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The Role of Antibody Testing and Vaccination in Paediatric Recurrent Acute Otitis Media
Karim Awad1, Farah Jeffry2, Bhaskar Molluru2
1Otolaryngology, University of Lancashire, Preston, GBR.
Insights
Booster vaccination effectively addresses suboptimal pneumococcal antibody levels in children with recurrent acute otitis media (RAOM). This strategy improved symptoms and reduced RAOM episodes in vaccinated individuals.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Vaccinology
Background:
- Recurrent acute otitis media (RAOM) is a prevalent childhood infection, primarily caused by Streptococcus pneumoniae.
- Pneumococcal vaccination is a key prophylactic measure against RAOM.
- Assessing pneumococcal immunity via antibody testing allows for targeted booster vaccinations.
Purpose of the Study:
- To investigate the role of pneumococcal antibody testing and booster vaccination in managing pediatric RAOM.
- To evaluate the effectiveness of booster vaccination in children with suboptimal pneumococcal immunity.
Main Methods:
- A retrospective review of 1,004 pediatric referrals (age ≤ 16 years) was conducted.
- 169 children diagnosed with RAOM were identified, with 42 undergoing pneumococcal antibody testing.
- Suboptimal antibody levels were defined as ≥ 6 low serotypes out of 13.
Main Results:
- Nearly half (45.2%) of tested RAOM patients had suboptimal pneumococcal antibody levels.
- Booster vaccination was administered to 68.4% of those with suboptimal levels.
- 92.3% of vaccinated children showed reduced RAOM episodes and symptom improvement; all tested children had adequate Haemophilus influenzae antibody levels.
Conclusions:
- Approximately 50% of children with RAOM exhibit suboptimal pneumococcal antibody levels, responsive to booster vaccination.
- Routine re-testing of pneumococcal or Haemophilus influenzae antibody levels post-vaccination is not indicated.
- Further research is needed to confirm if booster vaccinations decrease RAOM frequency or severity.
Introduction:
Recurrent acute otitis media (RAOM) is a common condition most frequently affecting children under two years of age. The main causative agent is Streptococcus pneumoniae. Pneumococcal vaccination has been shown to be an effective method of RAOM prophylaxis. Currently, pneumococcal antibody testing can be performed to assess immunity levels, followed by booster vaccination if protection is suboptimal. We aimed to explore the role of antibody testing and vaccination in the context of managing paediatric RAOM.
Method:
A retrospective study was performed between January and December 2023. A total of 1,004 paediatric referrals (age: ≤ 16 years) to our trust were reviewed. Patients with RAOM who underwent pneumococcal antibody testing were identified. Suboptimal antibody levels were defined as ≥ 6 low serotypes out of 13. This study took place at Royal Preston Hospital, United Kingdom.
Results:
Our cohort includes 169 children with RAOM, of which 42 underwent pneumococcal antibody testing with available results. Of these patients, 19 (45.2%) had suboptimal pneumococcal antibody levels; 13 (68.4%) patients received a booster vaccine. A reduction in RAOM episodes was reported in 92.3% (12/13) of vaccinated children at follow-up (≥ 3 months), with improvement in symptoms, including otalgia, fever, and hearing loss. Adequate Haemophilus influenzae antibody levels were found in every tested child with RAOM (n=43).
Conclusion:
These findings indicate that approximately half of children with RAOM have suboptimal pneumococcal antibody levels, which can be successfully addressed with booster vaccination. Re-testing pneumococcal antibody levels after booster vaccination and performing H. influenzae antibody levels are not required. Further work is required to identify if booster vaccinations reduce the frequency or severity of RAOM presentations.
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