Bacterial otitis media: a vaccine preventable disease?
Introduction
Otitis media (OM) is one of the most frequent childhood diseases, the primary reason for a child under the age of 3 years of age to visit a general practitioner [1] and the most common indication for the prescription of antibiotics [2]. In the mid 1990s, in USA, it was estimated that there were 14 million episodes of OM per annum in children under the age of 5 and that the cost of treatment was in excess of $US5 billion [3]. Similar estimates are most likely to describe OM disease burden in other developed countries. In developing countries where the burden of respiratory disease is thought to be in the order of 10 times greater, compared with developed nations, the burden of suffering due to OM would be predictably higher and, without ready access to medical treatment, the serious and long term sequelae greater. The excessive use and indeed the necessity of antimicrobial therapy in OM remains controversial [2]. With the increase in the number of bacterial pathogens resistant to many antimicrobial agents there has been a corresponding increase in suppurative complications [4]. Over the past 30 years, there have been numerous studies examining the complex relationship of recurrent otitis media in early life to hearing loss and potential impact on language and academic achievement [5]. Because of the human and economic costs associated with OM, there is great interest in developing intervention strategies to manage this challenging disease. The burden of disease in many at risk cohorts meets the World Health Organisation's (WHO) criteria as a massive public health problem [6].
Section snippets
Otitis media
OM is the general term for a continuum of related middle ear diseases. There are three main categories of OM of which, there is no accepted and standard definition amongst health professionals. Acute otitis media (AOM) is generally defined as the presence of middle ear effusion accompanied with the rapid onset of one or more signs or symptoms of inflammation in the middle ear, such as otalgia, otorrhea, fever and irritability. Otitis media with effusion (OME) is a condition without signs or
Epidemiology
In the USA, approximately 80% of children have at least one episode of AOM by 3 years of age, with a peak incidence between 6 and 18 months [9], [10]. Recurrent AOM is generally diagnosed when 3 or more episodes of AOM have occurred within a period of 6 months or 4 or more episodes in 12 months. It commonly affects 10–20% of children by 12 months of age. By 7 years of age, almost 40% of children have had 6 or more episodes of AOM [10]. By their first birthday, >50% of children have experienced
Risk factors
An immature immune system and Eustachian tube is thought to account for the predisposition of infants and young children to OM. However, some children are at risk of severe and recurrent disease. It is important to identify risk factors for OM in these children as they can inform strategies for early prevention and intervention. To this end, much work has been done to understand the factors that have been associated with AOM, such as: microbial agents (bacterial and viral); anatomic factors
Antibiotics and other chemotherapies
From a meta-analysis of 21 studies up until 1993, Williams and colleagues [39] concluded that antibiotic treatment had a beneficial but limited effect on recurrent OM and short term resolution on OME. A more recent Cochrane Review [40] of 10 trials concluded that antibiotics shortened the duration of AOM. Neither analysis provided evidence that antibiotic treatment altered the course of otitis disease in children. A recent Clinical Practice Guideline: Otitis Media with Effusion [11] also
Vaccination
OM is a polymicrobial disease in which complex relationships between the different bacteria and viruses have been described and hypothesised. In fact the complex nature of these interactions are poorly understood. With this background and the large number of predisposing risk factors the concept of developing a successful vaccine to protect children against OM is indeed a challenge.
For a vaccine formulation to be efficacious for OM it must: contain one or more antigens from each of the
Relief from the misery of otitis media
Millions of children are afflicted with the misery of OM across the globe. The disease is complex and multifactorial in aetiology. Interventions include widespread use of antibiotics, invasive surgical procedures, and risk reduction strategies. However, none of these interventions are likely to result in a sustained global reduction in the incidence of OM. The most successful intervention strategy for controlling infectious diseases has been immunisation. Whilst immunisation against what are
References (53)
Cost-effectiveness considerations in otitis media treatment
Tolaryngol Head Neck Surg
(1996)- et al.
Epidemiologic patterns in childhood hearing loss: a review
Int J Pediatr Otorhinolaryngol
(1989) Health screening in schools Part I
J Pediatr
(1985)- et al.
Eustachian tube function in otitis-prone and healthy children
Int J Pediatr Otorhinolaryngol
(1991) - et al.
Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study
Lancet
(2003) - et al.
Colonisation by Streptococcus pneumoniae and Staphylococcus aureus in healthy children
Lancet
(2004) - et al.
Phase I study of a lipooligosaccharide-based conjugate vaccine against nontypeable Haemophilus influenzae
Vaccine
(2003) - et al.
Passive immunization for the prevention of otitis media
Vaccine
(2000) - et al.
Ambulatory health care visit by children: principal diagnosis and place of visit
Vital Health Stat
(1998) - et al.
Excessive antibiotic use for acute respiratory infections in the United States
Clin Infect Dis
(2001)
Suppurative complications of acute otitis media in the era of antibiotic resistance
Arch Otolaryngol Head Neck Surg
Otitis media, hearing loss and language learning: controversies and current research
J Dev Behav Pediatr
Recent advances in otitis media. 1. Definitions, terminology, and classification of otitis media
Ann Otol Rhinol Aryngol Suppl
Chronic suppurative otitis media
Ann Pharmacother
Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study
J Infect Dis
Epidemiology
Clinical practice guideline: Otitis media with effusion
Otolaryngol Head Neck Surg
Increase in paediatric acute otitis media diagnosed by primary care in two Finnish municipalities 1994–5 versus 1978–9
Epidemiol Infect
Increasing prevalence of recurrent otitis media among children in the United States
Pediatrics
Trends in otitis media among children in the United States
Pediatrics
Otitis media in developing countries
Pediatrics
Ear disease in three aboriginal communities in Western Australia
Med J Aust
Otitis media and speech and language: a meta-analysis of prospective studies
Pediatrics
Otitis media
Clin Infect Dis
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