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Streptococcus pneumoniae Serotypes Carried by Young Children and Their Association With Acute Otitis Media During the
Esra Ekinci1, Stefanie Desmet2, Liesbet Van Heirstraeten3
1Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
Insights
Pneumococcal conjugate vaccine (PCV) programs did not alter overall Streptococcus pneumoniae carriage in young Belgian children. However, specific non-vaccine serotypes were more prevalent in children with acute otitis media (AOM) compared to healthy controls.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
- Microbiology
Background:
- Streptococcus pneumoniae (Sp) is a primary cause of acute otitis media (AOM) in children.
- Pneumococcal conjugate vaccine (PCV) programs have influenced the epidemiology of pneumococcal serotypes in disease and carriage.
- Understanding the relationship between carried pneumococcal strains and AOM clinical presentation is crucial post-PCV implementation.
Purpose of the Study:
- To investigate the association between carried pneumococcal strains and the clinical picture of AOM in young children in Belgium.
- To compare the pneumococcal carriage profile of children with AOM to that of healthy children attending daycare centers (DCC).
- To assess the impact of PCV programs on pneumococcal serotype distribution in AOM and carriage.
Main Methods:
- A cross-sectional study involving nasopharyngeal swabs and clinical data from children aged 6-30 months.
- Participants were categorized into AOM group (physician-diagnosed) and DCC group (healthy daycare attendees).
- Pneumococcal detection, quantification, and serotyping were performed using conventional culture and real-time PCR.
Main Results:
- Overall pneumococcal carriage and density were similar between the AOM and DCC groups.
- Non-vaccine serotypes, particularly 23B, 11A, and 15B, were frequently carried in both groups.
- Specific serotypes (3, 6C, 7B, 9N, 12F, 17F, 29) were more common in AOM cases, while 23A and 23B were less frequent.
Conclusions:
- Pneumococcal carriage prevalence and density were comparable in young children with AOM and healthy controls in Belgium.
- Certain non-PCV serotypes showed a higher prevalence in children with AOM, suggesting a potential link to the disease.
- No predictors for AOM severity were identified in this study cohort.
Abstract:
Background: Streptococcus pneumoniae (Sp) is a major cause of acute otitis media (AOM). Pneumococcal conjugate vaccine (PCV) programs have altered pneumococcal serotype epidemiology in disease and carriage. In this study, we used samples collected during a cross-sectional study to examine if the clinical picture of acute otitis media (AOM) in young children exposed to the PCV program in Belgium was related to the carried pneumococcal strains, and if their carriage profile differed from healthy children attending daycare centers. Material/Methods: In three collection periods from February 2016 to May 2018, nasopharyngeal swabs and background characteristics were collected from children aged 6-30 months either presenting at their physician with AOM (AOM-group) or healthy and attending day care (DCC-group). Clinical signs of AOM episodes and treatment schedule were registered by the physicians. Sp was detected, quantified, and characterized using both conventional culture analysis and real-time PCR analysis. Results: Among 3,264 collected samples, overall pneumococcal carriage and density were found at similar rates in both AOM and DCC. As expected non-vaccine serotypes were most frequent: 23B (AOM: 12.3%; DCC: 17.4%), 11A (AOM: 7.5%; DCC: 7.4%) and 15B (AOM: 7.5%; DCC: 7.1%). Serotypes 3, 6C, 7B, 9N, 12F, 17F, and 29 were more often found in AOM than in DCC (p-value < 0.05), whereas 23A and 23B were less often present in AOM (p-value < 0.05). Antibiotic non-susceptibility of Sp strains was similar in both groups. No predictors of AOM severity were identified. Conclusion: In the present study, overall carriage prevalence and density of S. pneumoniae were found similar in young children with AOM and in healthy children attending day-care centers in Belgium. Certain serotypes not currently included in the PCV vaccines were found to be carried more often in children with AOM than in DCC, a finding that might suggest a relationship between these serotypes and AOM.
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