Prospects for prevention of otitis media

Understanding the pathogenesis of acute otitis media provides insight into strategies for immunoprophylaxis. This article evaluates the interactions between pathogen and host defense, and identifies potential bacterial and viral vaccine targets. Discussed in detail are the attributes for a candidate antigen necessary to achieve a greater reduction in the burden of middle ear disease. These include: (1) the need to target a broad spectrum of otopathogens; (2) antigens need to be shared across all (or most) isolates within a bacterial species; (3) antigens need to be surface exposed during middle ear infection; and (4) preferred antigens have an essential function such that nonexpressing bacterial mutants have reduced virulence. A vaccine candidate (Pnc-PD) that encompasses these "attributes" is discussed from the perspective of how it may provide additional protection from middle ear disease if further studies confirm initial data on efficacy.