vaccination with PCVs was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccination. Study assumptions, specifically vaccine local acquisition, the inclusion or exclusion of indirect effects (serotype replacement and herd effect), cross-protection, and protection against nontypeable haemophilus influenzae and serotype 3, were the main drivers of cost-effectiveness.
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Affiliation(s)
- Bruce Cm Wang
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | | | - Shuiqing Zhu
- Health Economics and Outcomes Research, Pfizer Investment Co. Ltd, Shanghai, China
| | | | - Wesley Furnback
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | - Ramaa Chitale
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Amgad Gamil
- Medical and Scientific Affairs, Pfizer Inc, Singapore
| | - Kun Zhao
- Health Technology Assessment, China National Health Development Research Center, National Health Commission of the People's Republic of China
| | - Matt Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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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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10
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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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Lee J, Kim KH, Jo DS, Ma SH, Kim JH, Kim CS, Kim HM, Kang JH. A longitudinal hospital-based epidemiology study to assess acute otitis media incidence and nasopharyngeal carriage in Korean children up to 24 months. Hum Vaccin Immunother 2020; 16:3090-3097. [PMID: 32330397 DOI: 10.1080/21645515.2020.1748978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This study was conducted to assess the nasopharyngeal (NP) carriage and acute otitis media (AOM) occurrence in Korean children who received pneumococcal conjugate vaccines (PCVs). The longitudinal study was conducted through four consecutive visits. At each visit, NP aspirates were obtained and subjects were asked to visit if AOM occurred. A total of 305 subjects were enrolled and received PCV13 (n = 182) or PCV10 (n = 123). In the PCV13 group, the NP carriage of Streptococcus pneumoniae at each visit was 2.7%, 14.8%, 18.7%, and 15.9%, respectively. Non-typeable Haemophilus influenzae (NTHi) was 3.3%, 2.7%, 2.7%, and 5.5%, and that of Moraxella catarrhalis was 1.1%, 9.3%, 4.9%, and 0.5%. In the PCV10 group, the NP carriage of S. pneumoniae at each visit was 3.3%, 7.3%, 6.5%, and 4.1%, respectively. That of NTHi was 2.4%, 4.1%, 1.6%, and 0.8%, and that of M. catarrhalis was 4.1%, 0.8%, 0.8%, and 0.0%. AOM occurrence in the PCV13 group observed after the primary dose and before booster dose was 20.9%, occurrence after booster dose was 11.0%, and the incidence of two or more AOM was 11.0%. In the PCV10 group, AOM occurrence was 9.8%, 7.3%, respectively, and the incidence of two or more AOM was 2.4%. The predominant S. pneumoniae isolated were non-vaccine type (10A, 15A, and 15B). In this study, AOM occurrence was lower in the PCV10 group than in the PCV13 group. This seems to be related to ecological changes that lead to differences in NP carriage, especially S. pneumoniae and NTHi.
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Affiliation(s)
- Jin Lee
- Department of Pediatrics, Hanil General Hospital , Seoul, Republic of Korea
| | - Ki Hwan Kim
- Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea , Incheon, Republic of Korea
| | - Dae Sun Jo
- Department of Pediatrics, Chonbuk National University Children's Hospital , Jeonju, Republic of Korea
| | - Sang Hyuk Ma
- Department of Pediatrics, Changwon Fatima Hospital , Changwon, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, the Catholic University of Korea , Suwon, Republic of Korea
| | - Chun Soo Kim
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine , Daegu, Republic of Korea
| | - Hwang Min Kim
- Department of Pediatrics, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Republic of Korea
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Ngocho JS, Minja L, van der Gaast-de Jongh CE, Rahamat-Langendoen JC, Langereis JD, Mmbaga BT, de Jonge MI. Viral-bacterial (co-)occurrence in the upper airways and the risk of childhood pneumonia in resource-limited settings. J Infect 2020; 81:213-220. [PMID: 32533999 DOI: 10.1016/j.jinf.2020.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the association between bacterial-viral co-occurrence in the nasopharynx and the risk of community acquired pneumonia (CAP) in young children living in resource-limited settings. METHODS A case-control study was conducted between January and December 2017 in Moshi, Tanzania. Children 2-59 months with CAP and healthy controls were enrolled. RSV and Influenza A/B were detected with a standardized polymerase chain reaction (PCR) method, and a simplified real-time quantitative PCR method, without sample pre-processing, was developed to detect bacterial pathogens in nasopharyngeal samples. RESULTS A total of 109 CAP patients and 324 healthy controls were enrolled. Co-detection of H. influenzae and S. pneumoniae in nasopharyngeal swabs was linked with higher odds of CAP (aOR=3.2, 95% CI=1.1-9.5). The majority of the H. influenzae isolated in cases and controls (95.8%) were non-typeable. Of the viruses examined, respiratory syncytial virus (RSV) was most common (n = 31, 7.2%) in cases and controls. Children with RSV had 8.4 times higher odds to develop pneumonia than healthy children (aOR=8.4, 95%CI= 3.2 - 22.1). CONCLUSIONS Co-occurence of H. influenzae and S. pneumoniae in the nasopharynx was strongly associated with CAP. The high prevalence of non-typeable H. influenzae might be a sign of replacement as a consequence of Haemophilus influenzae type b vaccination.
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Affiliation(s)
- James S Ngocho
- Kilimanjaro Christian Medical University College (KCMUCo), Box 2240, Moshi, Tanzania.
| | - Linda Minja
- Kilimanjaro Clinical Research Institute (KCRI), Box 2236, Moshi, Tanzania
| | - Christa E van der Gaast-de Jongh
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janette C Rahamat-Langendoen
- Department of Medical Microbiology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen D Langereis
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Kilimanjaro Clinical Research Institute (KCRI), Box 2236, Moshi, Tanzania
| | - Marien I de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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13
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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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Leach AJ, Homøe P, Chidziva C, Gunasekera H, Kong K, Bhutta MF, Jensen R, Tamir SO, Das SK, Morris P. Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109857. [PMID: 32057518 PMCID: PMC7259423 DOI: 10.1016/j.ijporl.2019.109857] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: Summarise the published evidence on otitis media and associated hearing loss in low to middle-income countries (LMIC) and disadvantaged populations. DATA SOURCES: PubMed and other databases. REVIEW METHODS: Firstly, sensitive search strategy using ‘otitis media’, combined with specific key words for each topic of the review, from January 2015 to June 2019. Then, restriction to LMIC and disadvantaged populations. Topics covered included prevention, epidemiology, risk factors, microbiology, prognosis, diagnosis, and treatment. CONCLUSIONS: There was a high degree of methodological heterogeneity and high risk of bias. The majority of studies were school-based. In Africa, Asia and Oceania (e.g., Australian Aboriginal populations) the prevalence of OM was respectively 8% (range 3–16%), 14% (range 7–22%) and 50% (4–95%). Prevalence of any hearing loss in these regions was 12% (range 8–17%), 12% (range 3–24%), and 26% (range 25–28%) respectively. Risk factors in LMIC and disadvantaged populations included age, gender, exposure to smoke and pollution. Microbiology was reported for otitis media with effusion at time of surgery or ear discharge (acute otitis media with perforation or chronic suppurative otitis media). Specimen handling and processing in hospital laboratories was associated with low detection of S. pneumoniae and H. influenzae. Case series described complicated cases of OM due to M. tuberculosis, multidrug resistance and HIV. QOL studies identified discrimination of persons with OM and hearing loss. Diagnostic methods varied greatly, from naked eye to tympanometry. Treatment interventions were reported from four RCTs. Non-RCTs included evaluations of guidelines, surgery outcomes, access to ENTs. IMPLICATIONS FOR CLINICAL PRACTICE: Chronic suppurative otitis media, otitis media with effusion and conductive hearing loss are common in LMIC and disadvantaged populations. Paucity of research, poor regional representation, non-standardised methods and low-quality reporting preclude accurate assessment of disease burden in LMIC and disadvantaged populations. Awareness and adherence to reporting Guidelines should be promoted.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Preben Homøe
- Køge University Hospital, Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Clemence Chidziva
- University of Zimbabwe, Department of Surgery, 630 Churchill Avenue, Harare, Zimbabwe.
| | - Hasantha Gunasekera
- University of Sydney, Australia; The Children's Hospital at Westmead, Cnr Hawkesbury Rd &, Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Kelvin Kong
- John Hunter Children's Hospital, Newcastle, Australia; Hunter ENT, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Mahmood F Bhutta
- Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
| | - Ramon Jensen
- Dept of Oto-rhino-laryngology and Audiology, F 2071 Rigshospitalet, Blegdamsvej 9, DK, 2100, Denmark; Department of Clinical Medicine, Blegdamsvej 3, 2200, København, Denmark.
| | - Sharon Ovnat Tamir
- Dept of OTO-HNS, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Department of Otolaryngology-Head and Neck Surgery, Assuta University Hospital, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel.
| | - Sumon Kumar Das
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia.
| | - Peter Morris
- Menzies School of Health Research, John Mathews Building 58, Royal Darwin Hospital Campus, Rocklands Dr, Tiwi, NT, 0810, Australia; Royal Darwin Hospital, Rocklands Dr, Tiwi, NT, 0810, Australia.
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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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Tin Tin Htar M, Sings HL, Syrochkina M, Taysi B, Hilton B, Schmitt HJ, Gessner BD, Jodar L. The impact of pneumococcal conjugate vaccines on serotype 19A nasopharyngeal carriage. Expert Rev Vaccines 2019; 18:1243-1270. [DOI: 10.1080/14760584.2019.1675521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Heather L. Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Maria Syrochkina
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Moscow, Russia
| | - Bulent Taysi
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Istanbul, Turkey
| | - Betsy Hilton
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Heinz-Josef Schmitt
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Bradford D. Gessner
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Negash AA, Asrat D, Abebe W, Hailemariam T, Gebre M, Aseffa A, Vaneechoutte M. Pneumococcal serotype 19A is the major cause of pediatric acute otitis media with ruptured tympanic membrane in Addis Ababa, Ethiopia, 5 years after the introduction of the ten-valent pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2019; 126:109638. [PMID: 31442868 DOI: 10.1016/j.ijporl.2019.109638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In Ethiopia, there is a lack of data on pneumococcal serotypes causing acute otitis media (AOM) in children. We aimed to study the etiology, pneumococcal serotypes and antimicrobial resistance patterns of isolates from children with AOM with spontaneous perforation of the tympanic membrane (SPTM). METHODS We carried out a prospective observational study in children with AOM with SPTM, aged 0-15 years in Addis Ababa, Ethiopia. Middle ear fluid was collected using sterile swabs, cultured and antibiotic susceptibility testing was performed. Serotypes of Streptococcus pneumoniae were determined by sequencing the cpsB gene and by the Quellung reaction. RESULTS A total of 55 children were enrolled. Out of 55 samples that were cultured, 52 (94.5%) were culture positive for a total of 66 bacterial species, and 56.4% (31/55) samples were positive for 41 (62.1%) known pathogenic bacterial species. The most common pathogenic bacterial isolates were S. pneumoniae (36.6%), Staphylococcus aureus (19.5%), Streptococcus pyogenes (14.6%) and Haemophilus influenzae (12.2%). Serotype 19A (73.3%) was the predominant pneumococcal serotype. There was a high rate of non-susceptibility to penicillin (86.6%) and trimethoprim/sulfamethoxazole (80%) among pneumococcal isolates. Out of 21 different isolates tested for amoxicillin susceptibility, 15 (71.4%) were resistant. CONCLUSIONS Pneumococcal serotype 19A was the predominant cause of AOM with SPTM in children in Addis Ababa, Ethiopia, 5 years after introduction of PCV10. There was a high rate of resistance to commonly prescribed antibiotics. The study highlights the need for wide scale surveillance of the etiology and antimicrobial susceptibility of AOM in Ethiopian children.
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Affiliation(s)
- Abel Abera Negash
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia; Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Hailemariam
- Department of Pediatrics and Child Health, Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Meseret Gebre
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Department of Diagnostic Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
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Otitis media related hearing loss in Indonesian school children. Int J Pediatr Otorhinolaryngol 2019; 125:44-50. [PMID: 31252198 DOI: 10.1016/j.ijporl.2019.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/13/2019] [Accepted: 06/16/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There are scant recent studies from low middle-income countries that investigate the impact of otitis media (OM) on hearing loss (HL) in school children. METHODS This was a prospective epidemiological survey conducted by otorhinolaryngologists and audiologists in a sample of 7005 public school children (6-15 years) from 6 urban and rural sub-districts, in Indonesia. Children with otoscopic abnormalities or who failed a hearing-screening test conducted at school, underwent diagnostic audiometry and tympanometry. RESULTS OM was detected in 172 children (2.5%), acute otitis media - AOM (17%), otitis media with effusion - OME (15%), and chronic suppurative otitis media - CSOM (67%). The overall rate of HL in the school children was 181/10,000, which was almost three-fold higher in rural (273/10,000) than urban areas 92.6/10,000. OME accounted for much of the mild HL, while CSOM accounted for most of the moderate HL. There was a significantly higher rate of OM related HL in rural areas (116.2/10,000), than in urban areas (47.4/10,000), p = 0.002. OM related disabling HL was found at a rate of 44.2/10,000, mostly due to CSOM (37.1/10,000). CONCLUSION Otitis media contributed to 57% of all HL in school children, and posed a significant burden on Indonesian school children. Most of the disabling HL was due to CSOM. Efforts to find these children and offer ear and hearing care are important.
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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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20
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The Effect of the 10-Valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine on H. influenzae in Healthy Carriers and Middle Ear Infections in Iceland. J Clin Microbiol 2019; 57:JCM.00116-19. [PMID: 31068412 PMCID: PMC6595461 DOI: 10.1128/jcm.00116-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/27/2019] [Indexed: 11/20/2022] Open
Abstract
Vaccinations with the 10-valent pneumococcal conjugated vaccine (PHiD-CV) started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine and may provide protection against PD-positive H. influenzae. Vaccinations with the 10-valent pneumococcal conjugated vaccine (PHiD-CV) started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine and may provide protection against PD-positive H. influenzae. We aimed to evaluate the effect of PHiD-CV vaccination on H. influenzae in children, both in carriage and in acute otitis media (AOM). H. influenzae was isolated from nasopharyngeal swabs collected from healthy children attending 15 day care centers in 2009 and from 2012 to 2017 and from middle ear (ME) samples from children with AOM collected from 2012 to 2017. All isolates were identified using PCR for the hpd and fucK genes. Of the 3,600 samples collected from healthy children, 2,465 were culture positive for H. influenzae (68.5% carriage rate); of these, 151 (6.1%) contained hpd-negative isolates. Of the 2,847 ME samples collected, 889 (31.2%) were culture positive for H. influenzae; of these, 71 (8.0%) were hpd negative. Despite the same practice throughout the study, the annual number of ME samples reduced from 660 in 2012 to 330 in 2017. The proportions of hpd-negative isolates in unvaccinated versus vaccinated children were 5.6% and 7.0%, respectively, in healthy carriers, and 5.4% and 7.8%, respectively, in ME samples. The proportion of hpd-negative isolates increased with time in ME samples but not in healthy carriers. The number of ME samples from children with AOM decreased. The PHiD-CV had no effect on the proportion of the hpd gene in H. influenzae from carriage, but there was an increase in hpd-negative H. influenzae in otitis media. The proportions of hpd-negative isolates remained similar in vaccinated and unvaccinated children.
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Dagan R. Relationship between immune response to pneumococcal conjugate vaccines in infants and indirect protection after vaccine implementation. Expert Rev Vaccines 2019; 18:641-661. [PMID: 31230486 DOI: 10.1080/14760584.2019.1627207] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide. Widespread infant vaccination with pneumococcal conjugate vaccines (PCVs) substantially reduced vaccine-serotype pneumococcal disease by direct protection of immunized children and indirect protection of the community via decreased nasopharyngeal carriage and transmission. Essential to grasping the public health implications of pediatric PCV immunization is an understanding of how PCV formulations impact carriage. Areas covered: Using clinical evidence, this review examines how the immune response to PCVs is associated with subsequent nasopharyngeal carriage reduction in vaccinated infants and toddlers. By combining direct and indirect protection, carriage reduction results in a reduced spread of vaccine serotypes, and eventually, a decrease in vaccine serotype disease incidence in community members of all ages. Expert opinion: The current review presents some of the aspects that influence the overall impact of PCVs on vaccine-serotype carriage, and thus, spread. The link between reduction of vaccine-serotype carriage and the eventual reduction of vaccine-serotype disease in the wider community is described by comparing data from current PCVs, specifically with respect to their ability to reduce carriage of some cross-reacting serotypes (i.e. 6A versus 6B and 19A versus 19F).
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Affiliation(s)
- Ron Dagan
- a The Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel
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Manning J, Dunne EM, Wang N, Pedersen JS, Ogier JM, Burt RA, Mulholland EK, Robins-Browne RM, Malley R, Wijburg OL, Satzke C. Effect of a pneumococcal whole cell vaccine on influenza A-induced pneumococcal otitis media in infant mice. Vaccine 2019; 37:3495-3504. [PMID: 31103366 DOI: 10.1016/j.vaccine.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
The pneumococcus remains a common cause of otitis media (OM) despite the widespread introduction of pneumococcal conjugate vaccines. In mice, a pneumococcal whole cell vaccine (WCV) induces serotype-independent protection against pneumococcal colonisation and invasive disease via TH17- and antibody-mediated immunity, respectively. We investigated the effect of WCV on influenza A-induced pneumococcal OM in an infant mouse model. C57BL/6 mice were immunised subcutaneously with a single dose of WCV or adjuvant at 6 days of age, infected with pneumococci (EF3030 [serotype 19F] or PMP1106 [16F]) at 12 days of age, and given influenza A virus (A/Udorn/72/307 [H3N2], IAV) at 18 days of age to induce pneumococcal OM. Pneumococcal density in middle ear and nasopharyngeal tissues was determined 6 and 12 days post-virus. Experiments were repeated in antibody (B6.μMT-/-)- and CD4+ T-cell-deficient mice to investigate the immune responses involved. A single dose of WCV did not prevent the development of pneumococcal OM, nor accelerate pneumococcal clearance compared with mice receiving adjuvant alone. However, WCV reduced the density of EF3030 in the middle ear at 6 days post-viral infection (p = 0.022), and the density of both isolates in the nasopharynx at 12 days post-viral infection (EF3030, p = 0.035; PMP1106, p = 0.011), compared with adjuvant alone. The reduction in density in the middle ear required antibodies and CD4+ T cells: WCV did not reduce EF3030 middle ear density in B6.μMT-/- mice (p = 0.35) nor in wild-type mice given anti-CD4 monoclonal antibody before and after IAV inoculation (p = 0.91); and WCV-immunised CD4+ T cell-deficient GK1.5 mice had higher levels of EF3030 in the middle ear than their adjuvant-immunised counterparts (p = 0.044). A single subcutaneous dose of WCV reduced pneumococcal density in the middle ears of co-infected mice in one of two strains tested, but did not prevent OM from occurring in this animal model.
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Affiliation(s)
- Jayne Manning
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Eileen M Dunne
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nancy Wang
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Jacqueline M Ogier
- Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia; Neurogenetics, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Rachel A Burt
- Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia; Neurogenetics, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - E Kim Mulholland
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Infectious Diseases, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital, Boston, United States
| | - Odilia L Wijburg
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catherine Satzke
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
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Mrkvan T, Pelton SI, Ruiz-Guiñazú J, Palmu AA, Borys D. Effectiveness and impact of the 10-valent pneumococcal conjugate vaccine, PHiD-CV: review of clinical trials and post-marketing experience. Expert Rev Vaccines 2019; 17:797-818. [PMID: 30185083 DOI: 10.1080/14760584.2018.1516551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pneumococcal diseases (including septicemia, meningitis, pneumonia, and upper respiratory infections) constitute a major public health problem. The World Health Organization recommends pneumococcal conjugate vaccine immunization of young children worldwide. AREAS COVERED We reviewed evidence on the effects of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), which is used in childhood immunization programs in over 45 countries or regions. The effectiveness of PHiD-CV against invasive pneumococcal disease (IPD), pneumonia, and acute otitis media was assessed. We also present its effect on pneumococcal nasopharyngeal carriage (NPC) and indirect effects (herd protection) among unvaccinated individuals. EXPERT COMMENTARY Results from randomized, double-blind trials and post-marketing studies in various countries provide evidence of the protective efficacy, effectiveness, and impact of PHiD-CV against pneumococcal diseases. Data from different geographic locations also show reductions in NPC of vaccine pneumococcal serotypes, laying the foundation for indirect protection against pneumococcal disease. In countries where PHiD-CV is included in childhood immunization programs, there are signs of herd protection for vaccine serotypes among unvaccinated individuals. Although increases in non-vaccine serotype IPD and NPC rates were observed, there was an overall reduction of pneumococcal disease.
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Affiliation(s)
| | - Stephen I Pelton
- b Maxwell Finland Laboratory for Infectious Diseases , Boston University , Boston , MA , USA
| | | | - Arto A Palmu
- c Department of Public Health Solutions , National Institute for Health and Welfare , Tampere , Finland
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de Gier C, Granland CM, Pickering JL, Walls T, Bhuiyan M, Mills N, Richmond PC, Best EJ, Thornton RB, Kirkham LAS. PCV7- and PCV10-Vaccinated Otitis-Prone Children in New Zealand Have Similar Pneumococcal and Haemophilus influenzae Densities in Their Nasopharynx and Middle Ear. Vaccines (Basel) 2019; 7:vaccines7010014. [PMID: 30708945 PMCID: PMC6466140 DOI: 10.3390/vaccines7010014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Otitis media (OM) is a major reason for antibiotic consumption and surgery in children. Nasopharyngeal carriage of otopathogens, Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi), is a prerequisite for development of OM, and increased nasopharyngeal otopathogen density correlates with disease onset. Vaccines can reduce or eliminate otopathogen carriage, as demonstrated for pneumococcal serotypes included in pneumococcal conjugate vaccines (PCV). The 10-valent PCV (PCV10) includes an NTHi carrier protein, and in 2011 superseded 7-valent PCV on the New Zealand Immunisation Program. Data are conflicting on whether PCV10 provides protection against NTHi carriage or disease. Assessing this in otitis-prone cohorts is important for OM prevention. We compared otopathogen density in the nasopharynx and middle ear of New Zealand PCV7-vaccinated and PCV10-vaccinated otitis-prone and non-otitis-prone children to determine PCV10 impact on NTHi and S. pneumoniae carriage. We applied qPCR to specimens collected from 217 PCV7-vaccinated children (147 otitis-prone and 70 non-otitis-prone) and 240 PCV10-vaccinated children (178 otitis-prone and 62 non-otitis-prone). After correcting for age and day-care attendance, no difference was observed between NTHi density in the nasopharynx of PCV7-vaccinated versus PCV10-vaccinated otitis-prone (p = 0.563) or non-otitis-prone (p = 0.513) children. In contrast, pneumococcal nasopharyngeal density was higher in PCV10-vaccinated otitis-prone children than PCV7-vaccinated otitis-prone children (p = 0.003). There was no difference in otopathogen density in middle ear effusion from PCV7-vaccinated versus PCV10-vaccinated otitis-prone children (NTHi p = 0.918; S. pneumoniae p = 0.415). When pneumococcal carriage was assessed by vaccine serotypes (VT) and non-vaccine serotypes (NVT), there was no difference in VT density (p = 0.546) or NVT density (p = 0.315) between all PCV7-vaccinated versus all PCV10-vaccinated children. In summary, PCV10 did not reduce NTHi density in the nasopharynx or middle ear, and was associated with increased pneumococcal nasopharyngeal density in otitis-prone children in New Zealand. Development of therapies that prevent or reduce otopathogen colonisation density in the nasopharynx are warranted to reduce the burden of OM.
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Affiliation(s)
- Camilla de Gier
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Janessa L Pickering
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand.
| | - Mejbah Bhuiyan
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Nikki Mills
- Starship Hospital, Auckland 1023, New Zealand.
- School of Medicine, University of Auckland, Auckland 1023, New Zealand.
| | - Peter C Richmond
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
- Department of General Paediatrics, Perth Children's Hospital, Perth 6009, Australia.
| | - Emma J Best
- Starship Hospital, Auckland 1023, New Zealand.
- School of Medicine, University of Auckland, Auckland 1023, New Zealand.
| | - Ruth B Thornton
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
- Centre for Child Health Research, University of Western Australia, Perth 6009, Australia.
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Coleman A, Wood A, Bialasiewicz S, Ware RS, Marsh RL, Cervin A. The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. MICROBIOME 2018; 6:199. [PMID: 30396360 PMCID: PMC6219068 DOI: 10.1186/s40168-018-0577-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Otitis media (OM) imposes a great burden of disease in indigenous populations around the world, despite a variety of treatment and prevention programs. Improved understanding of the pathogenesis of OM in indigenous populations is required to advance treatment and reduce prevalence. We conducted a systematic review of the literature exploring the upper airway and middle ear microbiota in relation to OM in indigenous children. METHODS Papers targeting microbiota in relation to OM in children < 18 years indigenous to Australia, New Zealand, North America, and Greenland were sought. MEDLINE, CINAHL, EMBASE, Cochrane Library, and Informit databases were searched using key words. Two independent reviewers screened titles, abstracts, and then full-text papers against inclusion criteria according to PRISMA guidelines. RESULTS Twenty-five papers considering indigenous Australian, Alaskan, and Greenlandic children were included. There were high rates of nasopharyngeal colonization with the three main otopathogens (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) in indigenous children with OM. Middle ear samples had lower rates of otopathogen detection, although detection rates increased when molecular methods were used. Pseudomonas aeruginosa and Staphylococcus aureus were commonly detected in middle ear discharge of children with chronic suppurative OM. There was a significant heterogeneity between studies, particularly in microbiological methods, which were largely limited to culture-based detection of the main otopathogens. CONCLUSIONS There are high rates of otopathogen colonization in indigenous children with OM. Chronic suppurative OM appears to be associated with a different microbial profile. Beyond the main otopathogens, the data are limited. Further research is required to explore the entire upper respiratory tract/middle ear microbiota in relation to OM, with the inclusion of healthy indigenous peers as controls.
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Affiliation(s)
- Andrea Coleman
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland Australia
- Queensland Pediatric Infectious Disease Laboratory, Centre for Children’s Health Research, Children’s Health Queensland Hospital, Queensland University of Technology, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Amanda Wood
- The Deadly Ears Program, Children’s Health Queensland Hospital and Health Service, Brisbane, Queensland Australia
| | - Seweryn Bialasiewicz
- Queensland Pediatric Infectious Disease Laboratory, Centre for Children’s Health Research, Children’s Health Queensland Hospital, Queensland University of Technology, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland Australia
| | - Robyn L. Marsh
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Anders Cervin
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland Australia
- Head & Neck Surgery, Department of Otolaryngology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia
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26
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Le Meur JB, Ayukawa H, Proulx JF, De Wals P. Prevalence of middle ear abnormalities from otitis media in relation with pneumococcal vaccine use in the Inuit population of Nunavik, province of Quebec, Canada. Vaccine 2018; 36:5180-5186. [PMID: 30026032 DOI: 10.1016/j.vaccine.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Otitis media (OM) constitutes an important public health problem in the Inuit population of Nunavik, Northern Quebec. One of the objectives of the childhood pneumococcal vaccination program is to reduce OM burden. The program was implemented in 2002, and 7-, 10-, and 13-valent conjugate vaccines were used sequentially, with doses offered at 2, 4, 6 and 12-18 months, respectively. OBJECTIVE To assess the prevalence of middle ear abnormalities at age 5 years in relation with exposure to different pneumococcal conjugate vaccines. METHODS Immunization cards and audiology screening tests at age 5 years of children born in 1994-2010 were reviewed. Children were classified according to the vaccine schedule recommended for their birth cohort or to the vaccines they actually received. Log-linked binomial regression models were used to assess the relative abnormalities risk according to different vaccination schedules. RESULTS Among 3517 children with complete documentation, the prevalences of minor and major abnormalities were 29% and 18%, respectively. Minor abnormalities frequency was higher in unvaccinated children (34%) and lower in children vaccinated with PCV7 (22%), PCV7 + PCV10 (17%), PCV10 (15%) and PCV10 + PCV13 (18%). No substantial differences among vaccine schedules were observed for major abnormalities. CONCLUSIONS Pneumococcal conjugate vaccination was associated with a decreased frequency of middle ear abnormalities although no effect was seen for major abnormalities which may be trigger by OM with early onset. Clinicaltrials.gov registration number: NCT01694329.
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Affiliation(s)
- J B Le Meur
- Department of Social and Preventive Medicine, Laval University, Quebec City, Canada; Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec City, Canada
| | - H Ayukawa
- Ungava Tulattavik Health Centre, Canada
| | - J F Proulx
- Public Health Directorate, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Canada
| | - P De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Canada; Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec City, Canada; Quebec University Hospital Research Centre, Quebec City, Canada.
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Smith-Vaughan HC, Binks MJ, Beissbarth J, Chang AB, McCallum GB, Mackay IM, Morris PS, Marsh RL, Torzillo PJ, Wurzel DF, Grimwood K, Nosworthy E, Gaydon JE, Leach AJ, MacHunter B, Chatfield MD, Sloots TP, Cheng AC. Bacteria and viruses in the nasopharynx immediately prior to onset of acute lower respiratory infections in Indigenous Australian children. Eur J Clin Microbiol Infect Dis 2018; 37:1785-1794. [PMID: 29959609 PMCID: PMC7088242 DOI: 10.1007/s10096-018-3314-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
Acute lower respiratory infection (ALRI) is a major cause of hospitalization for Indigenous children in remote regions of Australia. The associated microbiology remains unclear. Our aim was to determine whether the microbes present in the nasopharynx before an ALRI were associated with its onset. A retrospective case-control/crossover study among Indigenous children aged up to 2 years. ALRI cases identified by medical note review were eligible where nasopharyngeal swabs were available: (1) 0–21 days before ALRI onset (case); (2) 90–180 days before ALRI onset (same child controls); and (3) from time and age-matched children without ALRI (different child controls). PCR assays determined the presence and/or load of selected respiratory pathogens. Among 104 children (182 recorded ALRI episodes), 120 case-same child control and 170 case-different child control swab pairs were identified. Human adenoviruses (HAdV) were more prevalent in cases compared to same child controls (18 vs 7%; OR = 3.08, 95% CI 1.22–7.76, p = 0.017), but this association was not significant in cases versus different child controls (15 vs 10%; OR = 1.93, 95% CI 0.97–3.87 (p = 0.063). No other microbes were more prevalent in cases compared to controls. Streptococcus pneumoniae (74%), Haemophilus influenzae (75%) and Moraxella catarrhalis (88%) were commonly identified across all swabs. In a pediatric population with a high detection rate of nasopharyngeal microbes, HAdV was the only pathogen detected in the period before illness presentation that was significantly associated with ALRI onset. Detection of other potential ALRI pathogens was similar between cases and controls.
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Affiliation(s)
- Heidi C Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia. .,School of Medicine, Griffith University, Gold Coast, 4222, Australia.
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, 4101, Australia
| | - Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Ian M Mackay
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, 4101, Australia.,Department of Health, Public and Environmental Health Virology Laboratory, Forensic and Scientific Services, Archerfield, 4108, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,Royal Darwin Hospital, Darwin, 0810, Australia
| | - Robyn L Marsh
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | | | - Danielle F Wurzel
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, 3052, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, 4222, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, Australia.,Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, 4215, Australia
| | - Elizabeth Nosworthy
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Jane E Gaydon
- QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Barbara MacHunter
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Theo P Sloots
- UQ Centre for Child Health Research, The University of Queensland, Brisbane, 4101, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Health, Melbourne, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, 3800, Australia.
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Varghese L, Talbot L, Govender A, Zhang XH, Mungall BA. A Cost-Effectiveness Analysis of the 10-Valent Pneumococcal Non-Typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) Compared to the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) for Universal Mass Vaccination Implementation in New Zealand. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:331-345. [PMID: 29633160 PMCID: PMC5940727 DOI: 10.1007/s40258-018-0387-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Invasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) still represent a significant medical burden in children < 5 years of age in New Zealand (NZ), with marked disparities across socio-economic and ethnic groups. This cost-effectiveness evaluation aims to compare the potential impact of two childhood universal immunisation strategies: vaccination with a 3 + 1 schedule of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix, GSK) and the 13-valent pneumococcal conjugate vaccine (PCV13, Prevenar 13, Pfizer). METHODS A static Markov-process cohort model was used to simulate the epidemiological and economic burden of pneumococcal diseases on a single-birth cohort over its lifetime. Costs and outcomes were discounted annually at 3.5%. Epidemiological and cost inputs were extracted from the most recently available NZ data, or derived from the most relevant reference countries' sources. The most updated evidence on the efficacies of the corresponding vaccines were used, particularly the significant effectiveness for PHiD-CV against IPD caused by serotype 19A. RESULTS The model estimated that both vaccines have a broadly comparable impact on IPD-related diseases and pneumonia. Due to the additional benefits possible through broader impact on AOM, PHiD-CV is estimated to potentially provide additional discounted cost offsets of approximately NZD 0.8 million over the lifetime of the birth cohort. CONCLUSIONS To ensure health equity in children, given the substantial burden of pneumonia and AOM, decision-makers should also take into account the impact of PCVs on these diseases for decisions relating to routine infant immunization. GSK STUDY IDENTIFIER HO-15-16775.
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Affiliation(s)
- Lijoy Varghese
- GSK Pte Ltd, 23 Rochester Park, Singapore, 139234 Singapore
| | | | | | - Xu-Hao Zhang
- GSK Pte Ltd, 23 Rochester Park, Singapore, 139234 Singapore
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29
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Reduced nontypeable Haemophilus influenzae lower airway infection in children with chronic endobronchial suppuration vaccinated with the 10-valent pneumococcal H. influenzae protein D conjugate vaccine. Vaccine 2018; 36:1736-1742. [DOI: 10.1016/j.vaccine.2018.02.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022]
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Lehmann D, Kirarock W, van den Biggelaar AHJ, Passey M, Jacoby P, Saleu G, Masiria G, Nivio B, Greenhill A, Orami T, Francis J, Ford R, Kirkham LA, Solomon V, Richmond PC, Pomat WS. Rationale and methods of a randomized controlled trial of immunogenicity, safety and impact on carriage of pneumococcal conjugate and polysaccharide vaccines in infants in Papua New Guinea. Pneumonia (Nathan) 2017; 9:20. [PMID: 29299402 PMCID: PMC5742486 DOI: 10.1186/s41479-017-0044-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children in third-world settings including Papua New Guinea (PNG) experience early onset of carriage with a broad range of pneumococcal serotypes, resulting in a high incidence of severe pneumococcal disease and deaths in the first 2 years of life. Vaccination trials in high endemicity settings are needed to provide evidence and guidance on optimal strategies to protect children in these settings against pneumococcal infections. METHODS This report describes the rationale, objectives, methods, study population, follow-up and specimen collection for a vaccination trial conducted in an endemic and logistically challenging setting in PNG. The trial aimed to determine whether currently available pneumococcal conjugate vaccines (PCV) are suitable for use under PNG's accelerated immunization schedule, and that a schedule including pneumococcal polysaccharide vaccine (PPV) in later infancy is safe and immunogenic in this high-risk population. RESULTS This open randomized-controlled trial was conducted between November 2011 and March 2016, enrolling 262 children aged 1 month between November 2011 and April 2014. The participants were randomly allocated (1:1) to receive 10-valent PCV (10vPCV) or 13-valent PCV (13vPCV) in a 1-2-3-month schedule, with further randomization to receive PPV or no PPV at age 9 months, followed by a 1/5th PPV challenge at age 23 months. A total of 1229 blood samples were collected to measure humoral and cellular immune responses and 1238 nasopharyngeal swabs to assess upper respiratory tract colonization and carriage load. Serious adverse events were monitored throughout the study. Of the 262 children enrolled, 87% received 3 doses of PCV, 79% were randomized to receive PPV or no PPV at age 9 months, and 67% completed the study at 24 months of age with appropriate immunization and challenge. CONCLUSION Laboratory testing of the many samples collected during this trial will determine the impact of the different vaccine schedules and formulations on nasopharyngeal carriage, antibody production and function, and immune memory. The final data will inform policy on pneumococcal vaccine schedules in countries with children at high risk of pneumococcal disease by providing direct comparison of an accelerated schedule of 10vPCV and 13vPCV and the potential advantages of PPV following PCV immunization. TRIAL REGISTRATION ClinicalTrials.gov CTN NCT01619462, retrospectively registered on May 28, 2012.
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Affiliation(s)
- Deborah Lehmann
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Wendy Kirarock
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | | | - Megan Passey
- The University of Sydney, University Centre for Rural Health, School of Public Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Gerard Saleu
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Birunu Nivio
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Andrew Greenhill
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
- School of Applied and Biomedical Sciences, Federation University, Northways Road, Churchill, VIC 3842 Australia
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Jacinta Francis
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Lea-Ann Kirkham
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Peter C. Richmond
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - William S. Pomat
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
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Wasserman M, Sings HL, Jones D, Pugh S, Moffatt M, Farkouh R. Review of vaccine effectiveness assumptions used in economic evaluations of infant pneumococcal conjugate vaccine. Expert Rev Vaccines 2017; 17:71-78. [DOI: 10.1080/14760584.2018.1409116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cookson WOCM, Cox MJ, Moffatt MF. New opportunities for managing acute and chronic lung infections. Nat Rev Microbiol 2017; 16:111-120. [PMID: 29062070 DOI: 10.1038/nrmicro.2017.122] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lung diseases caused by microbial infections affect hundreds of millions of children and adults throughout the world. In Western populations, the treatment of lung infections is a primary driver of antibiotic resistance. Traditional therapeutic strategies have been based on the premise that the healthy lung is sterile and that infections grow in a pristine environment. As a consequence, rapid advances in our understanding of the composition of the microbiota of the skin and bowel have not yet been matched by studies of the respiratory tree. The recognition that the lungs are as populated with microorganisms as other mucosal surfaces provides the opportunity to reconsider the mechanisms and management of lung infections. Molecular analyses of the lung microbiota are revealing profound adverse responses to widespread antibiotic use, urbanization and globalization. This Opinion article proposes how technologies and concepts flowing from the Human Microbiome Project can transform the diagnosis and treatment of common lung diseases.
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Affiliation(s)
- William O C M Cookson
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
| | - Michael J Cox
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
| | - Miriam F Moffatt
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
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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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Wang XJ, Saha A, Zhang XH. Cost-effectiveness analysis of a universal mass vaccination program with a PHiD-CV 2+1 schedule in Malaysia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:17. [PMID: 28852326 PMCID: PMC5568314 DOI: 10.1186/s12962-017-0079-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 08/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Currently, two pediatric pneumococcal conjugate vaccines are available in the private market of Malaysia—13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). This study aimed to evaluate the cost-effectiveness of a universal mass vaccination program with a PHiD-CV 2+1 schedule versus no vaccination or with a PCV13 2+1 schedule in Malaysia. Methods A published Markov cohort model was adapted to evaluate the epidemiological and economic consequences of programs with no vaccination, a PHiD-CV 2+1 schedule or a PCV13 2+1 schedule over a 10-year time horizon. Disease cases, deaths, direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were estimated. Locally published epidemiology and cost data were used whenever possible. Vaccine effectiveness and disutility data were based on the best available published data. All data inputs and assumptions were validated by local clinical and health economics experts. Analyses were conducted from the perspective of the Malaysian government for a birth cohort of 508,774. Costs and QALYs were discounted at 3% per annum. One-way and probabilistic sensitivity analyses were performed. Results Compared with no vaccination, a PHiD-CV 2+1 program was projected to prevent 1109 invasive pneumococcal disease (IPD), 24,679 pneumonia and 72,940 acute otitis media (AOM) cases and 103 IPD/pneumonia deaths over 10 years, with additional costs and QALYs of United States dollars (USD) 30.9 million and 1084 QALYs, respectively, at an ICER of USD 28,497/QALY. Compared with a PCV13 2+1 program, PHiD-CV 2+1 was projected to result in similar reductions in IPD cases (40 cases more) but significantly fewer AOM cases (30,001 cases less), with cost savings and additional QALYs gained of USD 5.2 million and 116 QALYs, respectively, demonstrating dominance over PCV13. Results were robust to variations in one-way and probabilistic sensitivity analyses. Conclusions A PHiD-CV 2+1 universal mass vaccination program could substantially reduce pneumococcal disease burden versus no vaccination, and was expected to be cost-effective in Malaysia. A PHiD-CV 2+1 program was also expected to be a dominant choice over a PCV13 2+1 program in Malaysia. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0079-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Jun Wang
- Department of Pharmacy, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543 Singapore.,GSK, 150 Beach Road, #22-00 Gateway West, Singapore, 189720 Singapore
| | - Ashwini Saha
- GSK Pharmaceutical Sdn Bhd, Level 6, Quill 9, 112 Jalan Semangat, 46300 Petaling Jaya, Selangor Malaysia
| | - Xu-Hao Zhang
- Department of Pharmacy, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543 Singapore.,GSK, 150 Beach Road, #22-00 Gateway West, Singapore, 189720 Singapore
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Slack MPE. The evidence for non-typeable Haemophilus influenzae as a causative agent of childhood pneumonia. Pneumonia (Nathan) 2017; 9:9. [PMID: 28702311 PMCID: PMC5483294 DOI: 10.1186/s41479-017-0033-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/31/2017] [Indexed: 11/21/2022] Open
Abstract
Haemophilus influenzae type b (Hib) was a major cause of bacterial pneumonia in children prior to the introduction of Hib-conjugate vaccines. The widespread use of Hib-conjugate vaccines has resulted in a significant decline in the number of cases of invasive Hib disease, including bacteraemic pneumonia, in areas where the vaccine has been implemented. In many countries, non-typeable H. influenzae (NTHI) is now the most common cause of invasive haemophilus infection in all ages. NTHI are a recognized cause of bacteraemic and non-bacteraemic pneumonia in children and in adults. Less than 10% of cases of pediatric pneumonia are bacteraemic, and children generally do not expectorate lower respiratory tract secretions, so determining the microbial cause of a non-bacteraemic pneumonia is challenging. In this commentary the evidence that NTHI is a cause of pneumonia in children is briefly reviewed.
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Affiliation(s)
- Mary P E Slack
- School of Medicine, Gold Coast Campus, Griffith University, Southport, Queensland 4222 Australia
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36
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Sartori AL, Minamisava R, Bierrenbach AL, Toscano CM, Afonso ET, Morais-Neto OL, Antunes JLF, Cristo EB, Andrade AL. Reduction in all-cause otitis media-related outpatient visits in children after PCV10 introduction in Brazil. PLoS One 2017; 12:e0179222. [PMID: 28594913 PMCID: PMC5464612 DOI: 10.1371/journal.pone.0179222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Few studies have reported the effect of 10-valent pneumococcal conjugate vaccine (PCV10) on otitis media (OM) in infants. In particular, no population-based study in upper-middle income countries is available. In 2010, Brazil introduced PCV10 into its routine National Immunization Program using a 3+1 schedule. We measured the impact of PCV10 on all-cause OM in children. An interrupted time-series analysis was conducted in Goiânia/Brazil considering monthly rates (per 100,000) of all-cause OM outpatient visits in children aged 2–23 months. We used case-based data from the Outpatient Visits Information System of the Unified Health System coded for ICD-10 diagnosis for the period of August/2008 to July/2015. As a comparator, we used rates of outpatient visits due to all-other causes. The relative reduction of all-cause OM and all-other causes of outpatient visits were calculated as the difference between the predicted and observed cumulative rates of the PCV10 post-vaccination period. We then subtracted the relative reduction of all-other causes of outpatient visits from all-cause OM to obtain the impact of PCV10 on OM. In total, 6,401 OM outpatient visits were recorded in 4,793 children aged 2–23 months. Of these, 922 (19.2%) children had more than one OM episode. A significant reduction in all-cause OM visits was observed (50.7%; 95%CI: 42.2–59.2%; p = 0.013), while the reduction in visits due to all-other causes was 7.7% (95% CI 0.8–14.7%; p<0.001). The impact of PCV10 on all-cause OM was thus estimated at 43.0% (95%CI 41.4–44.5). This is the first study to show significant PCV10 impact on OM outpatient visits in infants in a developing country. Our findings corroborate the available evidence from developed countries.
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Affiliation(s)
- Ana L. Sartori
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - Ana L. Bierrenbach
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Cristiana M. Toscano
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Eliane T. Afonso
- School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Otaliba L. Morais-Neto
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | - Elier B. Cristo
- Advisor of the Secretariat of Health, São Paulo, São Paulo, Brazil
| | - Ana Lucia Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- * E-mail:
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Clarke C, Bakaletz LO, Ruiz-Guiñazú J, Borys D, Mrkvan T. Impact of protein D-containing pneumococcal conjugate vaccines on non-typeable Haemophilus influenzae acute otitis media and carriage. Expert Rev Vaccines 2017; 16:1-14. [PMID: 28571504 DOI: 10.1080/14760584.2017.1333905] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Protein D-containing vaccines may decrease acute otitis media (AOM) burden and nasopharyngeal carriage of non-typeable Haemophilus influenzae (NTHi). Protein D-containing pneumococcal conjugate vaccine PHiD-CV (Synflorix, GSK Vaccines) elicits robust immune responses against protein D. However, the phase III Clinical Otitis Media and PneumoniA Study (COMPAS), assessing PHiD-CV efficacy against various pneumococcal diseases, was not powered to demonstrate efficacy against NTHi; only trends of protective efficacy against NTHi AOM in children were shown. Areas covered: This review aims to consider all evidence available to date from pre-clinical and clinical phase III studies together with further evidence emerging from post-marketing studies since PHiD-CV has been introduced into routine clinical practice worldwide, to better describe the clinical utility of protein D in preventing AOM due to NTHi and its impact on NTHi nasopharyngeal carriage. Expert commentary: Protein D is an effective carrier protein in conjugate vaccines and evidence gathered from pre-clinical, clinical and observational studies suggest that it also elicits immune response that can help to reduce the burden of AOM due to NTHi. There remains a need to develop improved vaccines for prevention of NTHi disease, which could be achieved by combining protein D with other antigens.
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Affiliation(s)
- Christopher Clarke
- a Department of Vaccine Research and Development, GSK Vaccines , Wavre , Belgium
| | - Lauren O Bakaletz
- b Center for Microbial Pathogenesis , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA.,c The Ohio State University College of Medicine , Columbus , OH , USA
| | - Javier Ruiz-Guiñazú
- a Department of Vaccine Research and Development, GSK Vaccines , Wavre , Belgium
| | - Dorota Borys
- a Department of Vaccine Research and Development, GSK Vaccines , Wavre , Belgium
| | - Tomas Mrkvan
- a Department of Vaccine Research and Development, GSK Vaccines , Wavre , Belgium
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Sriram KB, Cox AJ, Clancy RL, Slack MPE, Cripps AW. Nontypeable Haemophilus influenzae and chronic obstructive pulmonary disease: a review for clinicians. Crit Rev Microbiol 2017; 44:125-142. [PMID: 28539074 DOI: 10.1080/1040841x.2017.1329274] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. In the lower airways of COPD patients, bacterial infection is a common phenomenon and Haemophilus influenzae is the most commonly identified bacteria. Haemophilus influenzae is divided into typeable and nontypeable (NTHi) strains based on the presence or absence of a polysaccharide capsule. While NTHi is a common commensal in the human nasopharynx, it is associated with considerable inflammation when it is present in the lower airways of COPD patients, resulting in morbidity due to worsening symptoms and increased frequency of COPD exacerbations. Treatment of lower airway NTHi infection with antibiotics, though successful in the short term, does not offer long-term protection against reinfection, nor does it change the course of the disease. Hence, there has been much interest in the development of an effective NTHi vaccine. This review will summarize the current literature concerning the role of NTHi infections in COPD patients and the consequences of using prophylactic antibiotics in patients with COPD. There is particular focus on the rationale, findings of clinical studies and possible future directions of NTHi vaccines in patients with COPD.
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Affiliation(s)
- Krishna Bajee Sriram
- a Department of Respiratory Medicine , Gold Coast University Hospital, Gold Coast Health , Southport , Australia.,b Griffith University School of Medicine , Southport , Australia
| | - Amanda J Cox
- c Menzies Health Institute , Griffith University School of Medical Science , Gold Coast , Australia
| | - Robert L Clancy
- d Faculty of Health and Medicine , University of Newcastle , Callaghan , Australia
| | - Mary P E Slack
- b Griffith University School of Medicine , Southport , Australia
| | - Allan W Cripps
- b Griffith University School of Medicine , Southport , Australia
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Granath A. Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention? CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:93-100. [PMID: 28616364 PMCID: PMC5446546 DOI: 10.1007/s40136-017-0151-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review To survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM). Recent Findings Treatment with systemic antibiotics is required in recurrent episodes of acute otitis media. A cautious attitude is recommended due to antibiotic resistance. Antibiotics also provide effective prophylaxis for rAOM. Topical treatment with ear drops is recommended in rAOM with otorrhea from tympanostomy tubes. Pneumococcal conjugated vaccines seem to have a moderate reductive effect on overall otitis media. The effect on rAOM is still unclear. Different administrations of immunoglobulins have not been effective against rAOM. Breastfeeding had a protective effect against rAOM. A recommendation against cigarette smoke exposure as a measure to prevent otitis seems warranted. An effect for adenoidectomy in children <2 years old with rAOM has been suggested. There is a strong genetic connection with rAOM. Probiotics and nasal spray with Streptococci might offer future opportunities as prophylaxis. Too little is known about complimentary treatments to give any recommendations. Summary Systemic antibiotics are still needed as treatment against episodes of AOM in rAOM children. There are several preventive measures that can be taken to reduce the burden of AOM but they all have a small-moderate effect. Systemic antibiotics provide effective prophylaxis in rAOM, but must be used with extreme caution due to the emerging antibiotic resistance.
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Affiliation(s)
- Anna Granath
- ENT-Department Karolinska University Hospital and Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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40
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Bröker M, Berti F, Schneider J, Vojtek I. Polysaccharide conjugate vaccine protein carriers as a "neglected valency" - Potential and limitations. Vaccine 2017; 35:3286-3294. [PMID: 28487056 DOI: 10.1016/j.vaccine.2017.04.078] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 12/01/2022]
Abstract
The development of vaccines against polysaccharide-encapsulated pathogens (e.g. Haemophilus influenzae type b, pneumococci, meningococci) is challenging because polysaccharides do not elicit a strong and long-lasting immune response (i.e. T-cell independent). This can be overcome by conjugating the polysaccharide to a protein carrier (e.g. tetanus toxoid, cross-reacting material 197 [CRM]), which vastly improves the immune response and induces memory to the polysaccharide (T-cell dependent). Although it is well documented that protein carriers additionally induce an immune response against themselves, this potential "additional valency" has so far not been recognized. The only exception is for the protein D carrier (derived from non-typeable Haemophilus influenzae [NTHi]) used in a pneumococcal conjugate vaccine, which may have a beneficial impact on NTHi acute otitis media. In this review, we describe the immunogenicity of various protein carriers and discuss their potential dual function: as providers of T-cell helper epitopes and as protective antigens. If this "additional valency" could be proven to be protective, it may be possible to consider its potential effect on the number of required immunizations. We also describe the potential for positive or negative interference between conjugate vaccines using the same protein carriers, the resulting desire for novel carriers, and information on potential new carriers. The range of conjugate vaccines is ever expanding, with different carriers and methods of conjugation. We propose that new conjugate vaccine trials should assess immunogenicity to both the polysaccharide and carrier. Ultimately, this so-far "neglected valency" could be an exploitable characteristic of polysaccharide conjugate vaccines.
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Affiliation(s)
- Michael Bröker
- GSK Vaccines GmbH, Emil-von-Behring-Str. 76, 35041 Marburg, Germany.
| | | | - Joerg Schneider
- LimmaTech Biologics AG, Grabenstrasse 3, 8952 Schlieren, Switzerland.
| | - Ivo Vojtek
- GSK Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
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Australian Aboriginal Children with Otitis Media Have Reduced Antibody Titers to Specific Nontypeable Haemophilus influenzae Vaccine Antigens. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00556-16. [PMID: 28151410 PMCID: PMC5382827 DOI: 10.1128/cvi.00556-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
Abstract
Indigenous populations experience high rates of otitis media (OM), with increased chronicity and severity, compared to those experienced by their nonindigenous counterparts. Data on immune responses to otopathogenic bacteria in these high-risk populations are lacking. Nontypeable Haemophilus influenzae (NTHi) is the predominant otopathogen in Australia. No vaccines are currently licensed to target NTHi; however, protein D (PD) from NTHi is included as a carrier protein in the 10-valent pneumococcal polysaccharide conjugate vaccine (PHiD10-CV), and other promising protein vaccine candidates exist, including outer membrane protein 4 (P4) and protein 6 (P6). We measured the levels of serum and salivary IgA and IgG against PD, P4, and P6 in Aboriginal and non-Aboriginal children with chronic OM who were undergoing surgery and compared the levels with those in healthy non-Aboriginal children (controls). We found that Aboriginal cases had lower serum IgG titers to all NTHi proteins assessed, particularly PD. In contrast, serum IgA and salivary IgA and IgG titers to each of these 3 proteins were equivalent to or higher than those in both non-Aboriginal cases and healthy controls. While serum antibody levels increased with age in healthy controls, no changes in titers were observed with age in non-Aboriginal cases, and a trend toward decreasing titers with age was observed in Aboriginal cases. This suggests that decreased serum IgG responses to NTHi outer membrane proteins may contribute to the development of chronic and severe OM in Australian Aboriginal children and other indigenous populations. These data are important for understanding the potential benefits of PHiD10-CV implementation and the development of NTHi protein-based vaccines for indigenous populations.
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Harris TM, Rumaseb A, Beissbarth J, Barzi F, Leach AJ, Smith-Vaughan HC. Culture of non-typeable Haemophilus influenzae from the nasopharynx: Not all media are equal. J Microbiol Methods 2017; 137:3-5. [PMID: 28342745 DOI: 10.1016/j.mimet.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/19/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
Abstract
The efficacy of chocolate agar, versus bacitracin, vancomycin, clindamycin, chocolate agar (BVCCA) for the isolation of non-typeable Haemophilus influenzae (NTHi) from nasopharyngeal swabs was determined. BVCCA cultured NTHi from 97.3% of NTHi-positive swabs, compared to 87.1% for chocolate agar. To maximise culture sensitivity, the use of both media is recommended.
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Affiliation(s)
- Tegan M Harris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Angela Rumaseb
- 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.
| | - Federica Barzi
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
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Hare KM, Smith-Vaughan HC, Chang AB, Pizzutto S, Petsky HL, McCallum GB, Leach AJ. Propensity of pneumococcal carriage serotypes to infect the lower airways of children with chronic endobronchial infections. Vaccine 2017; 35:747-756. [PMID: 28062125 DOI: 10.1016/j.vaccine.2016.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic endobronchial infections in children are responsible for a high disease burden. Streptococcus pneumoniae is frequently isolated; however, few publications have described serotypes associated with non-invasive lower airway infection. METHODS Paired nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids were collected from children undergoing bronchoscopy for chronic cough. NP swabs were also collected from asymptomatic children in otitis media surveillance studies (controls). Specimens were processed and lower airway infection defined (⩾104 colony forming units/mL BAL) as previously described. Serotype-specific odds ratios (ORs) were calculated (as described for invasive pneumococcal disease) to indicate propensity for infection. RESULTS From 2007-2015, paired specimens were processed from 435 children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) or bronchiectasis. S. pneumoniae lower airway infection was detected in 95 children: 27% with PBB and 20% with CSLD/bronchiectasis. Most (91%) children were vaccinated with ⩾2 doses of 7-valent, 10-valent or 13-valent pneumococcal conjugate vaccine. Paired NP and BAL serotype distributions were very similar; prevalent serotypes (>10 isolates) were 19A (9%), 19F, 6C, 35B, 15B, 16F, 15A, 15C, 23A, 23F and 11A. For 21 serotypes found in both NP and BAL specimens, ORs for infection were low; range 0.46 (serotype 23B) to 2.15 (serotype 6A). In the 2008-2013 surveillance studies, NP swabs were collected from 1565 asymptomatic children; 74% were pneumococcal carriers. For 21 of 22 serotypes found in both control NP swabs and BAL specimens, ORs for infection were similarly low; range 0.33 (serotype 23B) to 3.29 (serotype 22F); none was significantly different from 1. The exception was serotype 7B with OR 8.84 (95% CI 1.46, 38.1). CONCLUSIONS Most NP carriage serotypes have a similar propensity to cause lower airway infection in children with suppurative lung diseases. Further development of pneumococcal vaccines is needed to prevent non-invasive disease caused by commonly carried serotypes.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia.
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia; Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Susan Pizzutto
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Helen L Petsky
- Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
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Pizzutto SJ, Hare KM, Upham JW. Bronchiectasis in Children: Current Concepts in Immunology and Microbiology. Front Pediatr 2017; 5:123. [PMID: 28611970 PMCID: PMC5447051 DOI: 10.3389/fped.2017.00123] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 12/26/2022] Open
Abstract
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by chronic infection, airway inflammation, and progressive decline in lung function. Early diagnosis and intensive treatment protocols can stabilize or even improve the clinical prognosis of children with bronchiectasis. However, understanding the host immunologic mechanisms that contribute to recurrent infection and prolonged inflammation has been identified as an important area of research that would contribute substantially to effective prevention strategies for children at risk of bronchiectasis. This review will focus on the current understanding of the role of the host immune response and important pathogens in the pathogenesis of bronchiectasis (not associated with cystic fibrosis) in children.
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Affiliation(s)
- Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Varghese L, Mungall B, Zhang XH, Hoet B. Response to Wu et al. - Cost-effectiveness analysis of infant pneumococcal vaccination in Malaysia and Hong Kong. Hum Vaccin Immunother 2016; 12:2675-2680. [PMID: 27459265 PMCID: PMC5084998 DOI: 10.1080/21645515.2016.1192738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A recently published paper that assessed the comparative cost-effectiveness of the 2 pneumococcal conjugate vaccines (PCVs) in Malaysia and Hong Kong reported that the 13-valent PCV vaccine (PCV13) is a better choice compared to the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV or PCV10) from both a payer and societal perspective as well as under various scenarios. However, the analysis relied on a large number of assumptions that were either erroneous or did not take into account the most recent body of evidence available. A rigorous evaluation of the underlying assumptions is necessary to present a fair and balanced analysis for decision-making.
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46
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Dagan R, Pelton S, Bakaletz L, Cohen R. Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:480-92. [PMID: 27036355 DOI: 10.1016/s1473-3099(15)00549-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/22/2022]
Abstract
Otitis media is a common childhood infection of the middle ear and a major cause of morbidity. This multifactorial disease manifests as a spectrum of clinical syndromes from uncomplicated acute otitis media to more complex recurrent and chronic cases (frequently polymicrobial), with the major pathogens involved being Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Pneumococcal conjugate vaccines (PCVs) target only a few serotypes that cause otitis media; however, results from studies suggest that existing PCVs can prevent early episodes of disease associated with vaccine serotypes, resulting in a reduction of subsequent complex cases caused by non-vaccine serotypes and other otopathogens, which contribute considerably to the disease burden. In this Review, we discuss the role of pneumococcus in the disease continuum and assess clinical evidence showing the effect of prevention of early episodes on the complex interplay between bacterial species implicated in otitis media.
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Affiliation(s)
- Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Lauren Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, and Unité Court Séjour, Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Paris, France
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Santos-Cortez RLP, Reyes-Quintos MRT, Tantoco MLC, Abbe I, Llanes EGDV, Ajami NJ, Hutchinson DS, Petrosino JF, Padilla CD, Villarta RL, Gloria-Cruz TL, Chan AL, Cutiongco-de la Paz EM, Chiong CM, Leal SM, Abes GT. Genetic and Environmental Determinants of Otitis Media in an Indigenous Filipino Population. Otolaryngol Head Neck Surg 2016; 155:856-862. [PMID: 27484237 DOI: 10.1177/0194599816661703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/08/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify genetic and environmental risk factors for otitis media in an indigenous Filipino population. STUDY DESIGN Cross-sectional study. SETTING Indigenous Filipino community. SUBJECTS AND METHODS Clinical history and information on breastfeeding, tobacco smoke exposure, and swimming were obtained from community members. Heads of households were interviewed for family history and personal beliefs on ear health. Height and weight were measured. Otoscopic findings were described for the presence and character of perforation or discharge. An A2ML1 duplication variant that confers otitis media susceptibility was Sanger sequenced in all DNA samples. Co-occurrence of middle ear bacteria detected by 16S rRNA gene sequencing was determined according to A2ML1 genotype and social cluster. RESULTS The indigenous Filipino population has a ~50% prevalence of otitis media. Young age was associated with otitis media (4 age strata; P = .004); however, age was nonsignificant as a bistratal or continuous variable. There was no association between otitis media and sex, body mass index, breastfeeding, tobacco exposure, or deep swimming. In multivariate analyses, A2ML1 genotype is the strongest predictor of otitis media, with an odds ratio of 3.7 (95% confidence interval: 1.3-10.8; P = .005). When otitis media diagnoses were plotted across ages, otitis media was observed within the first year of life, and chronic otitis media persisted up to adulthood, particularly in A2ML1-variant carriers. CONCLUSION Among indigenous Filipinos, A2ML1 genotype is the primary risk factor for otitis media and main determinant of disease progression, although age, the middle ear microbiome, and social clusters might modulate the effect of the A2ML1 genotype.
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Affiliation(s)
- Regie Lyn P Santos-Cortez
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Ma Rina T Reyes-Quintos
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Ma Leah C Tantoco
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Izoduwa Abbe
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Erasmo Gonzalo D V Llanes
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Nadim J Ajami
- Alkek Center for Metagenomics and Microbiome Research (CMMR), Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Diane S Hutchinson
- Alkek Center for Metagenomics and Microbiome Research (CMMR), Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph F Petrosino
- Alkek Center for Metagenomics and Microbiome Research (CMMR), Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Carmencita D Padilla
- Institute of Human Genetics, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Pediatrics, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines.,Philippine Genome Center, University of the Philippines Diliman, Quezon City, Philippines
| | - Romeo L Villarta
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Teresa Luisa Gloria-Cruz
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Abner L Chan
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Eva Maria Cutiongco-de la Paz
- Institute of Human Genetics, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Pediatrics, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines.,Philippine Genome Center, University of the Philippines Diliman, Quezon City, Philippines
| | - Charlotte M Chiong
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Suzanne M Leal
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Generoso T Abes
- Philippine National Ear Institute, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.,Department of Otorhinolaryngology, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
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Leach AJ, Wigger C, Beissbarth J, Woltring D, Andrews R, Chatfield MD, Smith-Vaughan H, Morris PS. General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines. Int J Pediatr Otorhinolaryngol 2016; 86:224-32. [PMID: 27260611 DOI: 10.1016/j.ijporl.2016.05.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009. METHODS We continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine. RESULTS Mean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist. CONCLUSIONS The general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.
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Affiliation(s)
- Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Christine Wigger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Donna Woltring
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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49
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Cerquetti M, Giufrè M. Why we need a vaccine for non-typeable Haemophilus influenzae. Hum Vaccin Immunother 2016; 12:2357-61. [PMID: 27171854 DOI: 10.1080/21645515.2016.1174354] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is increasingly recognized as emerging pathogen. The routine immunization of infants with conjugated vaccines against H. influenzae type b (Hib) has greatly reduced the incidence of invasive Hib disease; however a marked change in the predominant invasive serotype from Hib to NTHi has occurred. Localized infections where the role of H. influenzae is important, such as otitis media in children and acute exacerbations in chronic obstructive pulmonary disease (COPD) in adults, are almost exclusively associated with NTHi isolates. The implementation of pneumococcal conjugate vaccines has resulted in changes in frequency of nasopharynx colonizing pathogens with an increase of NTHi, although this data is yet under debate. An effective vaccine against NTHi is not currently available. The major challenge in developing a successful vaccine is the intrinsic heterogeneity of NTHi. H. influenzae protein D is used as carrier protein in the licensed 10-valent pneumococcal conjugate vaccine (Synflorix, GlaxoSmithKline), but no robust evidences for protective efficacy against NTHi otitis have been until now obtained. Several other vaccine candidates are under investigations and we hope that significant advancements in vaccine development will be achieved in the next future. Genome-based vaccine strategy might provide an additional useful tool for discovering further vaccine antigens.
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Affiliation(s)
- Marina Cerquetti
- a Department of Infectious , Parasitic and Immune-Mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Maria Giufrè
- a Department of Infectious , Parasitic and Immune-Mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
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50
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Pickering JL, Prosser A, Corscadden KJ, de Gier C, Richmond PC, Zhang G, Thornton RB, Kirkham LAS. Haemophilus haemolyticus Interaction with Host Cells Is Different to Nontypeable Haemophilus influenzae and Prevents NTHi Association with Epithelial Cells. Front Cell Infect Microbiol 2016; 6:50. [PMID: 27242968 PMCID: PMC4860508 DOI: 10.3389/fcimb.2016.00050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/18/2016] [Indexed: 02/02/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is an opportunistic pathogen that resides in the upper respiratory tract and contributes to a significant burden of respiratory related diseases in children and adults. Haemophilus haemolyticus is a respiratory tract commensal that can be misidentified as NTHi due to high levels of genetic relatedness. There are reports of invasive disease from H. haemolyticus, which further blurs the species boundary with NTHi. To investigate differences in pathogenicity between these species, we optimized an in vitro epithelial cell model to compare the interaction of 10 H. haemolyticus strains with 4 NTHi and 4 H. influenzae-like haemophili. There was inter- and intra-species variability but overall, H. haemolyticus had reduced capacity to attach to and invade nasopharyngeal and bronchoalveolar epithelial cell lines (D562 and A549) within 3 h when compared with NTHi. H. haemolyticus was cytotoxic to both cell lines at 24 h, whereas NTHi was not. Nasopharyngeal epithelium challenged with some H. haemolyticus strains released high levels of inflammatory mediators IL-6 and IL-8, whereas NTHi did not elicit an inflammatory response despite higher levels of cell association and invasion. Furthermore, peripheral blood mononuclear cells stimulated with H. haemolyticus or NTHi released similar and high levels of IL-6, IL-8, IL-10, IL-1β, and TNFα when compared with unstimulated cells but only NTHi elicited an IFNγ response. Due to the relatedness of H. haemolyticus and NTHi, we hypothesized that H. haemolyticus may compete with NTHi for colonization of the respiratory tract. We observed that in vitro pre-treatment of epithelial cells with H. haemolyticus significantly reduced NTHi attachment, suggesting interference or competition between the two species is possible and warrants further investigation. In conclusion, H. haemolyticus interacts differently with host cells compared to NTHi, with different immunostimulatory and cytotoxic properties. This study provides an in vitro model for further investigation into the pathogenesis of Haemophilus species and the foundation for exploring whether H. haemolyticus can be used to prevent NTHi disease.
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Affiliation(s)
- Janessa L Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western AustraliaPerth, WA, Australia; School of Paediatrics and Child Health, The University of Western AustraliaPerth, WA, Australia
| | - Amy Prosser
- School of Paediatrics and Child Health, The University of Western Australia Perth, WA, Australia
| | - Karli J Corscadden
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia Perth, WA, Australia
| | - Camilla de Gier
- School of Paediatrics and Child Health, The University of Western Australia Perth, WA, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western AustraliaPerth, WA, Australia; School of Paediatrics and Child Health, The University of Western AustraliaPerth, WA, Australia; Department of Paediatrics, Princess Margaret Hospital for ChildrenPerth, WA, Australia
| | - Guicheng Zhang
- School of Public Health, Curtin University Perth, WA, Australia
| | - Ruth B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western AustraliaPerth, WA, Australia; School of Paediatrics and Child Health, The University of Western AustraliaPerth, WA, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western AustraliaPerth, WA, Australia; School of Paediatrics and Child Health, The University of Western AustraliaPerth, WA, Australia
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