Multicenter Surveillance of <i>Streptococcus pneumoniae</i> Isolates From Middle Ear and Mastoid Cultures in the 13-Valent Pneumococcal Conjugate Vaccine Era

Kaplan, Sheldon L.; Center, Kimberly J.; Barson, William J.; Ling-Lin, P.; Romero, José R.; Bradley, John S.; Tan, Tina Q.; Hoffman, Jill A.; Peters, Timothy R.; Gurtman, Alejandra; Scott, Daniel A.; Trammel, James; Gruber, William C.; Hultén, Kristina G.; Mason, Edward O.

doi:10.1093/cid/civ067

Cited by 31 publications

(32 citation statements)

References 30 publications

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“…In contrast, no such increase was shown in complex OM. This is in accordance with a recent study from the United States in which pneumococcal isolates from middle ear or mastoid cultures from children were evaluated and no significant increase in non-VT was observed [39]. We speculate that a reduced host susceptibility to non-VT (generally less invasive) disease derived from prevention of primary damage caused by the generally more invasive VT serotypes [16,38] is responsible for the absence of non-VT OM increase, despite a parallel increase in nasopharyngeal carriage.…”

Section: Discussionsupporting

confidence: 93%

Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media

et al. 2016

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Background. Pneumococcal conjugated vaccines (PCVs) impact on complex otitis media (OM; including recurrent, nonresponsive, and chronic OM with effusion) was greater than that on simple, acute OM in previous studies. Since complex OM is often a polymicrobial disease, we speculated that reduction of complex OM by PCVs would be associated with reduction of nonpneumococcal OM.Methods. In a prospective, population-based, active surveillance, all OM episodes submitted for middle ear fluid culture in children <3 years from 2004 through 2015 were included. Three sub-periods were established: pre-PCV, PCV7, and PCV13. Incidence rate ratios (IRRs) comparing the 3 periods were calculated for pneumococcal, nontypable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pyogenes, and culture-negative OM.Results. Overall, 7475 episodes were included. Of all-NTHi cases in the pre-PCV period, 34% were mixed with Streptococcus pneumoniae. IRRs (95% confidence interval) comparing the pre-PCV to the PCV13 period were 0.02 (0.01-0.04), 0.12 (0.08-0.20), and 0.18 (0.15-0.21) for PCV7+6A serotypes, 5 additional PCV13 serotypes, and all-pneumococcal OM, respectively; non-PCV13 serotype episodes were not significantly reduced. IRRs for single NTHi, mixed NTHi + S. pneumoniae, and all-NTHi OM were 0.30 (0.25-0.35), 0.18 (0.13-0.24), and 0.25 (0.22-0.29), respectively. Moraxella catarrhalis, S. pyogenes, and culture-negative episodes were also significantly reduced.Conclusions. Both pneumococcal and non-pneumococcal OM episodes, enriched with complex cases, declined substantially in children <3 years following sequential PCV7/PCV13 introduction. The reduction in non-pneumococcal episodes may be attributed to early OM episodes prevention, resulting in a lower rate of complex, often non-pneumococcal OM.

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Section: Discussionsupporting

confidence: 93%

Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media

et al. 2016

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“…One study showed a decline in rates of mastoiditis in 2011 compared with a 3‐year period preceding release of PCV13, but the study was limited by a small sample size (n = 31 in 2007 and n = 4 in 2011) . A subsequent prospective multicenter study of pneumococcal culture isolates from the middle ear and mastoid in children with OM from 2011 to 2013 showed a significant reduction in the proportion of serotypes included in PCV13 during the study period, and the number of serotype 19A isolates decreased 76% between 2011 and 2013, thus largely accounting for the overall decline in pneumococcal AM . Bearing these findings in mind, it is possible the observed declines in rates of mastoiditis between 2009 and 2012 among children <2 years of age are attributable to the protective effect of PCV13 vaccination, as this age group was the first affected by the universal PCV13 vaccination recommendation in 2010.…”

Section: Discussionmentioning

confidence: 99%

Pediatric acute mastoiditis in the era of pneumococcal vaccination

Tawfik¹,

Ishman

Tabangin

et al. 2017

The Laryngoscope

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“…Notably, before the 1990s, most S. pneumoniae strains demonstrated universal sensitivity to penicillin (12). Today, however, penicillin resistance varies from 5-60% in various parts of the world (13,14). Of particular concern is the increase in multidrugresistant S. pneumoniae strains demonstrating resistance to three or more drug classes (15)(16)(17)(18), which creates substantial concerns about both the efficacy of current antibiotic regimens and the continual development of resistance.…”

mentioning

confidence: 99%

Directed vaccination against pneumococcal disease

Hill

Beitelshees

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Immunization strategies against commensal bacterial pathogens have long focused on eradicating asymptomatic carriage as well as disease, resulting in changes in the colonizing microflora with unknown future consequences. Additionally, current vaccines are not easily adaptable to sequence diversity and immune evasion. Here, we present a “smart” vaccine that leverages our current understanding of disease transition from bacterial carriage to infection with the pneumococcus serving as a model organism. Using conserved surface proteins highly expressed during virulent transition, the vaccine mounts an immune response specifically against disease-causing bacterial populations without affecting carriage. Aided by a delivery technology capable of multivalent surface display, which can be adapted easily to a changing clinical picture, results include complete protection against the development of pneumonia and sepsis during animal challenge experiments with multiple, highly variable, and clinically relevant pneumococcal isolates. The approach thus offers a unique and dynamic treatment option readily adaptable to other commensal pathogens.

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Multicenter Surveillance of Streptococcus pneumoniae Isolates From Middle Ear and Mastoid Cultures in the 13-Valent Pneumococcal Conjugate Vaccine Era

Abstract: The number of pneumococcal isolates and the percentage of isolates with high-level penicillin resistance from cultures taken from children with OM or mastoiditis for clinical indications have decreased following PCV13 use, largely related to decreases in serotype 19A isolates.

Cited by 31 publications

References 30 publications

Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media

Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media

Pediatric acute mastoiditis in the era of pneumococcal vaccination

Directed vaccination against pneumococcal disease

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