Association of Clinical Signs and Symptoms with Pneumococcal Acute Otitis Media by Serotype--Implications for Vaccine Effect

Palmu, Arto A.; Jokinen, Jukka; Kaijalainen, Tarja; Leinonen, Maija; Karma, Pekka; Kilpi, Terhi

doi:10.1086/426446

Cited by 17 publications

(8 citation statements)

References 11 publications

(24 reference statements)

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“…Serotype 19F has been associated with invasive infections in children and AOM with spontaneous otorrhea [24,32,68,69]. Furthermore, Palmu et al found serotype 19F as one of the most common pneumococcal serotypes recovered from samples of MEF and the serotype most often leading to earache [68,70]. In our study, carried 19F also had a high rate of resistance to at least one antibiotic (85.7%).…”

Section: Discussionsupporting

confidence: 56%

Streptococcus pneumoniaeserotypes carried by young children and their association with Acute Otitis Media during the period 2016 – 2019

Ekinci

Desmet

Heirstraeten

et al. 2020

Preprint

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BackgroundStreptococcus pneumoniae (Sp) is a major cause of acute otitis media (AOM). Pneumococcal conjugate vaccine (PCV) programs have altered pneumococcal serotype epidemiology in disease and carriage. To establish the clinical picture of AOM in young children exposed to the PCV program in Belgium and the Sp strains they carry, a cross-sectional study started in 2016.Material/methodsIn three collection periods from February 2016 to May 2018, nasopharyngeal swabs and background characteristics were collected from children aged 6-30 months either presenting at their physician with AOM (AOM-group) or healthy and attending day care (DCC-group). Sp was detected, quantified, and characterized using both conventional culture and qPCR. Clinical signs of AOM episodes and treatment were registered by the physicians.ResultsAmong 3264 collected samples, overall pneumococcal carriage and density were similar in AOM (79.2% and 0.50 ×106 copies/μl) and DCC (77.5% and 0.42 ×106 copies/μl). Non-vaccine serotypes were most frequent: 23B (AOM: 12.3%; DCC: 17.4%), 11A (AOM: 7.5%; DCC: 7.4%) and 15B (AOM: 7.5%; DCC: 7.1%). Serotypes 3, 6C, 7B, 9N, 12F, 17F and 29 were more frequent in AOM than in DCC, whereas 23A and 23B frequencies were lower. Antibiotic susceptibility of Sp strains was similar in both groups . No predictors of AOM severity were identified, and 77.3% received an antibiotic prescription.ConclusionYoung children with AOM did not carry Sp more frequently or at higher load than healthy children in day care, but some ST were more frequent in AOM and are not included in the currently used vaccines.

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Section: Discussionsupporting

confidence: 56%

Streptococcus pneumoniaeserotypes carried by young children and their association with Acute Otitis Media during the period 2016 – 2019

Ekinci

Desmet

Heirstraeten

et al. 2020

Preprint

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“…The presence of a purulent conjunctivitis gave a positive predictive value for H. influenzae AOM of 67% with an 86% negative predictive value. No useful predictors were found for M. catarrhalis AOM [34].…”

Section: Clinical Presentation and Identification Of Otopathogensmentioning

confidence: 86%

“…Some clinical signs have been associated with particular otopathogens (e.g. conjunctivitis is associated with H. influenzae, while more severe cases of AOM are more often caused by S. pneumoniae) [32][33][34]. However, accurate identification of underlying pathogens is not possible purely on clinical grounds.…”

Section: Clinical Presentation and Identification Of Otopathogensmentioning

confidence: 99%

Microbiology of otitis media: A moving target

Vergison

2008

Vaccine

106

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The microbiology of acute otitis media (AOM) is linked to the nasopharyngeal commensal flora. This respiratory ecosystem undergoes various selective pressures, such as antibiotic consumption and vaccine use. Socio-economic conditions also influence the bacterial composition of the nasopharynx. Streptococcus pneumoniae, non-encapsulated Haemophilus influenzae, Moraxella catarrhalis, and group A Streptococcus are the leading causes of bacterial AOM worldwide. This paper will discuss the causes and consequences of recent shifts in the underlying microbiology of AOM.

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“…pneumoniae remains the most frequently detected bacteria from patients with AOM in Asia, Africa, America and Europe. No significant differences between the clinical manifestations of AOM, resulting from the different pneumococcal serotypes, were identified but in general, PCV7 serotypes are reported to cause more otalgia or ear ache than non-PCV7-serotypes [ 123 ]. Additionally, children with AOM caused by S .…”

Section: Discussionmentioning

confidence: 99%

Predominant Bacteria Detected from the Middle Ear Fluid of Children Experiencing Otitis Media: A Systematic Review

et al. 2016

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BackgroundOtitis media (OM) is amongst the most common childhood diseases and is associated with multiple microbial pathogens within the middle ear. Global and temporal monitoring of predominant bacterial pathogens is important to inform new treatment strategies, vaccine development and to monitor the impact of vaccine implementation to improve progress toward global OM prevention.MethodsA systematic review of published reports of microbiology of acute otitis media (AOM) and otitis media with effusion (OME) from January, 1970 to August 2014, was performed using PubMed databases.ResultsThis review confirmed that Streptococcus pneumoniae and Haemophilus influenzae, remain the predominant bacterial pathogens, with S. pneumoniae the predominant bacterium in the majority reports from AOM patients. In contrast, H. influenzae was the predominant bacterium for patients experiencing chronic OME, recurrent AOM and AOM with treatment failure. This result was consistent, even where improved detection sensitivity from the use of polymerase chain reaction (PCR) rather than bacterial culture was conducted. On average, PCR analyses increased the frequency of detection of S. pneumoniae and H. influenzae 3.2 fold compared to culture, whilst Moraxella catarrhalis was 4.5 times more frequently identified by PCR. Molecular methods can also improve monitoring of regional changes in the serotypes and identification frequency of S. pneumoniae and H. influenzae over time or after vaccine implementation, such as after introduction of the 7-valent pneumococcal conjugate vaccine.ConclusionsGlobally, S. pneumoniae and H. influenzae remain the predominant otopathogens associated with OM as identified through bacterial culture; however, molecular methods continue to improve the frequency and accuracy of detection of individual serotypes. Ongoing monitoring with appropriate detection methods for OM pathogens can support development of improved vaccines to provide protection from the complex combination of otopathogens within the middle ear, ultimately aiming to reduce the risk of chronic and recurrent OM in vulnerable populations.

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Association of Clinical Signs and Symptoms with Pneumococcal Acute Otitis Media by Serotype--Implications for Vaccine Effect

Abstract: Introduction of the currently available pneumococcal conjugate vaccine is unlikely to result in a remarkable alteration in the clinical presentation of pneumococcal AOM in infants.

Cited by 17 publications

References 11 publications

Streptococcus pneumoniaeserotypes carried by young children and their association with Acute Otitis Media during the period 2016 – 2019

Streptococcus pneumoniaeserotypes carried by young children and their association with Acute Otitis Media during the period 2016 – 2019

Microbiology of otitis media: A moving target

Predominant Bacteria Detected from the Middle Ear Fluid of Children Experiencing Otitis Media: A Systematic Review

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