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Bacterial spectrum of spontaneously ruptured otitis media in the era of pneumococcal conjugate vaccination in Germany

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Abstract

Otitis media is a common pediatric disease and the main reason for antibiotic prescription in children. Before implementation of routine childhood pneumococcal vaccination in Germany, serotypes contained in the seven-valent pneumococcal conjugate vaccine (PCV) were among the most frequent pneumococcal serotypes responsible for acute otitis media (AOM). This report describes the first 3 years of a prospective, multicenter, epidemiological cross-sectional study examining the bacteriology of middle ear fluids (MEF) and nasopharyngeal swabs (NPS) of children 2 months to 5 years of age with spontaneously perforated AOM in the era of routine pneumococcal vaccination. MEF was obtained from 963 subjects; NPS from 877. Reported case numbers steeply decreased over the three study years even though the recruiting base remained the same. Among subjects with relevant bacterial growth in their MEF swabs, 113 (11.7 %) had Streptococcus pyogenes, 97 (10.1 %) Staphylococcus aureus, 88 (9.1 %) Streptococcus pneumoniae, 63 (6.5 %) Haemophilus influenzae, and 8 (0.8 %) Moraxella catarrhalis. S. pneumoniae isolates decreased from 41 (9.3 %) in year 1 to 12 (5.7 %) in year 3 (p = 0.128). PCV7 serotypes accounted for only 7.9 % (n = 7) of isolated pneumococci. Of the 877 subjects with NPS cultures, 465 (53.0 %) carried S. pneumoniae, 314 (35.8 %) H. influenzae, 292 (33.3 %) M. catarrhalis, and 110 (12.5 %) S. pyogenes; 79.4 % (n = 765) of the children were vaccinated with at least one dose of PCV. Carriage of pneumococci was slightly lower in vaccinated (47.8 %) than in unvaccinated (52.7 %) children (p = 0.254). PCV7 serotypes were carried by 9.6 % of unvaccinated children but by only 4.2 % of vaccinated children, resulting in a 56.3 % vaccine effectiveness.

Conclusions: Following universal PCV7 immunization, a clear epidemiological impact of pneumococcal conjugate vaccination was observed as PCV7 serotypes have almost disappeared among AOM.

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Abbreviations

AOM:

Acute otitis media

GAS:

Group A Streptococcus

IPD:

Invasive pneumococcal disease

MEF:

Middle ear fluid

NIP:

National immunization program

NIPD:

Noninvasive pneumococcal disease

NPS:

Nasopharyngeal swab

NT-H. influenzae :

Nontypeable Haemophilus influenzae

PCV:

Pneumococcal conjugate vaccine

PNSP:

Penicillin nonsusceptible Streptococcus pneumoniae

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Acknowledgments

We thank Stephanie Perniciaro for assistance with statistical calculations and critically reading the manuscript and improving the English language. This study was financed by Pfizer Pharma GmbH Germany. We sincerely thank all actively participating study sites.

Conflict of interest

ML, MR, AB, and DA have been members of advisory boards of Pfizer Pharma GmbH Germany.

Author information

Authors and Affiliations

  1. National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany

    Mark van der Linden & Matthias Imöhl

  2. Pediatric Medical Practice, Tegernsee, Germany

    Andreas Busse

  3. Children’s Hospital, Goethe University, Frankfurt, Germany

    Markus Rose

  4. Children’s Hospital, University of Munich, Munich, Germany

    Dieter Adam

  5. Department for Medical Microbiology, National Reference Center for Streptococci, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Mark van der Linden

Authors
  1. Mark van der Linden
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  2. Matthias Imöhl
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  3. Andreas Busse
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  4. Markus Rose
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  5. Dieter Adam
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Corresponding author

Correspondence to Mark van der Linden.

Additional information

Communicated by Peter de Winter

Author’s summary

This study examines the bacteriology of middle ear fluids and nasopharyngeal carriage of children with spontaneously perforated AOM, thus providing surveillance data on pneumococcal disease and carriage in the era of routine pneumococcal vaccination in Germany.

Following universal PCV7 immunization, a clear epidemiological impact of pneumococcal conjugate vaccination was observed, as PCV7 serotypes have almost disappeared among AOM. Among the remaining serotypes, 3 and 19A are the most prevalent, indicating the added value of higher-valent pneumococcal conjugate vaccination. Concerning carriage, the percentage of children carrying pneumococci has not changed. However, the serotype distribution of carriage has strongly shifted toward non-PCV7 serotypes, showing that vaccination has the ability to replace serotypes common in AOM with ones that are probably less harmful. This might particularly be the case after the effects of PCV13 vaccination on AOM become visible in the next study years.

Mark van der Linden and Matthias Imöhl contributed equally to this study.

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van der Linden, M., Imöhl, M., Busse, A. et al. Bacterial spectrum of spontaneously ruptured otitis media in the era of pneumococcal conjugate vaccination in Germany. Eur J Pediatr 174, 355–364 (2015). https://doi.org/10.1007/s00431-014-2409-0

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  • DOI: https://doi.org/10.1007/s00431-014-2409-0

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