Background: Acute otitis media (AOM) is closely associated with viral upper respiratory tract infections, but the most common microbial agent found in the middle ear fluid during AOM is Streptococcus pneumoniae (Pnc). Pnc is also a common colonizer of the nasopharynx, and its prevalence is further increased during the viral infection. The aim of this study was to investigate the interplay between viral infection, pneumococcal acquisition and carriage in the development of Pnc AOM.
Methods: Pnc carriage was assessed in a longitudinal study of 329 infants at scheduled visits at 3, 6, 9, 12, 15 and 18 months of age (N = 1715). The clinical outcome of the first episode of respiratory infection ("sick visit," N = 774) in the following 3-month period was recorded. The occurrence and timing of Pnc AOM in relation to serotype specific carriage at the start of the observation period were assessed.
Results: The occurrence, timing and duration of symptoms of the sick visits or the frequency of overall AOM were not associated with preceding pneumococcal carriage. Pnc AOM was in each case associated with concurrent carriage and 3.8 times (95% confidence interval, 1.4-10.0) more often with carriage acquired after the start of the observation period than with carriage already present at the scheduled visit. In all, 79% (55 of 70) of Pnc AOM events were caused by a serotype acquired after the start of the period.
Conclusion: The majority of Pnc AOM events develop in association with newly acquired carriage of pneumococcus.
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Ann Ig
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Facoltà di Farmacia, Università degli Studi di Padova e pbe consulting, Verona.
Pneumococcal (Pnc) disease represents a major healthcare concern being associated with severe complications. Scope of this study was to evaluate the budgetary impact effect of providing vaccination with seven-valent pneumococcal conjugate vaccine (PCV) to newborns in Lombardy (Italy). Budget impact analysis was applied to the 2004 cohort of newborns of Lombardy: efficacy data as number of pneumonia and acute otitis media (AOM) cases, and consumption of resources were derived from a large multicenter single-blind clinical study (results published) of vaccinated versus unvaccinated Italian children.
View Article and Find Full Text PDFThe value of nasopharyngeal culture in predicting the etiology of acute otitis media in children less than two years of age.
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November 2006
Department of Vaccines, National Public Health Institute, Helsinki, Finland.
Background: In selecting treatment of acute otitis media (AOM), knowledge of its etiology would be valuable. We revisited the possibility to use the nasopharyngeal culture of Streptococcus pneumoniae (Pnc) and Haemophilus influenzae (Hi) for predicting their presence in the middle ear fluid (MEF) during AOM.
Methods: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bacterial culture of the nasopharyngeal aspirate (NPA) in predicting the presence of the same pathogen in the MEF were assessed during AOM events among children followed from 2 to 24 months of age.
Pneumococcal acute otitis media in relation to pneumococcal nasopharyngeal carriage.
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September 2005
Department of Vaccines, National Public Health Institute, Helsinki, Finland.
Background: Acute otitis media (AOM) is closely associated with viral upper respiratory tract infections, but the most common microbial agent found in the middle ear fluid during AOM is Streptococcus pneumoniae (Pnc). Pnc is also a common colonizer of the nasopharynx, and its prevalence is further increased during the viral infection. The aim of this study was to investigate the interplay between viral infection, pneumococcal acquisition and carriage in the development of Pnc AOM.
View Article and Find Full Text PDFDoes the presence of pneumococcal DNA in middle-ear fluid indicate pneumococcal etiology in acute otitis media?
J Infect Dis
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Department of Vaccines, National Public Health Institute, Helsinki, Finland.
Bacterial culture of middle-ear fluid (MEF), the standard for etiologic diagnosis of acute otitis media (AOM), has revealed Streptococcus pneumoniae (Pnc) to be a major pathogen responsible for one-third of AOM cases. In the present study, we compared the results of polymerase chain reaction (PCR) based on the amplification of the pneumolysin gene with the results of pneumococcal culture, for 2595 MEF samples obtained during AOM events in 831 children who were followed from 2-24 months of age in the Finnish Otitis Media Vaccine Trial. PCR results were positive for 47.
View Article and Find Full Text PDFDo antibodies to pneumococcal surface adhesin a prevent pneumococcal involvement in acute otitis media?
J Infect Dis
September 2001
National Public Health Institute, Department of Vaccines, 00300 Helsinki, Finland.
Antibodies to the pneumococcal (Pnc) surface protein PsaA are immunogenic and protective in experimental animal models, but their role in protection from Pnc disease in humans is not known. In the present study, the ability of antibodies to PsaA to prevent the progression of Pnc carriage to Pnc acute otitis media (Pnc AOM) was evaluated. Antibodies to PsaA were measured in acute-phase serum samples of children with AOM and with Streptococcus pneumoniae cultured from the nasopharynx.
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