Association between early bacterial carriage and otitis media in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia: a cohort study

BMC Infectious Diseases

Deborah Lehmann²  Allan Cripps¹  Sharon Weeks³  Harvey Coates⁴  Amanda Jane Leach⁶  Jacinta Bowman⁵  Thomas V Riley⁷  Peter Jacoby²  Wenxing Sun² 

[1] School of Medicine, Griffith University, Gold Coast, Queensland, Australia;Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia;Professional Hearing Services, South Perth, Western Australia, Australia;University Department of Otolaryngology, Head and Neck Surgery, The University of Western Australia, Perth, Western Australia, Australia;Department of Microbiology & Infectious Diseases, PathWest Laboratory Medicine (WA), Perth, Western Australia, Australia;Ear Health Research Program, Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia;Microbiology & Immunology, The University of Western Australia, Perth, Western Australia, Australia

关键词: Moraxella catarrhalis;    Haemophilus influenzae;    Streptococcus pneumoniae;    Aboriginal;    Otitis media;   

Others  :  1158668
DOI  :  10.1186/1471-2334-12-366

 received in 2012-06-01, accepted in 2012-12-17,  发布年份 2012

【 摘 要 】

Background

Streptococcus pneumoniae (Pnc), nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are the most important bacterial pathogens associated with otitis media (OM). Previous studies have suggested that early upper respiratory tract (URT) bacterial carriage may increase risk of subsequent OM. We investigated associations between early onset of URT bacterial carriage and subsequent diagnosis of OM in Aboriginal and non-Aboriginal children living in the Kalgoorlie-Boulder region located in a semi-arid zone of Western Australia.

Methods

Aboriginal and non-Aboriginal children who had nasopharyngeal aspirates collected at age 1- < 3 months and at least one clinical examination for OM by an ear, nose and throat specialist before age 2 years were included in this analysis. Tympanometry to detect middle ear effusion was also performed at 2- to 6-monthly scheduled field visits from age 3 months. Multivariate regression models were used to investigate the relationship between early carriage and subsequent diagnosis of OM controlling for environmental factors.

Results

Carriage rates of Pnc, NTHi and Mcat at age 1- < 3 months were 45%, 29% and 48%, respectively, in 66 Aboriginal children and 14%, 5% and 18% in 146 non-Aboriginal children. OM was diagnosed at least once in 71% of Aboriginal children and 43% of non-Aboriginal children. After controlling for age, sex, presence of other bacteria and environmental factors, early nasopharyngeal carriage of NTHi increased the risk of subsequent OM (odds ratio = 3.70, 95% CI 1.22-11.23) in Aboriginal children, while Mcat increased the risk of OM in non-Aboriginal children (odds ratio = 2.63, 95% CI 1.32-5.23). Early carriage of Pnc was not associated with increased risk of OM.

Conclusion

Early NTHi carriage in Aboriginal children and Mcat in non-Aboriginal children is associated with increased risk of OM independent of environmental factors. In addition to addressing environmental risk factors for carriage such as overcrowding and exposure to environmental tobacco smoke, early administration of pneumococcal-Haemophilus influenzae D protein conjugate vaccine to reduce bacterial carriage in infants, may be beneficial for Aboriginal children; such an approach is currently being evaluated in Australia.

【 授权许可】

   
2012 Sun et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Klein JO: The burden of otitis media. Vaccine 2000, 19(Suppl 1):2-8.
• [2]Bluestone CD, Klein JO: Otitis media in infants and children. Philadelphia: W B Saunders; 1988.
• [3]Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM: Otitis media. Lancet 2004, 363:465-473.
• [4]Leach A, Boswell JB, Asche V, Nienhuys TG, Mathews JD: Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants. Pediatr Infect Dis J 1994, 13:983-989.
• [5]Lehmann D, Weeks S, Jacoby P, Elsbury D, Finucane J, Stokes A, Monck R, Coates H: Absent otoacoustic emissions predict otitis media in young Aboriginal children: a birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia. BMC Pediatr 2008, 8:32. BioMed Central Full Text
• [6]Couzos S, Murray R: Aboriginal primary health care. An evidence-based approach. Oxford: Oxford University Press; 1999.
• [7]Massa HM, Cripps AW, Lehmann D: Otitis media: viruses, bacteria, biofilms and vaccines. Med J Aust 2009, 191(9 Suppl):S44-S49.
• [8]Kilpi T, Herva E, Kaijalainen T, Syrjanen R, Takala AK: Bacteriology of acute otitis media in a cohort of Finnish children followed for the first two years of life. Pediatr Infect Dis J 2001, 20:654-662.
• [9]Watson K, Carville K, Bowman J, Jacoby P, Riley TV, Leach AJ, Lehmann D, Kalgoorlie Otitis Media Research Project Team: Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia. Pediatr Infect Dis J 2006, 25:782-790.
• [10]Smith-Vaughan H, Byun R, Halpin S, Nadkarni MA, Jacques NA, Hunter N, Morris PS, Leach AJ: Interventions for prevention of otitis media may be most effective if implemented in the first weeks of life. Int J Pediatr Otorhinolaryngol 2008, 72:57-61.
• [11]Faden H, Duffy L, Wasielewski R, Wolf J, Krystofik D, Tung Y: Relationship between nasopharyngeal colonization and the development of otitis media in children. J Infect Dis 1997, 175:1440-1445.
• [12]Lehmann D, Arumugaswamy A, Elsbury D, Finucane J, Stokes A, Monck R, Jeffries-Stokes C, McAullay D, Coates H, Stanley FJ: The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations. Paediatr Perinat Epidemiol 2008, 22:60-71.
• [13]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, 30:480-485.
• [14]Jacoby PA, Coates HL, Arumugaswamy A, Elsbury D, Stokes A, Monck R, Finucane JM, Weeks SA, Lehmann D: The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia. Med J Aust 2008, 188:599-603.
• [15]Ennis G: Consumer health services directory: Goldfields. Government of Western Australia, Perth; 2007.
• [16]Climate statistics for Australian locationshttp://www.bom.gov.au/climate/averages/tables/cw_012038.shtml webcite
• [17]Morris P, Ballinger D, Leach A, Koops H, Hayhurst B, Stubbs L, Scott J, Anand A, Daby J, Paterson B, Yonovitz A: Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: Indigenous and Public Health Media Unit, Commonwealth Department of Health and Aged Care; 2001.
• [18]American Speech-Language-Hearing Association: Guidelines for audiologic screening. http://www.asha.org/docs/html/GL1997-00199.html webcite
• [19]Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, IJ 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, 361:2189-2195.
• [20]van den Biggelaar AH, Pomat WS, Phuanukoonnon S, Michael A, Aho C, Nadal-Sims MA, Devitt CJ, Jacoby PA, Hales BJ, Smith WA, Mitchell T, Wiertsema S, Richmond P, Siba P, Holt PG, Lehmann D: Effect of early carriage of Streptococcus pneumoniae on the development of pneumococcal protein-specific cellular immune responses in infancy. Pediatr Infect Dis J 2012, 31:243-248.
• [21]Wiertsema SP, Leach AJ: Theories of otitis media pathogenesis, with a focus on indigenous children. Med J Aust 2009, 191(Suppl 9):50-54.
• [22]Binks MJ, Cheng AC, Smith-Vaughan H, Sloots T, Nissen M, Whiley D, McDonnell J, Leach AJ: Viral-bacterial co-infection in Australian Indigenous children with acute otitis media. BMC Infect Dis 2011, 11:161. BioMed Central Full Text
• [23]Krishnamurthy A, McGrath J, Cripps AW, Kyd JM: The incidence of Streptococcus pneumoniae otitis media is affected by the polymicrobial environment particularly Moraxella catarrhalis in a mouse nasal colonisation model. Microbes Infect 2009, 11:545-553.
• [24]Moore HC, Jacoby P, Taylor A, Harnett G, Bowman J, Riley TV, Reuter K, Smith DW, Lehmann D: The interaction between respiratory viruses and pathogenic bacteria in the upper respiratory tract of asymptomatic Aboriginal and non-Aboriginal children. Pediatr Infect Dis J 2010, 29:540-545.