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What is behind the ear drum? The microbiology of otitis media and the nasopharyngeal flora in children in the era of pneumococcal vaccination
Author(s) -
Mills Nikki,
Best Emma J,
Murdoch David,
Souter Melanie,
Neeff Michel,
Anderson Trevor,
Salkeld Lesley,
Ahmad Zahoor,
Mahadevan Murali,
Barber Colin,
Brown Colin,
Walker Cameron,
Walls Tony
Publication year - 2015
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.12710
Subject(s) - haemophilus influenzae , streptococcus pneumoniae , moraxella catarrhalis , medicine , otitis , serotype , carriage , pneumococcal conjugate vaccine , vaccination , ear infection , cohort , microbiology and biotechnology , adenoidectomy , conjugate vaccine , pediatrics , immunology , tonsillectomy , antibiotics , biology , surgery , pathology , audiology
Aim This study aims to describe the microbiology of middle ear fluid ( MEF ) in a cohort of children vaccinated with S treptococcus pneumoniae conjugate vaccine ( PCV 7) having ventilation tube insertion. Nasopharyngeal ( NP ) carriage of otopathogens in these children is compared with children without history of otitis media. Methods Between M ay and N ovember 2011, MEF and NP samples from 325 children aged <3 years were collected in three major centres in New Zealand at the time of ventilation tube insertion. An age‐matched non‐otitis‐prone comparison group of 137 children had NP samples taken. A questionnaire was completed by both groups. Results Immunisation coverage with at least one dose of PCV 7 was 97%. H aemophilus influenzae was cultured in 19.4% of MEF and was polymerase chain reaction (PCR) positive in 43.4%. S . pneumoniae and M oraxella catarrhalis were cultured in <10% of MEF samples but were PCR positive for 23.1% and 38.7%, respectively. H . influenzae was the most common organism isolated from NP samples (60%) in the grommet group, while M . catarrhalis (56%) was the most common in the non‐otitis prone group. S . pneumoniae was more commonly found in the nasopharynx of children with ear disease (41% vs. 29%). 19 F was the most prominent S . pneumoniae serotype in NP samples of both groups, but no serotype dominated in MEF . Ninety‐five per cent of H . influenzae isolates were confirmed to be non‐typeable H . influenzae.Conclusion In this cohort of children with established ear disease requiring surgical intervention, non‐typeable H . influenzae is the dominant pathogen in both the nasopharynx and MEF .