Anticipated Effects of Higher-valency Pneumococcal Conjugate Vaccines on Colonization and Acute Otitis Media

Authors

Ravinder Kaur, Rochester Regional HealthFollow
Steven Schulz, Rochester Regional HealthFollow
Andrew Sherman, Rochester Regional HealthFollow
Kristin Andrejko, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Miwako Kobayashi, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Michael Pichichero, Rochester Regional HealthFollow

Department

Research

Additional Department

Medicine

Document Type

Article

Publication Title

The Pediatric Infectious Disease Journal

Abstract

BACKGROUND: Bacterial etiologies of acute otitis media (AOM) have shifted from the introduction of pneumococcal conjugate vaccines (PCVs), antibiotic selection and competition among species. We characterized Streptococcus pneumoniae ( Spn ), Haemophilus influenzae ( Hflu ) and Moraxella catarrhalis ( Mcat ) in the nasopharynx during well-child healthy visits and at the onset of AOM, and in middle ear fluid (MEF) of children with AOM to assess anticipated effects of higher-valency PCVs (PCV15 and PCV20).

METHODS: From September 2021 to September 2023, we conducted a prospective longitudinal cohort study of PCV13 immunized children 6-36 months old. MEF was collected via tympanocentesis. Serotyping and antibiotic susceptibility testing were performed on Spn , Hflu and Mcat isolates.

RESULTS: We obtained 825 nasopharyngeal and 216 MEF samples from 301 children. The order of frequency of nasopharyngeal colonization was Mcat , Spn and Hflu ; Hflu was the predominant otopathogen in MEF. Among Spn isolates, non-PCV15, non-PCV20 serotypes predominated in the nasopharynx and in MEF; the most frequent serotype was 35B. Among MEF samples, 30% of Spn isolates were amoxicillin nonsusceptible; 23% of Hflu isolates and 100% of Mcat isolates were β-lactamase-producing.

CONCLUSION: The majority of Spn isolates among young children were non-PCV15, non-PCV20 serotypes, especially serotype 35B; therefore, the impact of higher-valency PCVs in reducing pneumococcal colonization or AOM is expected to be limited. Hflu continues to be the most frequent AOM pathogen. Antibiotic susceptibility data suggest a high dose of amoxicillin/clavulanate or alternative drugs that are effective against contemporary mix of otopathogens could be considered for optimal empiric selection to provide the best efficacy.

First Page

1004

Last Page

1010

DOI

10.1097/INF.0000000000004413

Volume

43

Issue

10

Publication Date

10-1-2024

Medical Subject Headings

Humans; Pneumococcal Vaccines (administration & dosage); Otitis Media (microbiology, prevention & control, epidemiology); Infant; Child, Preschool; Nasopharynx (microbiology); Prospective Studies; Streptococcus pneumoniae (immunology, drug effects, isolation & purification); Longitudinal Studies; Female; Moraxella catarrhalis (drug effects, isolation & purification); Male; Haemophilus influenzae (drug effects, isolation & purification); Anti-Bacterial Agents (pharmacology, therapeutic use); Vaccines, Conjugate (administration & dosage); Pneumococcal Infections (prevention & control, microbiology, epidemiology); Microbial Sensitivity Tests; Acute Disease

PubMed ID

38838209

Recommended Citation

Kaur, R., Schulz, S., Sherman, A., Andrejko, K., Kobayashi, M., & Pichichero, M. (2024). Anticipated Effects of Higher-valency Pneumococcal Conjugate Vaccines on Colonization and Acute Otitis Media. The Pediatric Infectious Disease Journal, 43 (10), 1004-1010. https://doi.org/10.1097/INF.0000000000004413