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Clin Infect Dis. 2017 Nov 13;65(11):1853-1861. doi: 10.1093/cid/cix673.

Pan-serotype Reduction in Progression of Streptococcus pneumoniae to Otitis Media After Rollout of Pneumococcal Conjugate Vaccines.

Author information

1
Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
2
Pediatric Infectious Diseases Unit, Soroka University Medical Center.
3
Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
4
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.

Abstract

Background:

Reductions in otitis media (OM) burden following rollout of pneumococcal conjugate vaccines (PCVs) have exceeded predictions of vaccine impact. In settings with active surveillance, reductions in OM caused by vaccine-targeted pneumococcal serotypes have co-occurred with reductions in OM caused by other pathogens carried in the upper-respiratory tract of children. To understand these changes, we investigated the progression of vaccine-targeted and non-vaccine pneumococcal serotypes from carriage to OM before and after vaccine rollout.

Methods:

Nasopharyngeal carriage prevalence of pneumococcus was monitored in prospective studies of Bedouin and Jewish children <3 years old in southern Israel between 2004 and 2016. Incidence of OM necessitating middle-ear fluid culture (predominantly complex OM including recurrent, spontaneously-draining, non-responsive, and chronic cases) was monitored via prospective, population-based active surveillance. We estimated rates of pneumococcal serotype-specific progression from carriage to disease before and after rollout of PCV7/13, measured as OM incidence per carrier. We pooled serotype-specific estimates using Bayesian random-effects models.

Results:

On average, rates of progression declined 92% (95% credible interval: 79-97%) and 80% (46-93%) for PCV7/13 serotypes among Bedouin and Jewish children <12 months old, respectively, and 32% (-58-71%) and 61% (-5-86%) among children aged 12-35m. For non-vaccine serotypes, rates of progression among Bedouin and Jewish children aged <12m declined 74% (55-85%) and 43% (4-68%), respectively.

Conclusions:

Vaccine-targeted and non-vaccine pneumococcal serotypes showed lower rates of progression to complex OM after rollout of PCV7/13. Early-life OM episodes historically associated with vaccine-serotype pneumococci may impact the susceptibility of children to OM progression.

KEYWORDS:

complex otitis media; otitis media; pneumococcal conjugate vaccine; surveillance

PMID:
29020218
PMCID:
PMC6248775
DOI:
10.1093/cid/cix673
[Indexed for MEDLINE]
Free PMC Article

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