Abstract
This retrospective analysis examined the pneumococcal serotype distribution of acute otitis media in Germany from 1995 to 2007. Data from the German National Reference Centre for Streptococci included 512 cases of pneumococcal otitis media in children and adults. Infections were mainly seen in children aged <5 years, who represented 67.0% of all reported cases. Most isolates (86.7%) were from spontaneous ruptures of the tympanum; 11.1% of the isolates were from otogenic sepsis or meningitis. Serotype 19F was the leading serotype (21.5%); serotype 3 (13.9%) was also often encountered. In children aged <5 years, the 7-valent, 10-valent, and 13-valent pneumococcal conjugate vaccines covered 54.3%, 60.2%, and 84.6% of the serotypes, respectively. Reduced penicillin susceptibility (minimum inhibitory concentration ≥0.1 mg/l) was seen in 11.0% of strains; 22.4% of strains were resistant to macrolides. Although based on a very limited selection of acute otitis media isolates, this analysis provides an estimate of the pneumococcal serotypes responsible for otitis media in Germany and underscores the need for future prospective studies.
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Fletcher MA, Fritzell B (2007) Brief review of the clinical effectiveness of PREVENAR® against otitis media. Vaccine 25:2507–2512
Palmu AAI, Herva E, Savolainen H, Karma P, Makela PH, Kilpi TM (2004) Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clin Infect Dis 38:234–242
Block SL, Hedrick J, Harrison CJ, Tyler R, Smith A, Findlay R, Keegan E (2002) Pneumococcal serotypes from acute otitis media in rural Kentucky. Pediatr Infect Dis J 21:859–865
Butler JC, Breiman RF, Lipman HB, Hofmann J, Facklam RR (1995) Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978–1994: implications for development of a conjugate vaccine. J Infect Dis 171:885–889
Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, Elvin L, Ensor KM, Hackell J, Siber G, Malinoski F, Madore D, Chang I, Kohberger R, Watson W, Austrian R, Edwards K (2000) Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 19:187–195
Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, Takala A, Kayhty H, Karma P, Kohberger R, Siber G, Makela PH (2001) Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 344:403–409
Fireman B, Black SB, Shinefield HR, Lee J, Lewis E, Ray P (2003) Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J 22:10–16
Palmu AAI, Verho J, Jokinen J, Karma P, Kilpi TM (2004) The seven-valent pneumococcal conjugate vaccine reduces tympanostomy tube placement in children. Pediatr Infect Dis J 23:732–738
Shouval DS, Greenberg D, Givon-Lavi N, Porat N, Dagan R (2009) Serotype coverage of invasive and mucosal pneumococcal disease in Israeli children younger than 3 years by various pneumococcal conjugate vaccines. Pediatr Infect Dis J 28:277–282
Rodgers GL, Arguedas A, Cohen R, Dagan R (2009) Global serotype distribution among Streptococcus pneumoniae isolates causing otitis media in children: potential implications for pneumococcal conjugate vaccines. Vaccine 27:3802–3810
Block SL, Hedrick J, Harrison CJ, Tyler R, Smith A, Findlay R, Keegan E (2004) Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Pediatr Infect Dis J 23:829–833
Casey JR, Pichichero ME (2004) Changes in frequency and pathogens causing acute otitis media in 1995–2003. Pediatr Infect Dis J 23:824–828
McEllistrem MC, Adams J, Mason EO, Wald ER (2003) Epidemiology of acute otitis media caused by Streptococcus pneumoniae before and after licensure of the 7-valent pneumococcal protein conjugate vaccine. J Infect Dis 188:1679–1684
Zhou F, Shefer A, Kong Y, Nuorti JP (2008) Trends in acute otitis media-related health care utilization by privately insured young children in the United States, 1997–2004. Pediatrics 121:253–260
Claes C, Reinert RR, Vauth C, Greiner W (2008) Health Technology Assessment. Heptavalenter Pneumokokkenkonjugat-Impfstoff (PCV7). http://portal.dimdi.de/de/hta/hta_berichte/hta202_bericht_de.pdf. Accessed 26 April 2010
Ziebold C, von Kries R, Siedler A, Schmitt HJ (2000) Epidemiology of pneumococcal disease in children in Germany. Acta Paediatr Suppl 435:17–21
Reinert RR, Simic S, Al-Lahham A, Reinert S, Lemperle M, Lütticken R (2001) Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients with respiratory tract infections in Germany from 1998 to 1999: results of a national surveillance study. J Clin Microbiol 39:1187–1189
Reinert RR, van der Linden M, Seegmuller I, Al-Lahham A, Siedler A, Weissmann B, Toschke AM, von Kries R (2007) Molecular epidemiology of penicillin-non-susceptible Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Germany. Clin Microbiol Infect 13:363–368
Siedler A, Reinert RR, Toschke M, Al-Lahham A, von Kries R (2005) Regional differences in the epidemiology of invasive pneumococcal disease in toddlers in Germany. Pediatr Infect Dis J 24:1114–1115
von Kries R, Hermann M, Al-Lahham A, Siedler A, Reinert RR (2002) Will the 7-valent pneumococcal vaccine have a similar impact on all invasive pneumococcal infections in children in Germany as in the Kaiser Permanente Trial? Eur J Pediatr 161:S140–S143
von Kries R, Hermann M, Hachmeister A, Siedler A, Schmitt HJ, Al-Lahham A, Reinert RR (2002) Prediction of the potential benefit of different pneumococcal conjugate vaccines on invasive pneumococcal disease in German children. Pediatr Infect Dis J 21:1017–1023
von Kries R, Siedler A, Schmitt HJ, Reinert RR (2000) Proportion of invasive pneumococcal infections in German children preventable by pneumococcal conjugate vaccines. Clin Infect Dis 31:482–487
Reinert RR, Haupts S, van der Linden M, Heeg C, Cil MY, Al-Lahham A, Fedson DS (2005) Invasive pneumococcal disease in adults in North-Rhine Westphalia, Germany, 2001–2003. Clin Microbiol Infect 11:985–991
Clinical and Laboratory Standards Institute (2006) Performance standards for antimicrobial disk susceptibility tests; approved standard—9th edition. CLSI, Wayne, PA, USA
Whitney CG, Pilishvili T, Farley MM, Schaffner W, Craig AS, Lynfield R, Nyquist A-C, Gershman KA, Vazquez M, Bennett NM, Reingold A, Thomas A, Glode MP, Zell ER, Jorgensen JH, Beall B, Schuchat A (2006) Effectiveness of seven-valent pneumoccoccal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet 368:1495–1502
Vesikari T, Wysocki J, Chevallier B, Karvonen A, Czajka H, Arsene J-P, Lommel P, Dieussaert I, Schuerman L (2009) Immunogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared to the licensed 7vCRM vaccine. Pediatr Infect Dis J 28:S66–S76
Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, Kohl I, Lommel P, Poolman J, Prieels JP, Schuerman L (2006) Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 367:740–748
Hausdorff WP, Yothers G, Dagan R, Kilpi T, Pelton SI, Cohen R, Jacobs MR, Kaplan SL, Levy C, Lopez EL, Mason EO Jr, Syriopoulou V, Wynne B, Bryant J (2002) Multinational study of pneumococcal serotypes causing acute otitis media in children. Pediatr Infect Dis J 21:1008–1016
Vergison A, Reinert RR (2007) Streptococcus pneumoniae incidence in Western Europe. Lancet Infect Dis 7:240–242
Acknowledgements
Medical writing support for this manuscript was provided by Prasad Kulkarni of Excerpta Medica (Bridgewater, NJ), and was funded by Wyeth, which was acquired by Pfizer Inc in October 2009.
Conflicts of interest
Dr Reinert is an employee of Pfizer Inc. Dr van der Linden has been a member of advisory boards for Wyeth and GlaxoSmithKline, and has received invitations to scientific conferences from Wyeth and GlaxoSmithKline.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s10096-010-1012-1
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van der Linden, M., Reinert, R.R. Serotype distribution in pneumococcal acute otitis media with ruptured tympanic membrane or sepsis in Germany. Eur J Clin Microbiol Infect Dis 29, 749–754 (2010). https://doi.org/10.1007/s10096-010-0945-8
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DOI: https://doi.org/10.1007/s10096-010-0945-8