Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France

BMC Infectious Diseases

Research Article

Véronique Derkx¹  Michel Boucherat¹  Corinne Levy¹  Robert Cohen²  Franck Thollot³  Edouard Bingen⁴  Emmanuelle Varon⁵ 

[1] ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne, 27 rue Inkermann, F94100, Saint Maur des Fossés, France;ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne, 27 rue Inkermann, F94100, Saint Maur des Fossés, France;Department of Microbiology, CHI 40 Avenue de Verdun, Créteil, France;AFPA: Association Française de Pédiatrie Ambulatoire 4 rue Parmentier, F54270, Essey les Nancy, France;Department of Microbiology, Université Denis-Diderot-Paris 7, Robert Debré hospital (AP-HP), 48Bd, Sérurier, 75019, Paris, France;National Reference Center for Pneumococci, AP-HP, HEGP 20, rue, F75015, Leblanc, Paris, France;

关键词: Acute Otitis Medium;    Carriage Rate;    Pneumococcal Conjugate Vaccine;    Moraxella Catarrhalis;    Cefpodoxime Proxetil;   

DOI  :  10.1186/1471-2334-12-52

 received in 2011-10-11, accepted in 2012-03-07,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundSeveral studies have investigated the impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal (Sp) and staphylococcal (Sa) nasopharyngeal (NP) carriage. Few have investigated the impact on Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mc) carriage. We aimed to compare the NP carriage rates in young children with acute otitis media (AOM) before and after PCV7 implementation in France.MethodsPrior to PCV7 implementation, we performed 4 successive randomized trials with NP samples. These studies compared several antibiotic regimens for treating AOM in young children (6 to 30 months). After PCV7 implementation, to assess the impact of the vaccination program on NP flora, young children with AOM were enrolled in a prospective surveillance study. In each study, we obtained an NP sample to analyze the carriage rates of Sp, Hi, Mc and Sa and the factors influencing the carriage. Standardized history and physical examination findings were recorded; the methods used for NP swabs (sampling and cultures) were the same in all studies.ResultsWe enrolled 4,405 children (mean age 13.9 months, median 12.8). Among the 2,598 children enrolled after PCV7 implementation, 98.3% were vaccinated with PCV7. In comparing the pre- and post-PCV7 periods, we found a slight but non-significant decrease in carriage rates of pneumococcus (AOR = 0.85 [0.69;1.05]), H. influenzae (AOR = 0.89 [0.73;1.09]) and S. aureus (AOR = 0.92 [0.70;1.19]). By contrast, the carriage rate of M. catarrhalis increased slightly but not significantly between the 2 periods (AOR = 1.08 [0.95;1.2]). Among Sp carriers, the proportion of PCV7 vaccine types decreased from 66.6% to 10.7% (P < 0.001), penicillin intermediate-resistant strains increased from 30.3% to 43.4% (P < 0.001), and penicillin-resistant strains decreased greatly from 22.8% to 3.8% (P < 0.001). The proportion of Hi ß-lactamase-producing strains decreased from 38.6% to 17.1% (P < 0.001).ConclusionThe carriage rates of otopathogen species (Sp, Hi, Mc) and Sa did not significantly change in children with AOM after PCV7 implementation in France. However, we observed significant changes in carriage rates of PCV7 vaccine serotypes and penicillin non-susceptible Sp.

【 授权许可】

CC BY   
© Cohen et al; licensee BioMed Central Ltd. 2012