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Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France.
BMC Infect Dis 2012; 12:52BI

Abstract

BACKGROUND

Several studies have investigated the impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal (Sp) and staphylococcal (Sa) nasopharyngeal (NP) carriage. Few have investigated the impact on Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mc) carriage. We aimed to compare the NP carriage rates in young children with acute otitis media (AOM) before and after PCV7 implementation in France.

METHODS

Prior to PCV7 implementation, we performed 4 successive randomized trials with NP samples. These studies compared several antibiotic regimens for treating AOM in young children (6 to 30 months). After PCV7 implementation, to assess the impact of the vaccination program on NP flora, young children with AOM were enrolled in a prospective surveillance study. In each study, we obtained an NP sample to analyze the carriage rates of Sp, Hi, Mc and Sa and the factors influencing the carriage. Standardized history and physical examination findings were recorded; the methods used for NP swabs (sampling and cultures) were the same in all studies.

RESULTS

We enrolled 4,405 children (mean age 13.9 months, median 12.8). Among the 2,598 children enrolled after PCV7 implementation, 98.3% were vaccinated with PCV7. In comparing the pre- and post-PCV7 periods, we found a slight but non-significant decrease in carriage rates of pneumococcus (AOR = 0.85 [0.69;1.05]), H. influenzae (AOR = 0.89 [0.73;1.09]) and S. aureus (AOR = 0.92 [0.70;1.19]). By contrast, the carriage rate of M. catarrhalis increased slightly but not significantly between the 2 periods (AOR = 1.08 [0.95;1.2]). Among Sp carriers, the proportion of PCV7 vaccine types decreased from 66.6% to 10.7% (P < 0.001), penicillin intermediate-resistant strains increased from 30.3% to 43.4% (P < 0.001), and penicillin-resistant strains decreased greatly from 22.8% to 3.8% (P < 0.001). The proportion of Hi β-lactamase-producing strains decreased from 38.6% to 17.1% (P < 0.001).

CONCLUSION

The carriage rates of otopathogen species (Sp, Hi, Mc) and Sa did not significantly change in children with AOM after PCV7 implementation in France. However, we observed significant changes in carriage rates of PCV7 vaccine serotypes and penicillin non-susceptible Sp.

Authors+Show Affiliations

ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne, 27 rue Inkermann, F94100 Saint Maur des Fossés, France. robert.cohen@wanadoo.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22397629

Citation

Cohen, Robert, et al. "Nasopharyngeal Flora in Children With Acute Otitis Media Before and After Implementation of 7 Valent Pneumococcal Conjugate Vaccine in France." BMC Infectious Diseases, vol. 12, 2012, p. 52.
Cohen R, Bingen E, Levy C, et al. Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France. BMC Infect Dis. 2012;12:52.
Cohen, R., Bingen, E., Levy, C., Thollot, F., Boucherat, M., Derkx, V., & Varon, E. (2012). Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France. BMC Infectious Diseases, 12, p. 52. doi:10.1186/1471-2334-12-52.
Cohen R, et al. Nasopharyngeal Flora in Children With Acute Otitis Media Before and After Implementation of 7 Valent Pneumococcal Conjugate Vaccine in France. BMC Infect Dis. 2012 Mar 7;12:52. PubMed PMID: 22397629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France. AU - Cohen,Robert, AU - Bingen,Edouard, AU - Levy,Corinne, AU - Thollot,Franck, AU - Boucherat,Michel, AU - Derkx,Véronique, AU - Varon,Emmanuelle, Y1 - 2012/03/07/ PY - 2011/10/11/received PY - 2012/03/07/accepted PY - 2012/3/9/entrez PY - 2012/3/9/pubmed PY - 2012/7/25/medline SP - 52 EP - 52 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 12 N2 - BACKGROUND: Several studies have investigated the impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal (Sp) and staphylococcal (Sa) nasopharyngeal (NP) carriage. Few have investigated the impact on Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mc) carriage. We aimed to compare the NP carriage rates in young children with acute otitis media (AOM) before and after PCV7 implementation in France. METHODS: Prior to PCV7 implementation, we performed 4 successive randomized trials with NP samples. These studies compared several antibiotic regimens for treating AOM in young children (6 to 30 months). After PCV7 implementation, to assess the impact of the vaccination program on NP flora, young children with AOM were enrolled in a prospective surveillance study. In each study, we obtained an NP sample to analyze the carriage rates of Sp, Hi, Mc and Sa and the factors influencing the carriage. Standardized history and physical examination findings were recorded; the methods used for NP swabs (sampling and cultures) were the same in all studies. RESULTS: We enrolled 4,405 children (mean age 13.9 months, median 12.8). Among the 2,598 children enrolled after PCV7 implementation, 98.3% were vaccinated with PCV7. In comparing the pre- and post-PCV7 periods, we found a slight but non-significant decrease in carriage rates of pneumococcus (AOR = 0.85 [0.69;1.05]), H. influenzae (AOR = 0.89 [0.73;1.09]) and S. aureus (AOR = 0.92 [0.70;1.19]). By contrast, the carriage rate of M. catarrhalis increased slightly but not significantly between the 2 periods (AOR = 1.08 [0.95;1.2]). Among Sp carriers, the proportion of PCV7 vaccine types decreased from 66.6% to 10.7% (P < 0.001), penicillin intermediate-resistant strains increased from 30.3% to 43.4% (P < 0.001), and penicillin-resistant strains decreased greatly from 22.8% to 3.8% (P < 0.001). The proportion of Hi β-lactamase-producing strains decreased from 38.6% to 17.1% (P < 0.001). CONCLUSION: The carriage rates of otopathogen species (Sp, Hi, Mc) and Sa did not significantly change in children with AOM after PCV7 implementation in France. However, we observed significant changes in carriage rates of PCV7 vaccine serotypes and penicillin non-susceptible Sp. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/22397629/Nasopharyngeal_flora_in_children_with_acute_otitis_media_before_and_after_implementation_of_7_valent_pneumococcal_conjugate_vaccine_in_France_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-12-52 DB - PRIME DP - Unbound Medicine ER -