Immunoprophylaxis of otitis media

Prospects for an effective otitis media vaccine are bolstered by a number of encouraging observations. Results of pneumococcal polysaccharide vaccine trials beginning in 1975, the enormously enhanced immunogenicity of protein-Hib polysaccharide coupled vaccines in infants, and the apparent effectiveness of a protein-PCP coupled vaccine in experimental otitis media suggest that a pneumococcal vaccine targeted to prevent invasive and middle ear infections is not too distant. The identification of several conserved surface antigens on NTHi and demonstration of otitis media protection elicited by these antigens in an animal model give promise for the development of H. influenzae vaccines for otitis media. Evidence that attenuated influenza A virus vaccination may also be an effective strategy for otitis media prevention, at least in an animal model, suggests that priority should be given to testing the efficacy of influenza, parainfluenza and respiratory syncytial virus vaccines with respect to otitis media prevention. It seems quite likely that not one but several immunoprophylaxis approaches will be necessary to reduce the overall incidence of otitis media given the multifactorial nature of the disease. Increasing parent and physician concern with the high incidence of otitis media and its morbidity suggests high participation rates in vaccine trials and high utilization of vaccines shown to be protective. Even if a vaccine could reduce the incidence of otitis media by 30%, an annual health care savings of $300-750 million would be achieved.