Pneumococcal vaccine impact on otitis media microbiology: A New Zealand cohort study before and after the introduction of PHiD-CV10 vaccine.
We compared the microbiology of middle ear fluid (MEF) in two cohorts of children having ventilation tube (VT) insertion; the first in the era of 7-valent Streptococcus pneumoniae conjugate vaccine (PCV7) and the second following introduction of the ten-valent pneumococcal vaccine (PHiD-CV10).



During 2011 (Phase 1) and again in 2014 (Phase 2) MEF and NP samples from 325 children and 319 children were taken at the time of VT insertion. A matched comparison group had NP swabs collected with 137 children (Phase 1) and 154 (Phase 2). Culture was performed on all NP and MEF samples with further molecular identification of Haemophilus species, serotyping of S. pneumoniae, and polymerase chain reaction (PCR) testing on all MEF samples.



In Phase 2 immunisation coverage with ⩾3 doses of PHiD-CV10 was 93%. The rate and ratios of culture and molecular detection of the 3 main otopathogens was unchanged between Phase 1 and Phase 2 in both MEF and NP. Haemophilus influenzae was cultured in one quarter and detected by PCR in 53% of MEF samples in both time periods. S. pneumoniae and Moraxella catarrhalis were cultured in up to 13% and detected by PCR in 27% and 40% respectively of MEF samples. H. influenzae was the most common organism isolated from NP samples (61%) in the children undergoing VT surgery whilst M. catarrhalis (49%) was the most common in the non-otitis prone group. 19A was the most prominent S. pneumoniae serotype in both MEF and NP samples in Phase 2. Of Haemophilus isolates, 95% were confirmed to be non-typeable H. influenzae (NTHi) over both time periods.



Following implementation of PHiD-CV10 in New Zealand, there has been no significant change in the 3 major otopathogens in NP or MEF in children with established ear disease. For these children non-typeable H. influenzae remains the dominant otopathogen detected.
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand; Department of Paediatrics, The University of Auckland, New Zealand. Electronic address: e.best@auckland.ac.nz.
Emma J
EJ
Best
Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand; University of Otago, Christchurch, New Zealand.
Tony
T
Walls
Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
Melanie
M
Souter
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
Michel
M
Neeff
Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
Trevor
T
Anderson
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand; Manukau Superclinic, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
Lesley
L
Salkeld
Manukau Superclinic, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
Zahoor
Z
Ahmad
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand; Department of Paediatrics, The University of Auckland, New Zealand.
Murali
M
Mahadevan
Department of Engineering, The University of Auckland, New Zealand.
Cameron
C
Walker
Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand; University of Otago, Christchurch, New Zealand.
David
D
Murdoch
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
Nikki
N
Mills
D002675:Child, Preschool; D015331:Cohort Studies; D004432:Ear, Middle / Q000382:microbiology; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D009520:New Zealand / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000453:epidemiology / Q000382:microbiology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
C586648:10-valent pneumococcal conjugate vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
Child; Nasopharyngeal carriage; Otitis media; Pneumococcal conjugate vaccine