Pneumococcal conjugate vaccination in children with recurrent acute otitis media: a therapeutic alternative?
BACKGROUND
Based on two clinical trials in healthy infants the American Academy of Pediatrics (AAP) advices immunization with a 7-valent pneumococcal conjugate vaccine in children with recurrent acute otitis media (AOM).


OBJECTIVE
To study the efficacy of a 7-valent pneumococcal conjugate vaccine on acute otitis media recurrences, its immunogenicity and impact on nasopharyngeal Streptococcus pneumoniae carriage in children with a history of frequent acute otitis media.


METHODS
In this double-blind, randomized study, 74 Belgian children, aged 1-7 years, with at least 2 clinically diagnosed episodes of acute otitis media in the previous year were enrolled. Children were immunized with either a 7-valent pneumococcal conjugate vaccine followed by a 23-valent pneumococcal polysaccharide booster or a control hepatitis A vaccine. Total follow-up was 26 months.


RESULTS
Despite adequate serum IgG responses to all conjugate vaccine pneumococcal serotypes, no reduction of acute otitis media episodes was observed in the pneumococcal vaccine group as compared to the control group (rate ratio: 1.16; 95% CI: 0.69-1.96). Overall nasopharyngeal pneumococcal carriage remained stable. However, a transient shift from conjugate vaccine related S. pneumoniae serogroups to non-vaccine related serogroups was noted following conjugate vaccination.


CONCLUSIONS
Clinically no protective effect of pneumococcal conjugate vaccination on acute otitis media recurrences was found in children with a history of frequent AOM.
van Kempen
Muriel J P
MJ
Department of Otorhinolaryngology, Ghent University Hospital, Belgium.
Vermeiren
Judith S
JS
Vaneechoutte
Mario
M
Claeys
Geert
G
Veenhoven
Reinier H
RH
Rijkers
Ger T
GT
Sanders
Elisabeth A M
EA
Dhooge
Ingeborg J
IJ
D000208:Acute Disease; D002353:Carrier State / Q000382:microbiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D022362:Hepatitis A Vaccines; D006801:Humans; D007117:Immunization, Secondary; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation / Q000706:statistics & numerical data; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000382:microbiology / Q000517:prevention & control*; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000592:standards; D055502:Secondary Prevention; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D016896:Treatment Outcome; D018074:Vaccines, Conjugate / Q000592:standards
D022362:Hepatitis A Vaccines; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate