Reduced middle ear infection with non-typeable Haemophilus influenzae, but not Streptococcus pneumoniae, after transition to 10-valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine.
BACKGROUND
In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: Prevenar(TM) Pfizer) was replaced in the Northern Territory childhood vaccination schedule by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; Synflorix(™) GlaxoSmithKline Vaccines). This analysis aims to determine whether the reduced prevalence of suppurative otitis media measured in the PHiD-CV10 era was associated with changes in nasopharyngeal (NP) carriage and middle ear discharge (ED) microbiology in vaccinated Indigenous children.


METHODS
Swabs of the NP and ED were collected in remote Indigenous communities between September 2008 and December 2012. Swabs were cultured using standardised methods for otitis media pathogens. Children less than 3 years of age and having received a primary course of 2 or more doses of one PCV formulation and not more than one dose of another PCV formulation were included in the primary analysis; children with non-mixed single formulation PCV schedules were also compared.


RESULTS
NP swabs were obtained from 421 of 444 (95%) children in the PCV7 group and 443 of 451 (98%) children in the PHiD-CV10 group. Non-mixed PCV schedules were received by 333 (79%) and 315 (71%) children, respectively. Pneumococcal (Spn) NP carriage was 76% and 82%, and non-typeable Haemophilus influenzae (NTHi) carriage was 68% and 73%, respectively. ED was obtained from 60 children (85 perforations) in the PCV7 group and from 47 children (59 perforations) in the PHiD-CV10 group. Data from bilateral perforations were combined. Spn was cultured from 25% and 18%, respectively, and NTHi was cultured from 61% and 34% respectively (p = 0.008).


CONCLUSIONS
The observed reduction in the prevalence of suppurative OM in this population was not associated with reduced NP carriage of OM pathogens. The prevalence of NTHi-infected ED was lower in PHiD-CV10 vaccinated children compared to PCV7 vaccinated children. Changes in clinical severity may be explained by the action of PHiD-CV10 on NTHi infection in the middle ear. Randomised controlled trials are needed to answer this question.
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Amanda.leach@menzies.edu.au.
Amanda Jane
AJ
Leach
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Christine.Wigger@menzies.edu.au.
Christine
C
Wigger
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Kim.hare@menzies.edu.au.
Kim
K
Hare
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Vanya.hampton@menzies.edu.au.
Vanya
V
Hampton
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Jemima.beissbarth@menzies.edu.au.
Jemima
J
Beissbarth
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Ross.Andrews@menzies.edu.au.
Ross
R
Andrews
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Mark.Chatfield@menzies.edu.au.
Mark
M
Chatfield
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Heidi.Smith-Vaughan@menzies.edu.au.
Heidi
H
Smith-Vaughan
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. Peter.Morris@menzies.edu.au.|Royal Darwin Hospital, Darwin, Northern Territory, Australia. Peter.Morris@menzies.edu.au.
Peter Stanley
PS
Morris
D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018073:Haemophilus Vaccines / Q000627:therapeutic use*; D006193:Haemophilus influenzae / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology*; D018074:Vaccines, Conjugate; D014904:Western Australia / Q000453:epidemiology
D018073:Haemophilus Vaccines; C547294:PHiD-CV vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate