Antipolysaccharide antibodies in 450 children with otitis media

Abstract

SUMMARYWe have measured antibodies to pneumococcal and Haemophilus polysaccharides in a prospective study of 450 children aged 2-16 years with otitis media requiring grommets (ear tubes). Pneumococcal antibody levels were significantly higher in the 2-6 year (P < 0 . 004) and 7-10 year (P < 0 . 04) study groups in comparison with age-matched controls. There was no difference in Haemophilus antibody levels between the study and control group children for the age groups 2-6 years and 11-16 years. Haemophilus antibody levels were significantly lower in the 7-10 year (P < 0 . 003) group in comparison with age-matched controls. Eighty-eight out of 450 (19 . 6%) children had pneumococcal antibody levels below the 25th percentile. Nineteen out of 88 (21 . 6%) children with pneumococcal antibody levels below the 25th centile were test immunized with 23 valent Pneumococcal polysaccharide and unconjugated Haemophilus type b capsular polysaccharide. Of these 19 children (aged 4-11 years), five mounted suboptimal responses to both polysaccharide antigens, whilst one child failed to respond to Haemophilus polysaccharide alone. There was no significant difference in the prevalence of IgG subclass deficiency between the normal responders and poor responders to immunization (P = 0 . 12). We found no evidence of specific polysaccharide antibody deficiency in the vast majority of the 450 children studied. However, the significance of poor antibody responses to test immunization in a small minority of children with otitis media is unclear. Long-term follow up of these children is required to determine whether poor immunization responses herald the development of frank antibody deficiency.

Clinical correlates of response to pneumococcal immunization

“…Recurrent otitis media with otorrhoea is likely to provide a more definitive indication of true episodes of acute otitis media than a history of ‘otitis media’ alone; 20,21 however, in the present study these symptoms were not significantly associated with a reduced pneumococcal antibody response. This finding extends the previous observations of Misbah et al who, in a study of 450 children presenting for grommet insertion and/or adenotonsillectomy for middle ear disease, found no evidence of specific polysaccharide antibody deficiency in study subjects compared with controls 22 . It is likely that a large number of children in the quoted study suffered from recurrent glue ear rather than true otitis media.…”

Antibody Deficiency in Chronic Rhinosinusitis: Epidemiology and Burden of Illness

“…34 A prospective study by Misbah examined antibody levels against pneumococcus and Haemophilus in children with a history of recurrent otitis media requiring tympanostomy tube placement. 25 Although the majority of patients actually had significantly higher pneumococcal antibody titers compared with controls, 19.6% of the patients had pneumococcal titers below the 25th percentile, with 26% failing to adequately mount a response to Pneumovax. Interestingly, 25% of the children in the control group also had low pneumococcal antibody levels.…”

“…32 The clinical significance of SAD has been addressed in a few studies. 25,[33][34][35][36] A retrospective study by Hidalgo characterized preimmunization and postimmunization pneumococcal antibody titers in a pediatric population with a history of recurrent respiratory infections, but no known immunodeficiency syndrome. 34 Before immunization, 50% of the patients did not have protective antibody levels against any of the serotypes tested.…”

“…Interestingly, 25% of the children in the control group also had low pneumococcal antibody levels. 25 Boyle examined children with recurrent infections and found that 14.9% had SAD. 33 SAD was associated with otitis media and atopy, in particular allergic rhinitis.…”

Anti-pneumococcal antibody titre measurement: what useful information does it yield?

“…This would have been laborious to perform and, assuming that the ELISA utilised had been absorbent to remove nonfunctional antibodies, gave a good indication of whether a patient had responded to vaccination and whether he or she had normal or abnormal humoral immunity. 21 However, when patients have been immunised with pneumococcal conjugate vaccine, use of vaccine, whether 23vPPV or 7vPCV, as the assay antigen is not so appropriate. One small study compared an ELISA using pneumococcal polysaccharide vaccine (PPV) as antigen with a serotype-specific IgG assay, and demonstrated that only the latter could discriminate responders.…”