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

Amanda Jane Leach, Christine Wigger, Kim Hare, Vanya Hampton, Jemima Beissbarth, Ross Andrews, Mark Chatfield, Heidi Smith-Vaughan, Peter Stanley Morris

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    Abstract

    Background: In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM 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.

    Original languageEnglish
    Article number162
    Pages (from-to)1-13
    Number of pages13
    JournalBMC Pediatrics
    Volume15
    DOIs
    Publication statusPublished - 19 Oct 2015

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    Conjugate Vaccines
    Haemophilus influenzae
    Middle Ear
    Streptococcus pneumoniae
    Infection
    Ear
    Appointments and Schedules
    Haemophilus influenzae glpQ protein
    Haemophilus
    Otitis Media
    Microbiology
    Vaccination
    Vaccines
    Randomized Controlled Trials

    Cite this

    @article{f0e067b23a4a48c895d91fc17066fa42,
    title = "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",
    abstract = "Background: In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM 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.",
    keywords = "Child, Indigenous, Nasopharynx, Nontypeable Haemophilus influenzae, Otitis media, Pneumococcal vaccines, Prevalence, Risk factors, Streptococcus pneumoniae, Surveillance",
    author = "Leach, {Amanda Jane} and Christine Wigger and Kim Hare and Vanya Hampton and Jemima Beissbarth and Ross Andrews and Mark Chatfield and Heidi Smith-Vaughan and Morris, {Peter Stanley}",
    note = "The study was funded by the Australian National Health and Medical Research Council (project #545232) for the years 2008 to 2010, and by GlaxoSmithKline for the years 2009 to 2012.",
    year = "2015",
    month = "10",
    day = "19",
    doi = "10.1186/s12887-015-0483-8",
    language = "English",
    volume = "15",
    pages = "1--13",
    journal = "BMC Pediatrics",
    issn = "1471-2431",
    publisher = "BioMed Central",

    }

    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. / Leach, Amanda Jane; Wigger, Christine; Hare, Kim; Hampton, Vanya; Beissbarth, Jemima; Andrews, Ross; Chatfield, Mark; Smith-Vaughan, Heidi; Morris, Peter Stanley.

    In: BMC Pediatrics, Vol. 15, 162, 19.10.2015, p. 1-13.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - 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

    AU - Leach, Amanda Jane

    AU - Wigger, Christine

    AU - Hare, Kim

    AU - Hampton, Vanya

    AU - Beissbarth, Jemima

    AU - Andrews, Ross

    AU - Chatfield, Mark

    AU - Smith-Vaughan, Heidi

    AU - Morris, Peter Stanley

    N1 - The study was funded by the Australian National Health and Medical Research Council (project #545232) for the years 2008 to 2010, and by GlaxoSmithKline for the years 2009 to 2012.

    PY - 2015/10/19

    Y1 - 2015/10/19

    N2 - Background: In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM 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.

    AB - Background: In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM 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.

    KW - Child

    KW - Indigenous

    KW - Nasopharynx

    KW - Nontypeable Haemophilus influenzae

    KW - Otitis media

    KW - Pneumococcal vaccines

    KW - Prevalence

    KW - Risk factors

    KW - Streptococcus pneumoniae

    KW - Surveillance

    UR - http://www.scopus.com/inward/record.url?scp=84944408025&partnerID=8YFLogxK

    U2 - 10.1186/s12887-015-0483-8

    DO - 10.1186/s12887-015-0483-8

    M3 - Article

    VL - 15

    SP - 1

    EP - 13

    JO - BMC Pediatrics

    JF - BMC Pediatrics

    SN - 1471-2431

    M1 - 162

    ER -