General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines

https://doi.org/10.1016/j.ijporl.2016.05.011Get rights and content
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Abstract

Objectives

This study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009.

Methods

We continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine.

Results

Mean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist.

Conclusions

The general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.

Keywords

Otitis media
Nasopharyngeal carriage
Middle ear microbiology
Pneumococcal conjugate vaccines
Streptococcus pneumoniae
Non-typeable Haemophilus influenzae

Abbreviations

AOMwiP
acute otitis media with perforation
AOMwoP
acute otitis media without perforation
CI
confidence interval
CSOM
chronic suppurative otitis media
DP
dry perforation
IPD
invasive pneumococcal disease
Mcat
Moraxella catarrhalis
mo
month
NT
Northern Territory
NTHi
non-typeable Haemophilus influenzae
OM
otitis media
OME
otitis media with effusion
PCV13
13-valent pneumococcal conjugate vaccine
PCV7
7-valent pneumococcal conjugate vaccine
PHiD-CV10
10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine
PPV23
23-valent pneumococcal polysaccharide vaccine
Prevenar® and Prevenar 13®
trademarks of Pfizer Inc
RD
risk difference
SD
standard deviation
Synflorix®
trademark of the GlaxoSmithKline group of companies
TMP
tympanic membrane perforation

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