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

Leach, Amanda J.; Wigger, Christine; Beissbarth, Jemima; Woltring, Donna; Andrews, Ross M.; Chatfield, Mark D.; Smith‐Vaughan, Heidi; Morris, Peter S.

doi:10.1016/j.ijporl.2016.05.011

Cited by 78 publications

(58 citation statements)

References 24 publications

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“…The response to some of the serotypes, including 23F and 6B, is known to be lower based on poorer immunogenicity [122], and vaccine escape is easily observable for the vaccine-serotypes 19F, 23F, and 6B in AOM cases [101, 123, 124]. As new formulations of the conjugate vaccines have been introduced, it is becoming clearer that to provide better protection against AOM in the future, we will need to add to the current vaccine regimen using protein vaccines with broader and more AOM-specific activities.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Bergenfelz

Håkansson

2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewThis study aimed to review the literature regarding the mechanisms of transition from asymptomatic colonization to induction of otitis media and how the insight into the pathogenesis of otitis media has the potential to help design future otitis media-directed vaccines.Recent FindingsRespiratory viruses have long been shown to predispose individuals to bacterial respiratory infections, such as otitis media. Recent information suggests that Streptococcus pneumoniae, which colonize the nasopharynx asymptomatically, can sense potentially “threatening” changes in the nasopharyngeal environment caused by virus infection by upregulating specific sets of genes involved in biofilm release, dissemination from the nasopharynx to other sites, and protection against the host immune system. Furthermore, an understanding of the transcriptional and proteomic changes occurring in bacteria during transition to infection has led to identification of novel vaccine targets that are disease-specific and will not affect asymptomatic colonization. This approach will avoid major changes in the delicate balance of microorganisms in the respiratory tract microbiome due to elimination of S. pneumoniae.SummaryOur recent findings are reviewed in the context of the current literature on the epidemiology and pathogenesis of otitis media. We also discuss how other otopathogens, such as Haemophilus influenzae and Moraxella catarrhalis, as well as the normal respiratory microbiome, can modulate the ability of pneumococci to cause infection. Furthermore, the unsatisfactory protection offered by the pneumococcal conjugate vaccines is highlighted and we review potential future strategies emerging to confer a more specific protection against otitis media.

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Section: Discussionmentioning

confidence: 99%

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Bergenfelz

Håkansson

2017

Curr Otorhinolaryngol Rep

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“…That study differed from the two Brisbane studies in that the NT study focused on children hospitalised with pneumonia rather than non-severe ARIwC, different specimen collection techniques were used, the PCR for bacteria was performed at a different laboratory and the Central Australian study was undertaken prior to widespread implementation of pneumococcal conjugate vaccines. However, more recent community based studies of nasopharyngeal carriage of these bacteria in the Northern Territory in the 13-valent pneumococcal conjugate vaccine era identified prevalences of 77% for S. pneumoniae , 45% for M. catarrhalis and 63% for NTHi [16]. Viruses were not reported in that study.…”

Section: Discussionmentioning

confidence: 88%

“…In a study of upper airway viruses and bacteria in Central Australian Aboriginal children hospitalised for pneumonia [8], a population with high rates of hospitalised lower ARI [15] and nasal colonisation [16], the overall prevalence of any organism was 94.5%, with 34.5% positive for both viruses and bacteria. The prevalences of S. pneumoniae , M. catarrhalis and NTHi were 64%, 70.3% and 76.5% respectively [8].…”

Section: Discussionmentioning

confidence: 99%

Upper airway viruses and bacteria in urban Aboriginal and Torres Strait Islander children in Brisbane, Australia: a cross-sectional study

et al. 2017

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BackgroundRespiratory morbidity in Australian Indigenous children is higher than their non-Indigenous counterparts, irrespective of urban or remote residence. There are limited studies addressing acute respiratory illness (ARI) in urban Indigenous children, particularly those that address the upper airway microbiome and its relationship to disease. We aimed to describe the prevalence of upper airway viruses and bacteria in symptomatic and asymptomatic urban-based Australian Indigenous children aged less than 5 years.MethodsA cross-sectional analysis of data collected at baseline in an ongoing prospective cohort study of urban Aboriginal and Torres Strait Islander children registered with a primary health care service in the northern suburbs of Brisbane, Australia. Clinical, demographic and epidemiological data and bilateral anterior nasal swabs were collected on enrolment. Polymerase chain reaction was performed on nasal swabs to detect 17 respiratory viruses and 7 bacteria. The primary outcome was the prevalence of these microbes at enrolment. Logistic regression was performed to investigate differences in microbe prevalence between children with and without acute respiratory illness with cough as a symptom (ARIwC) at time of specimen collection.ResultsBetween February 2013 and October 2015, 164 children were enrolled. The median age at enrolment was 18.0 months (IQR 7.2–34.3), 49.4% were boys and 56 children (34.2%) had ARIwC. Overall, 133/164 (81%) nasal swabs were positive for at least one organism; 131 (79.9%) for any bacteria, 59 (36.2%) for any virus and 57 (34.8%) for both viruses and bacteria. Co-detection of viruses and bacteria was more common in females than males (61.4% vs 38.6%, p = 0.044). No microbes, alone or in combination, were significantly associated with the presence of ARIwC.ConclusionsThe prevalence of upper airways microbes in asymptomatic children is similar to non-Indigenous children with ARIwC from the same region. Determining the aetiology of ARIwC in this community is complicated by the high prevalence of multiple respiratory pathogens in the upper airways.Study registrationAustralia New Zealand Clinical Trial Registry Registration Number: 12,614,001,214,628. Retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2349-1) contains supplementary material, which is available to authorized users.

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“…The authors speculate that the reduction in non- Spn -OM might be due to PCV protecting against early OM which could potentially result in more complex OM. A study from Australia [55] focused on OM and a recent shift between PHiD-CV and CRM197-PCV13. Introduction of PHiD-CV was previously reported to result in reduced frequency of suppurative OM among children from socioeconomically challenged communities [56, 57].…”

Section: Preventionmentioning

confidence: 99%

Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

Granath

2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewTo survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM).Recent FindingsTreatment 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.SummarySystemic 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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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

Cited by 78 publications

References 24 publications

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Upper airway viruses and bacteria in urban Aboriginal and Torres Strait Islander children in Brisbane, Australia: a cross-sectional study

Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

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