Clin Infect Dis. 2005 Jan 1;40(1):52-7. Epub 2004 Dec 06.
Related Articles, Links
Association of clinical signs and symptoms with pneumococcal acute otitis
media by serotype--implications for vaccine effect.
Palmu AA, Jokinen JT, Kaijalainen T, Leinonen M, Karma P, Kilpi TM.
National Public Health Institute, Helsinki, Finland. arto.palmu@ktl.fi
BACKGROUND: Clinical symptoms and signs in acute otitis media (AOM) may
differ depending on the various pneumococcal serotypes causing the disease.
Alteration in clinical presentation of AOM could be expected after wide-scale
pneumococcal vaccinations if there were considerable differences between
vaccine serotypes and nonvaccine serotypes. METHODS: In this study, data from
831 children in the control arm of the Finnish Otitis Media Vaccine Trial
were used. The children were followed up prospectively in 8 study clinics
from 2 to 24 months of age. If AOM was diagnosed, myringotomy was done, and
middle ear fluid was aspirated for bacterial culture. Clinical symptoms and
signs of AOM were routinely recorded on structured case report forms.
RESULTS: Consistent with previous studies, 60% of pneumococcal episodes were
caused by vaccine serotypes. There were no major differences between the
clinical presentations of AOM due to different serotypes or serotype
categories. However, earache was more often associated with AOM caused by
vaccine and cross-reactive serotypes, compared with AOM caused by
non-vaccine-related serotypes (42% vs. 29%; odds ratio, 1.66; 95% confidence
interval, 1.02-2.70). CONCLUSIONS: Introduction of the currently available
pneumococcal conjugate vaccine is unlikely to result in a remarkable
alteration in the clinical presentation of pneumococcal AOM in infants.
PMID: 15614692 [PubMed - in process]
http://www.medscape.com/viewarticle/528710
Vaccination Is No Help Against Childhood Otitis Media
By David Douglas
NEW YORK (Reuters Health) Mar 28 - A combination of pneumococcal conjugate and
polysaccharide vaccination does not help reduce the recurrence of otitis media
with effusion (OME), Dutch researchers report in the March issue of Pediatrics.
The condition, lead investigator Dr. Niels van Heerbeek told Reuters Health, "is
very frequent during childhood and the costs of subsequent medical and
surgical... treatments are huge."
Because Streptococcus pneumoniae is one of the most common bacterial pathogens
involved, Dr. van Heerbeek of Radboud University Medical Center Nijmegan, and
colleagues sought to find out whether combined pneumococcal conjugate and
polysaccharide vaccination might be helpful. The investigators randomized 161
children with persistent bilateral OME who were being treated with tympanostomy
tubes to receive or not receive a conjugate vaccine before tube insertion and a
polysaccharide vaccine some 3
months later. There was a significant increase in antibody titers in vaccine
recipients. However, as Dr. van Heerbeek pointed out "combined pneumococcal
vaccination did not protect children prone to OME against recurrences."
"Therefore," he concluded, "pneumococcal vaccines are not indicated in the
management of children suffering from recurrent OME. A causative treatment for
recurrent OME is therefore still desired."
Pediatrics 2006;117:603-608
http://ap.google.com/article/ALeqM5ikSAE-746aflWJZc32diXfBsde9A
Vaccine Tied to 'Superbug' Ear Infection
By MARILYNN MARCHIONE – 14 hours ago
CHICAGO (AP) — A vaccine that has dramatically curbed pneumonia and other
serious illnesses in children is also having an unfortunate effect: promoting
new superbugs that cause ear infections. On Monday, doctors reported discovering
the first such germ that is resistant to all drugs approved to treat childhood
ear infections. Nine toddlers in Rochester, N.Y., have had the bug and
researchers say it may be turning up elsewhere, too. It is a strain of strep
bacteria not included in the pneumococcal vaccine, Wyeth's Prevnar, which came
on the market in 2000. It is recommended for children under age 2.
Doctors say parents should continue to have their toddlers get the shots because
the vaccine prevents serious illness and even saves lives. But the new resistant
strep is a worry. "The best way to prevent these resistant infections from
spreading is to be careful about how we use antibiotics," said Dr. Cynthia
Whitney, chief of respiratory diseases at the federal Centers for Disease
Control and Prevention.
Avoiding antibiotics when they are not needed is the best way to ensure they
will work when they are, she said. Prevnar prevents seven strains responsible
for most cases of pneumonia, meningitis and deadly bloodstream infections. But
dozens more strep strains exist, and some have flourished and become impervious
to antibiotics since the vaccine combats the more common strains.
If the new strains continue to spread, "it tells us the vaccine is becoming less
effective" and needs to be revised, said Dr. Dennis Maki, infectious diseases
chief at the University of Wisconsin- Madison Hospitals and Clinics. Wyeth
anticipated this and is testing a second-generation vaccine. But it is at least
two years from reaching the market, and the new strains could become a public
health problem in the meantime if they spread hard-to-treat infections through
day care centers and schools.
"I don't think the new strains are moving fast enough to call it a race, but the
fact is that certain strains are increasing," said Peter Paradiso, a scientist
at Wyeth Vaccines, the Collegeville, Pa., division that makes Prevnar. "It is
very worrying," said Dr. Keith Klugman, an infectious diseases specialist at
Emory University. "With the eradication of all the other types in the vaccine,
this one is emerging." Several research teams reported on the situation Monday
at microbiologists meeting.
A different pneumonia vaccine has long been available for adults but it doesn't
work in children, so Prevnar was hailed as a breakthrough. It is used in dozens
of countries and had sales of more than $1.5 billion last year. In the United
States, it is given as four shots between 2 months and 15 months.
Before the vaccine, many babies and toddlers developed pneumonia, meningitis and
serious blood infections that led to hearing loss, drain damage and even death.
Drug-resistant ear infections also were a problem. "Prevnar has done a
remarkable job. Over the last seven years, it's prevented thousands and
thousands of infections," not just in vaccinated kids but also in unvaccinated
family members, said the CDC's Whitney.
But it is a unique vaccine because it covers only seven of the 90-odd strains of
the germ. By contrast, measles is caused by one type of virus. Booster shots
are needed for chickenpox, mumps and measles because immunity wanes, not because
the germ changed. Prevnar, however, is losing its punch because strains not
covered by the vaccine are filling the biological niche that the vaccine
strains used to occupy, and they are causing disease.
One strain in particular, called 19A, is big trouble. A new subtype of it caused
ear infections in the nine Rochester children, ages 6 months to 18 months, that
were resistant to all pediatric medications, said Dr. Michael Pichichero, a
microbiologist at the University of Rochester Medical Center. The children had
been unsuccessfully treated with two or more antibiotics, including high-dose
amoxicillin and multiple shots of another drug. Many needed surgery to place ear
tubes to drain the infection, and some recovered only after treatment with a
newer, powerful antibiotic whose safety in children has not been established.
Pichichero refused further comment because he has submitted a report to a
medical journal. His work was paid for by antibiotic maker Abbott Laboratories
and the Thrasher Foundation, which funds projects related to child health. All
19A strep subtypes tend to be resistant to some drugs and have been growing in
prevalence:
_Scientists from a drug company and two labs analyzed more than 21,000 bacterial
samples from around the nation and found 19A increasing. Among children 2 and
under, the portion of samples that were this strain rose to 15 percent in
2005-2006, from 4 percent in the previous three years.
_A British lab tracking respiratory infections in U.S. kids found that the 19A
strain accounted for 40 percent of drug-resistant cases. University of Iowa
researchers found 19A accounted for 35 percent of penicillin-resistant
infections in 2004-05, compared with less than 2 percent the year before the new
vaccine came out.
Because these bacteria easily swap gene components to become even more hardy,
"new types may emerge that can both escape containment by vaccine and spread
throughout the world," Dr. Daniel Musher of Baylor College of Medicine wrote in
the New England Journal of Medicine last year. Some think Prevnar might be
destined to be like flu shots that must be periodically updated to reflect new
strains causing illness. But each tweak requires new safety studies and more
expense.
Wyeth expects to finish testing its updated vaccine next year and to seek
federal approval in early 2009. Review can take a year or more, Paradiso said.
British-based GlaxoSmithKline has a similar vaccine in final-phase testing that
targets 10 strains common in Europe and other regions.
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