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Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study.
PLoS One. 2017; 12(2):e0170316.Plos

Abstract

The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.

Authors+Show Affiliations

Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain.Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain.Catlab, Viladecavalls, Barcelona, Spain.School of Medicine, Universidad Complutense, Madrid, Spain.H. General de Cataluña, Barcelona, Spain.Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain.CAP Valldoreix, Barcelona, Spain.CAP Turó de Can Mates, San Cugat del Vallés, Barcelona, Spain.CAP Rambla, Barcelona, Spain.CAP Terrassa Sud, Barcelona, Spain.Medical Department, Pfizer, Madrid, Spain.Medical Department, Pfizer, Madrid, Spain.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28146590

Citation

Cilveti, Robert, et al. "Epidemiology of Otitis Media With Spontaneous Perforation of the Tympanic Membrane in Young Children and Association With Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - the Prospective HERMES Study." PloS One, vol. 12, no. 2, 2017, pp. e0170316.
Cilveti R, Olmo M, Pérez-Jove J, et al. Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PLoS One. 2017;12(2):e0170316.
Cilveti, R., Olmo, M., Pérez-Jove, J., Picazo, J. J., Arimany, J. L., Mora, E., Pérez-Porcuna, T. M., Aguilar, I., Alonso, A., Molina, F., Del Amo, M., & Mendez, C. (2017). Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PloS One, 12(2), e0170316. https://doi.org/10.1371/journal.pone.0170316
Cilveti R, et al. Epidemiology of Otitis Media With Spontaneous Perforation of the Tympanic Membrane in Young Children and Association With Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - the Prospective HERMES Study. PLoS One. 2017;12(2):e0170316. PubMed PMID: 28146590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. AU - Cilveti,Robert, AU - Olmo,Montserrat, AU - Pérez-Jove,Josefa, AU - Picazo,Juan-José, AU - Arimany,Josep-Lluis, AU - Mora,Emiliano, AU - Pérez-Porcuna,Tomás M, AU - Aguilar,Ignacio, AU - Alonso,Aurora, AU - Molina,Francesc, AU - Del Amo,María, AU - Mendez,Cristina, AU - ,, Y1 - 2017/02/01/ PY - 2016/10/18/received PY - 2017/01/03/accepted PY - 2017/2/2/entrez PY - 2017/2/2/pubmed PY - 2017/8/9/medline SP - e0170316 EP - e0170316 JF - PloS one JO - PLoS One VL - 12 IS - 2 N2 - The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28146590/Epidemiology_of_Otitis_Media_with_Spontaneous_Perforation_of_the_Tympanic_Membrane_in_Young_Children_and_Association_with_Bacterial_Nasopharyngeal_Carriage_Recurrences_and_Pneumococcal_Vaccination_in_Catalonia_Spain___The_Prospective_HERMES_Study_ L2 - https://dx.plos.org/10.1371/journal.pone.0170316 DB - PRIME DP - Unbound Medicine ER -