1
|
Gisselsson-Solen M. Acute otitis media in children-current treatment and prevention. Curr Infect Dis Rep 2015; 17:476. [PMID: 25896748 DOI: 10.1007/s11908-015-0476-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute otitis media (AOM) is the most common bacterial infection in children and has a very varied clinical spectrum, ranging from spontaneous resolutions to serious complications. The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM. Today, not all episodes of AOM are treated with antibiotics, but most countries have issued guidelines that include an option of watchful waiting in many cases. Prevention of AOM reaches from modification of environmental risk factors to vaccinations and surgery. Conjugate pneumococcal vaccines and influenza vaccines have been shown to somewhat reduce the number of AOM episodes in different groups of children. Grommets, with or without adenoidectomy, are effective at least during the first 6 months after surgery.
Collapse
Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden,
| |
Collapse
|
2
|
Menon VJ, Corscadden KJ, Fuery A, Thornton RB, Kirkham LAS, Richmond PC, Wiertsema SP. Children with otitis media mount a pneumococcal serotype specific serum IgG and IgA response comparable to healthy controls after pneumococcal conjugate vaccination. Vaccine 2012; 30:3136-44. [DOI: 10.1016/j.vaccine.2012.01.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/16/2011] [Accepted: 01/30/2012] [Indexed: 10/14/2022]
|
3
|
Gisselsson-Solén M, Melhus A, Hermansson A. Pneumococcal vaccination in children at risk of developing recurrent acute otitis media - a randomized study. Acta Paediatr 2011; 100:1354-8. [PMID: 21517964 DOI: 10.1111/j.1651-2227.2011.02332.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Acute otitis media (AOM) is a common childhood disease, which often becomes recurrent (rAOM). A small reduction in AOM episodes has been noted in unselected child cohorts after vaccination with heptavalent conjugate pneumococcal vaccine (PCV7). The purpose of this study was to investigate how vaccination affects young children at risk of developing rAOM. METHODS Ninety-six children with an AOM onset before 6 months of age, implying a high risk for rAOM, were closely monitored until the age of 2 years. Forty-six were vaccinated with PCV7 and 50 were not. All episodes of AOM, emergency visits and ventilation tube insertions were registered. RESULTS A total of 363 AOM episodes were diagnosed. The incidence was reduced by 26% (p = 0.03), the number of emergency visits because of suspected AOM by 36% (p = 0.01) and the proportion of children who received ventilation tubes was halved in the vaccine group (p = 0.02). CONCLUSIONS During the first 2 years of life, PCV7 significantly reduced AOM episodes, emergency visits and ventilation tube insertions in children with rAOM. Pneumococcal vaccine may be a future route to reduce antibiotic use and health care consumption in otitis-prone children.
Collapse
Affiliation(s)
- Marie Gisselsson-Solén
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
| | | | | |
Collapse
|
4
|
Abstract
Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media (AOM) in otitis-prone children. In literature, data on immunology have been based on studies of small groups of severely otitis-prone children and have not been consistent. Humoral immune status was assessed in 365 children, 1-7 years old, with two or more documented episodes of AOM in the previous year. Children with 4 or more episodes in the preceding year were defined as otitis-prone. Serum immunoglobulin levels were determined by radial immunodiffusion. Immunoglobulin levels of otitis-prone children were compared with those of children who had experienced 2-3 AOM episodes per year. Children with recurrent episodes of AOM were found to have normal or increased serum IgA, IgM, IgG, and IgG1 levels compared with normal values for age, whereas the serum IgG2 levels were mostly in the lower normal range. Twenty-two percent of all children showed IgG2 levels lower than 2 SD below the age-specific mean. Interestingly, the otitis-prone group of children showed significantly lower median and mean levels for all immunoglobulins compared with those children with only 2-3 previous AOM episodes. Lower immunoglobulin levels in otitis-prone children suggest a generalized decreased antibody response in otitis-prone children.
Collapse
Affiliation(s)
- Reinier Veenhoven
- Department of Pediatrics, Spaarne Hospital Haarlem, Van Heythuijzenweg 1, P.O. Box 1644, 2003 BR Haarlem, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
5
|
Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, IJzerman E, Hermans P, de Groot R, Zegers B, Kuis W, Rijkers G, Schilder A, Sanders E. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet 2003; 361:2189-95. [PMID: 12842372 DOI: 10.1016/s0140-6736(03)13772-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccine prevents recurrent acute otitis media (AOM) in infants immunised at 2, 4, 6, and 12-15 months of age. We aimed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM. METHODS In this double-blind, randomised study, we enrolled 383 patients aged 1-7 years who had had two or more episodes of AOM in the year before entry. Randomisation was stratified in four groups according to age (12-24 months vs 25-84 months) and the number of previous AOM episodes (two or three episodes vs four or more episodes). Children received either 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine, or hepatitis A or B vaccines. They were followed up for 18 months for recurrence of AOM. We also cultured samples of middle-ear fluid and nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM after vaccination. FINDINGS We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place. INTERPRETATION These data do not lend support to the use of pneumococcal conjugate vaccine to prevent otitis media in previously unvaccinated toddlers and children with a history of recurrent AOM.
Collapse
|
6
|
Straetemans M, Sanders EA, Veenhoven RH, Schilder AG, Damoiseaux RA, Zielhuis GA. Review of randomized controlled trials on pneumococcal vaccination for prevention of otitis media. Pediatr Infect Dis J 2003; 22:515-24. [PMID: 12799508 DOI: 10.1097/01.inf.0000069763.08122.1c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing resistance to antibiotics of the pathogens causing acute otitis media (AOM) emphasize the need for effective methods to prevent episodes of otitis media in young children. OBJECTIVE To assess the effectiveness of pneumococcal vaccination for prevention of AOM in children age 12 years and younger. METHODS Systematic review of 11 randomized controlled trials including 46 074 children in whom pneumococcal vaccination against AOM was compared with a control treatment. Vaccine effect was estimated as a rate ratio (RR): AOM episodes per child month in pneumococcal vaccination group divided by the AOM episodes per child-month in control group. RESULTS A moderate effect of pneumococcal polysaccharide vaccination was found in children 24 months of age and older [RR 0.78; 95% confidence interval (CI) 0.63 to 0.97]. Pneumococcal polysaccharide vaccine had little effect on prevention of AOM in children without previous documented episodes before vaccination (RR 0.92; 95% CI 0.85 to 0.99). Better efficacy was seen in those children with documented prior AOM before vaccination (RR 0.81; 95% CI 0.72 to 0.91). Pooled results of pneumococcal conjugate vaccine trials in infants vaccinated as early as 2 months of age and in toddlers attending day care showed only a small effect on prevention of AOM (RR 0.92; 95% CI 0.85 to 0.99). CONCLUSION Based on these results, a large scale pneumococcal vaccination program for a primary indication of preventing AOM in infancy is not indicated. The results of ongoing trials should provide more information whether the conjugate vaccine is effective in high risk (otitis-prone) children after 1 year of age.
Collapse
Affiliation(s)
- Masja Straetemans
- Department of Epidemiology and Biostatistics, University Medical Center Nijmegen, Nijmegen, the Netherlands
| | | | | | | | | | | |
Collapse
|
7
|
Affiliation(s)
- S I Pelton
- Boston University School of Medicine and Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, MA 02118, USA.
| | | |
Collapse
|
8
|
Prellner K, Kalm O. Are there immunological or genetic markers that can predict recurrent acute otitis media? Ann N Y Acad Sci 1997; 830:82-94. [PMID: 9616669 DOI: 10.1111/j.1749-6632.1997.tb51881.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K Prellner
- Department of Otorhinolaryngology, University Hospital, Lund, Sweden
| | | |
Collapse
|
9
|
Svinhufvud M, Hermansson A, Prellner K. Active immunisation and resistance to experimental acute pneumococcal otitis media. Int J Pediatr Otorhinolaryngol 1993; 25:91-103. [PMID: 8436484 DOI: 10.1016/0165-5876(93)90013-s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The middle ear mucosal system and the humoral systemic immune factors are the two immunological systems whose involvement in the defence against acute otitis media (AOM) have been most intensively studied. However, their respective importance and their mutual influence is not clear. In the present study, a rat model for pneumococcal AOM was used to further elucidate the involvement of systemic immunity in protection against pneumococcal AOM. Six groups of male Sprague-Dawley rats were immunised with pneumococcal vaccine (PneumovaxRN) or live pneumococci (type 3) via one of three different routes: intraperitoneally, into the gastrointestinal tract (GIT) or into the right middle ear. A subsequent middle ear challenge (re-challenge in one group) with the same pneumococcal strain was performed after 4 days to 8 weeks in the different groups. Systemic immunity was found to be triggered, not only by systemic immunisation, but also by antigenic stimulation of the mucosa in the middle ear and in the GIT. In all groups but that immunised in the GIT, no new peak of specific IgG antibody response was demonstrated in serum after middle ear challenge/re-challenge. In contrast, half of the rats immunised in the GIT showed such a response not only after the inoculation into the GIT but also after a later performed middle ear challenge. Though a faster resolution of pus from the middle ear was observed in rats from all but one group, a significant reduction in the number of rats who developed AOM occurred exclusively among those rats that had previously manifested serological response to immunisation in the GIT.
Collapse
Affiliation(s)
- M Svinhufvud
- Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden
| | | | | |
Collapse
|
10
|
Hermansson A, Hellstrom S, Prellner K. Mucosal changes induced by experimental pneumococcal otitis media are prevented by penicillin V. Otolaryngol Head Neck Surg 1991; 105:578-85. [PMID: 1762794 DOI: 10.1177/019459989110500409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Penicillin V (pcV) was administered to 50 rats, either before bacterial challenge (prevention group), or after bacterial challenge but before fulminant purulent acute otitis media (AOM) was established (early treatment group). Five animals from each group were killed on days 4, 8, and 12, and 2 and 6 months after challenge. Middle ear mucosa was sampled at six different sites and studied in the light microscope. Untreated pneumococcal AOM in the rat has been shown to cause persistent structural changes of the middle ear mucosa. Both in the early treatment group and in the prevention group, the structural changes were diminished, as compared with those of untreated infected controls. The persistent structural changes seen after 6 months in untreated controls were not seen in animals that had received pcV in conjunction with the AOM episode. Though the beneficial effect on the mucosal changes during the first 2 weeks was more pronounced when pcV was given prophylactically, its use as early treatment would seem to be almost as effective in preventing the persistence of mucosal changes.
Collapse
Affiliation(s)
- A Hermansson
- Department of Oto-rhino-laryngology, University of Lund, Sweden
| | | | | |
Collapse
|
11
|
|
12
|
van Dam JE, Fleer A, Snippe H. Immunogenicity and immunochemistry of Streptococcus pneumoniae capsular polysaccharides. Antonie Van Leeuwenhoek 1990; 58:1-47. [PMID: 2195989 DOI: 10.1007/bf02388078] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J E van Dam
- Eijkman-Winkler Laboratory of Medical Microbiology, Utrecht University, The Netherlands
| | | | | |
Collapse
|
13
|
Harsten G, Prellner K, Löfgren B, Heldrup J, Kalm O, Kornfält R. Serum antibodies against respiratory tract viruses: a prospective three-year follow-up from birth. J Laryngol Otol 1989; 103:904-8. [PMID: 2584849 DOI: 10.1017/s0022215100110473] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acute otitis media (AOM) has been epidemiologically related to viral respiratory tract infections, and viral antigens have also been detected in middle ear secretion in some AOM episodes. Successive serum samples from children followed prospectively for three years from birth were analysed for IgG antibodies against respiratory syncytial virus (RSV), adenoviruses and influenza A virus. Values from serum antibody activity gradually decreased during the first six months of life, followed by a gradual increase. Various relationships were found to obtain between age and the increases of antibody activity against the different viruses. Thus, three quarters of those tested had manifested increased antibody activity against RSV by 18 months of age, and against adenoviruses by 30 months of age. No increase of antibody activity against influenza A was noted before 12 months of age, and then only seen in two thirds of those tested during the entire three-year observation period. With regard to age, however, the proportion of children with increased antibody activity to RSV, adenoviruses or influenza A virus did not differ between otitis-prone and non-otitis-prone children. Thus, as compared to non-otitis-prone children, development of the ability to produce antibodies against these viruses was not found to be delayed in otitis-prone children.
Collapse
Affiliation(s)
- G Harsten
- Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden
| | | | | | | | | | | |
Collapse
|
14
|
Prellner K, Kalm O, Harsten G, Heldrup J, Oxelius VA. Pneumococcal serum antibody concentrations during the first three years of life: a study of otitis-prone and non-otitis-prone children. Int J Pediatr Otorhinolaryngol 1989; 17:267-79. [PMID: 2767896 DOI: 10.1016/0165-5876(89)90052-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
One hundred and thirteen children were followed prospectively from birth until the age of 3, serum being obtained from cord blood, and at the ages of 3, 6, 12, 18, 24, 30 and 36 months. Thirteen children developed recurrent acute otitis media (rAOM), 29 remained very healthy and the remaining children formed an intermediate group. Cord serum concentrations were determined of total IgG class, of IgG1 and IgG2 subclasses, as well as of specific IgG antibodies against the pneumococcal capsular types, 3, 6A and 19F. The specific pneumococcal IgG as well as IgA and IgM antibodies were also followed in the sequential serum samples up to the age of 3 in the rAOM and healthy children. Despite total IgG class and IgG1 and IgG2 subclass concentrations being of the same magnitude in cord serum of rAOM (median: 11.15, 7.48 and 2.16 g/l for IgG, IgG1 and IgG2, respectively) as in that of healthy children (median: 10.21, 8.16 and 2.16 g/l, respectively), both in cord serum and in most serum samples drawn during the first year of life, specific IgG antibodies against types 6A and 19F, but not against type 3, were significantly lower in the rAOM group than in the healthy children. In the intermediate group, cord serum concentrations of specific IgG antibodies to type 6A were of the same magnitude as in the healthy children. The only significant difference in specific IgM and IgA antibody concentrations against types 3, 6A and 19F between the two groups was noted for type 6A antibodies at 36 months of age where rAOM children exhibited lower values. The results indicate an association between pre-existing low specific IgG antibody levels against AOM-associated pneumococcal types and the development of rAOM.
Collapse
Affiliation(s)
- K Prellner
- Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden
| | | | | | | | | |
Collapse
|
15
|
Sørensen CH, Nielsen LK. Plasma IgG, IgG subclasses and acute-phase proteins in children with recurrent acute otitis media. APMIS 1988; 96:676-80. [PMID: 2458119 DOI: 10.1111/j.1699-0463.1988.tb00929.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Quantitation of IgG, IgG subclasses and acute-phase proteins was performed in plasma samples from 156 children, aged 2 to 162 months, with varying degrees of otitis proneness. None of the children had acute otitis media or had received any antibiotics 3 weeks before the examination. Children with recurrent acute otitis media (rAOM) had significantly higher levels of total IgG, IgG1, and significantly lower levels of IgG2 than healthy children (p less than 0.02, p less than 0.0003, and p less than 0.03, respectively). However, the low levels of IgG2 found in the rAOM children could at least, to some extent, be explained by the observation that these children were somewhat younger than the healthy children. Except for recurrent episodes of common colds, children suffering from secretory otitis media (SOM) most often show no clinical signs of inflammatory events. Nevertheless, children with SOM had raised levels of plasma IgG1, indicating recurrent polyclonal stimulation of the immune apparatus, which seems to be less pronounced than that of rAOM children. Levels of acute-phase proteins, haptoglobin, orosomucoid and alpha 1-antitrypsin were evenly distributed in the children investigated, reflecting that they had no acute illness at the time of plasma sampling.
Collapse
Affiliation(s)
- C H Sørensen
- ENT-Department, Gentofte University Hospital, Hellerup, Denmark
| | | |
Collapse
|
16
|
Prellner K, Christensen P, Kalm O, Offenbartl K. The effect of serial intravenous immunoglobulin infusion on type-specific anti-pneumococcal antibodies in children. ACTA PATHOLOGICA, MICROBIOLOGICA, ET IMMUNOLOGICA SCANDINAVICA. SECTION C, IMMUNOLOGY 1986; 94:207-11. [PMID: 3565026 DOI: 10.1111/j.1699-0463.1986.tb02113.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effect of a series of five immunoglobulin G infusions--at 3-4 week interval--on serum IgG antibody concentrations against some pneumococcal types commonly associated with acute otitis media (AOM) was studied in 11 children, 1-4 years old, suffering from recurrent AOM. Increase of specific IgG antibody concentrations was observed when the initial concentrations were low. However, once higher antibody concentrations had been achieved as a result of the treatment, subsequent infusions resulted in a decrease of the antibodies. In two children with initially high specific antibody concentrations, antibodies successively decreased in response to repeated immunoglobulin infusions.
Collapse
|
17
|
Kalm O, Prellner K, Christensen P. The effect of intravenous immunoglobulin treatment in recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 1986; 11:237-46. [PMID: 3533818 DOI: 10.1016/s0165-5876(86)80035-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effect of serial intravenous infusion of human immunoglobulin on the frequency of acute otitis media (AOM) episodes and on other upper respiratory tract infections was prospectively studied in a group of 22 otitis-prone children, 1-4 years old. After pair-matching, the children were allocated to immunoglobulin treatment or to a control group. Increased specific IgG antibody activities against pneumococcal types associated with recurrent AOM (rAOM) were generally achieved, but no significant difference was noted in the frequency of AOM attacks or other respiratory tract infections between the immunoglobulin-treated children and their pair-matched untreated controls. The results indicate that, although serum antibody activities against bacteria associated with AOM are increased by immunoglobulin infusions, this does not prevent the development of AOM in children suffering from rAOM.
Collapse
|