Prevention of acute otitis media using currently available vaccines

[tetano]

Future Microbiol. 2012 Apr;7:457-465.
Prevention of acute otitis media using currently available vaccines.
Principi N, Baggi E, Esposito S.
Source

Department of Maternal & Pediatric Sciences, Universit? degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy.
Abstract

Acute otitis media (AOM) is common in infants and children. Although approximately two-thirds of cases are due to bacteria, almost all of the episodes are preceded by upper respiratory viral infection. Several viruses, among which respiratory syncytial virus is the most common, are involved in the determination of AOM. However, a significant number of AOM cases are associated with influenza infection, and influenza viruses are among the most frequently found respiratory viruses in the middle ear fluid during an acute episode of AOM. Consequently, influenza vaccination may have a favorable impact on the incidence and course of AOM. Moreover, as Streptococcus pneumoniae is one of the leading AOM bacterial pathogens and it is well known that influenza virus infection predisposes to pneumococcal infection, there is a further reason to suggest the use of influenza vaccine to reduce the risk of AOM. On the other hand, the administration of pneumococcal conjugate vaccine is considered per se a possible means of reducing the incidence of the disease. However, although a number of studies have measured the impact of both vaccines on AOM, it is still not known whether (and to what extent) they are really effective, nor what impact the more recently licensed vaccines may have. The aim of this review is to examine the clinical impact of vaccinations on AOM.

PMID:
22439723
[PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/22439723

[tetano]

Re: Prevention of acute otitis media using currently available vaccines

Prevention of Acute Otitis Media Using Currently Available Vaccines

Nicola Principi; Elena Baggi; Susanna Esposito

Authors and Disclosures

Posted: 04/23/2012; Future Microbiology. 2012;7(4):457-465. ? 2012 Future Medicine Ltd.


Abstract

Acute otitis media (AOM) is common in infants and children. Although approximately two-thirds of cases are due to bacteria, almost all of the episodes are preceded by upper respiratory viral infection. Several viruses, among which respiratory syncytial virus is the most common, are involved in the determination of AOM. However, a significant number of AOM cases are associated with influenza infection, and influenza viruses are among the most frequently found respiratory viruses in the middle ear fluid during an acute episode of AOM. Consequently, influenza vaccination may have a favorable impact on the incidence and course of AOM. Moreover, as Streptococcus pneumoniae is one of the leading AOM bacterial pathogens and it is well known that influenza virus infection predisposes to pneumococcal infection, there is a further reason to suggest the use of influenza vaccine to reduce the risk of AOM. On the other hand, the administration of pneumococcal conjugate vaccine is considered per se a possible means of reducing the incidence of the disease. However, although a number of studies have measured the impact of both vaccines on AOM, it is still not known whether (and to what extent) they are really effective, nor what impact the more recently licensed vaccines may have. The aim of this review is to examine the clinical impact of vaccinations on AOM.
Introduction

Acute otitis media (AOM) is common in infants and children: a number of studies have shown that almost all children experience at least one episode of the disease in the first years of life, and that up to 50% suffer from recurrent episodes.[1,2] In most cases, AOM spontaneously disappears or evolves favorably when treated with antibiotics, but it can occasionally give rise to troublesome problems, such as tympanic membrane perforation, or serious complications, such as mastoiditis, meningitis or brain abscesses.[3] Because of its very high absolute frequency and risk of complications, AOM has substantial medical, social and economic consequences.[4?6] Moreover, as most cases are treated with antibiotics,[7] AOM is considered one of the most important causes of the emergence of microbial resistance. For all of these reasons, the prevention of AOM is widely advocated.[2]

Together with other preventive measures, the use of vaccines could lead to a significant reduction in the incidence of the disease.[2] This assumption is based on an evaluation of the etiology of AOM, which includes some infectious agents for which effective and safe vaccines are available. Although approximately two-thirds of the cases of AOM are caused by bacteria, almost all of the episodes are preceded by an upper respiratory viral infection that plays a fundamental role in the pathogenesis of the disease.[8] Moreover, respiratory viruses can be cultured from the middle ear fluid of up to 30% of children with AOM.[9,10] Although several respiratory viruses, including respiratory syncytial virus, are more frequently associated with AOM, a relevant number of influenza cases every year are complicated by the development of this disease,[9,11] and in most of them, influenza viruses are identified in the middle ear fluid.[12] It has therefore been suggested that the vaccine prevention of influenza may have a favorable effect on the incidence and course of AOM, and various experts have supported its use as a means of reducing the risk of AOM, particularly in otitis-prone children.[13,14] Moreover, as Streptococcus pneumoniae is one of the leading AOM bacterial pathogens,[15?17] and it has been repeatedly demonstrated that the influenza virus alters the respiratory mucosa in a way that predisposes to adherence, invasion and induction of disease by pneumococcus,[18] this has been considered a further reason for the administration of influenza vaccine to prevent AOM. Finally, independently from a previous influenza infection, because the administration of pneumococcal conjugate vaccine (PCV) is capable of inducing a significant immune response even in younger children (i.e., those with the highest incidence of AOM), it has been supposed that its use could be per se a possible means of reducing the incidence of AOM and its related problems.[19] However, although a number of studies have measured the impact of both vaccines on AOM, it is still not known whether (and to what extent) they are really effective, nor what impact the more recently licensed vaccines may have. The aim of this review is to examine the clinical impact of vaccinations on AOM.

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