title: Interventions for prevention of otitis media may be most effective if implemented in the first weeks of life.
abstract: OBJECTIVE
  For Indigenous Australian children living in remote communities, onset of otitis media commences within weeks of birth and is associated with early nasopharyngeal colonisation with multiple respiratory bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The high prevalence of eardrum perforation and the failure of standard therapies to cure or prevent OM in this population require urgent attention. The objective of this study was to measure the changes in nasopharyngeal bacterial flora between birth and first episode of otitis media.
  
  
  METHODS
  For 10 randomly selected Indigenous children with early onset otitis media, S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, and total bacterial load were enumerated in serial nasopharyngeal swabs using real-time quantitative PCR.
  
  
  RESULTS
  Between 0 and 3 weeks of age, all 10 infants had bilaterally normal ears. At 3-6 weeks of age, seven of eight infants examined had otitis media. By 6-13 weeks of age, all 10 infants had otitis media. The relative density of respiratory pathogens among total nasopharyngeal flora increased significantly with onset of otitis media, and the majority of children became colonised with the three respiratory pathogens. There was no association between OM onset and S. aureus load.
  
  
  CONCLUSIONS
  Onset of otitis media between 3 and 6 weeks of life was associated with a significant increase in all major bacterial OM pathogens (S. pneumoniae, H. influenzae, M. catarrhalis), as well as total bacterial load in the nasopharynx. Interventions to prevent acquisition of multiple OM pathogens in the first weeks of life are needed.
authors.affiliation: Menzies School of Health Research, Darwin, Australia. heidi@menzies.edu.au
authors.forename: Heidi
authors.initials: H
authors.lastname: Smith-Vaughan
authors.forename: Roy
authors.initials: R
authors.lastname: Byun
authors.forename: Stephen
authors.initials: S
authors.lastname: Halpin
authors.forename: Mangala A
authors.initials: MA
authors.lastname: Nadkarni
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Jacques
authors.forename: Neil
authors.initials: N
authors.lastname: Hunter
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Leach
mesh_terms: D000367:Age Factors; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D016133:Polymerase Chain Reaction; D013211:Staphylococcus aureus / Q000302:isolation & purification