Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules

BMC Pediatrics

Peter Stanley Morris¹  Heidi Smith-Vaughan²  Mark Chatfield²  Ross Andrews²  Christine Wigger²  Amanda Jane Leach² 

[1] Royal Darwin Hospital, Darwin, NT, Australia;Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia

关键词: Risk factors;    Surveillance;    Public health;    Prevalence;    Pneumococcal vaccines;    Indigenous;    Child;    Otitis media;   

Others  :  1137333
DOI  :  10.1186/1471-2431-14-200

 received in 2014-03-03, accepted in 2014-07-29,  发布年份 2014

【 摘 要 】

Background

In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).

Methods

We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.

Results

Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD −12% [95% CI −19 to −5] p = 0.0004], and TMP in 17% versus 14% (RD −3% [95% CI −8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.

Conclusions

Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted.

【 授权许可】

   
2014 Leach et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, Hamilton E, Beissbarth J: Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey. BMC Pediatr 2005, 5:27-37.
• [2]Morris PS, Leach AJ, Halpin S, Mellon G, Gadil G, Wigger C, Mackenzie G, Wilson C, Gadil E, Torzillo P: An overview of acute otitis media in Australian Aboriginal children living in remote communities. Vaccine 2007, 25(13):2389-2393.
• [3]Leach AJ, Morris PS: The burden and outcome of respiratory tract infection in Australian and aboriginal children. Pediatr Infect Dis J 2007, 26(10 Suppl):S4-S7.
• [4]Smith-Vaughan HC, Binks MJ, Marsh RL, Kaestli M, Ward L, Hare KM, Pizzutto SJ, Thornton RB, Morris PS, Leach AJ: Dominance of Haemophilus influenzae in ear discharge from Indigenous Australian children with acute otitis media with tympanic membrane perforation. BMC Ear Nose Throat Disord 2013, 13:1-12.
• [5]Roca A, Hill PC, Townend J, Egere U, Antonio M, Bojang A, Akisanya A, Litchfield T, Nsekpong DE, Oluwalana C, Howie SR, Greenwood B, Adegbola RA: Effects of community-wide vaccination with PCV-7 on pneumococcal nasopharyngeal carriage in the Gambia: a cluster-randomized trial. PLoS Med 2011, 8(10):e1001107.
• [6]Leach AJ, Morris PS, McCallum GB, Wilson CA, Stubbs L, Beissbarth J, Jacups S, Hare K, Smith-Vaughan HC: Emerging pneumococcal carriage serotypes in a high-risk population receiving 7-valent pneumococcal conjugate vaccine and 23-valent polysaccharide vaccine since 2001. BMC Infect Dis 2009, 9(1):121.
• [7]Williams SR, Mernagh PJ, Lee MH, Tan JT: Changing epidemiology of invasive pneumococcal disease in Australian children after introduction of a 7-valent pneumococcal conjugate vaccine. Med J Aust 2011, 194(3):116-120.
• [8]Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, Kohl I, Lommel P, Poolman J, Prieels JP, Schuerman L: Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 2006, 367(9512):740-748.
• [9]Product information for AusPAR Synflorix Pneumococcal polysaccharide conjugate vaccine, 10-valent adsorbed GlaxoSmithKline Pty Ltd PM-2010-02793-3-2 Final 22 October 2012. [http://www.tga.gov.au/pdf/auspar/auspar-pneumococcal-polysaccharide-vaccine-121022-pi.pdf webcite]
• [10]Morris P, Leach A, Shah P, Nelson S, Anand A, Daby J, Allnutt R, Bainbridge D, Edwards K, Patel H: Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal & Torres Strait Islander Populations (April 2010). The Office of Aboriginal and Torres Strait Islander Health, Australian Governement; 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-otitismedia-clinical-guidelines2010 webcite
• [11]StataCorp: Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
• [12]Jacoby P, Carville KS, Hall G, Riley TV, Bowman J, Leach AJ, Lehmann D: Crowding and other strong predictors of upper respiratory tract carriage of otitis media-related bacteria in Australian aboriginal and non-aboriginal children. Pediatr Infect Dis J 2011, 30(6):480-485.
• [13]Otsuka T, Chang B, Shirai T, Iwaya A, Wada A, Yamanaka N, Okazaki M, Group SA-sW: Individual risk factors associated with nasopharyngeal colonization with Streptococcus pneumoniae and Haemophilus influenzae: a Japanese birth cohort study. Pediatr Infect Dis J 2013, 32(7):709-714.
• [14]Rovers MM, Zielhuis GA, Ingels K, van der Wilt GJ: Day-care and otitis media in young children: a critical overview. Eur J Pediatr 1999, 158(1):1-6.
• [15]Leach AJ, Morris PS, Mathews JD: Compared to placebo, long-term antibiotics resolve otitis media with effusion (OME) and prevent acute otitis media with perforation (AOMwiP) in a high-risk population: a randomized controlled trial. BMC Pediatr 2008, 8:23.
• [16]Leach AJ, Morris PS: Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev 2006, 4:CD004401.
• [17]Morris PS, Gadil G, McCallum GB, Wilson CA, Smith-Vaughan HC, Torzillo P, Leach AJ: Single-dose azithromycin versus seven days of amoxycillin in the treatment of acute otitis media in Aboriginal children (AATAAC): a double blind, randomised controlled trial. Med J Aust 2010, 192(1):24-29.
• [18]van den Bergh MR, Spijkerman J, Swinnen KM, Francois NA, Pascal TG, Borys D, Schuerman L, Ijzerman EP, Bruin JP, van der Ende A, Veenhoven RH, Sanders EA: Effects of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D-conjugate vaccine on nasopharyngeal bacterial colonization in young children: a randomized controlled trial. Clin Infect Dis 2013, 56(3):e30-39.