title: Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study.
abstract: BACKGROUND
  Pneumococcal conjugate vaccine prevents recurrent acute otitis media (AOM) in infants immunised at 2, 4, 6, and 12-15 months of age. We aimed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM.
  
  
  METHODS
  In this double-blind, randomised study, we enrolled 383 patients aged 1-7 years who had had two or more episodes of AOM in the year before entry. Randomisation was stratified in four groups according to age (12-24 months vs 25-84 months) and the number of previous AOM episodes (two or three episodes vs four or more episodes). Children received either 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine, or hepatitis A or B vaccines. They were followed up for 18 months for recurrence of AOM. We also cultured samples of middle-ear fluid and nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM after vaccination.
  
  
  RESULTS
  We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place.
  
  
  CONCLUSIONS
  These data do not lend support to the use of pneumococcal conjugate vaccine to prevent otitis media in previously unvaccinated toddlers and children with a history of recurrent AOM.
authors.affiliation: Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Veenhoven
authors.forename: Debby
authors.initials: D
authors.lastname: Bogaert
authors.forename: Cuno
authors.initials: C
authors.lastname: Uiterwaal
authors.forename: Carole
authors.initials: C
authors.lastname: Brouwer
authors.forename: Herma
authors.initials: H
authors.lastname: Kiezebrink
authors.forename: Jacob
authors.initials: J
authors.lastname: Bruin
authors.forename: Ed
authors.initials: E
authors.lastname: IJzerman
authors.forename: Peter
authors.initials: P
authors.lastname: Hermans
authors.forename: Ronald
authors.initials: R
authors.lastname: de Groot
authors.forename: Ben
authors.initials: B
authors.lastname: Zegers
authors.forename: Wietse
authors.initials: W
authors.lastname: Kuis
authors.forename: Ger
authors.initials: G
authors.lastname: Rijkers
authors.forename: Anne
authors.initials: A
authors.lastname: Schilder
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sanders
mesh_terms: D000208:Acute Disease; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D007223:Infant; D008297:Male; D009297:Nasal Mucosa / Q000382:microbiology; D010033:Otitis Media / Q000382:microbiology / Q000517:prevention & control*; D010614:Pharynx / Q000382:microbiology; D022242:Pneumococcal Vaccines; D016016:Proportional Hazards Models; D012044:Regression Analysis; D055502:Secondary Prevention; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification; D016896:Treatment Outcome; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate