Acute otitis media in the era of effective pneumococcal conjugate vaccine: will new pathogens emerge?
The immunogenicity of pneumococcal conjugate vaccine (PCV) in young infants and its serotype-specific efficacy in otitis media (OM) results in a modest reduction in total episodes of OM and a more substantial reduction in disease due to the most frequent pneumococcal serotypes. Since PCV will only prevent disease due to the most common serotypes, concerns about potential changes in the microbiology of OM have emerged. Insight into potential changes can be obtained from reviewing middle ear and nasopharyngeal isolates from studies of antimicrobial prophylaxis and bacterial polysaccharide immune globulin for prevention of OM and PCV for prevention of invasive pneumococcal disease, respectively. In children receiving PCV, a shift in serotypes of SP colonizing the nasopharynx has been observed. Since non-vaccine serotypes are already present in the community as the etiology of acute purulent OM, it is predictable that these non-vaccine serotypes will become more common especially in children less than two years of age.
Pelton
S I
SI
Section of Pediatric Infectious Diseases, Boston Medical Center, Boston University School of Medicine, 774 Albany Street-Suite 512, Boston, MA 02118, USA. spelton@bu.edu
D000208:Acute Disease; D000907:Antibodies, Bacterial / Q000276:immunology; D000918:Antibody Specificity; D000940:Antigenic Variation / Q000235:genetics; D000942:Antigens, Bacterial / Q000235:genetics / Q000276:immunology; D001826:Body Fluids / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D005061:Europe, Eastern / Q000453:epidemiology; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology; D007223:Infant; D007557:Israel / Q000453:epidemiology; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D010034:Otitis Media with Effusion / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011135:Polysaccharides, Bacterial / Q000235:genetics / Q000276:immunology; D012641:Selection, Genetic; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D014481:United States / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000276:immunology
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D007136:Immunoglobulins; D022242:Pneumococcal Vaccines; D011135:Polysaccharides, Bacterial; D018074:Vaccines, Conjugate