Pneumococcal vaccines for preventing otitis media

When administered in infancy, pneumococcal conjugate vaccine (PCV) appears to have a small beneficial effect in prevention of acute otitis media (AOM), depending on the type of PCV used. When administered in high-risk infants, after early infancy and in older children with a history of AOM, there appears to have no benefit in preventing further episodes.

A Cochrane review included 9 RCTs with a total of 48 426 children (range 74 to 37 868 per study). 7- to 11-valent pneumococcal conjugate vaccines (PCV) (with different carrier proteins) were studied. Five trials (n = 47 108) included infants, while 4 trials (n = 1318) included children aged one to 7 years that were either healthy (one study, n = 264) or had a previous history of upper respiratory tract infection (URTI), including acute otitis media (AOM). The results were not pooled due to heterogeneity between studies. In 4 studies (n=42 140), the 7-valent PCV with CRM197 as carrier protein (CRM197-PCV7) administered during early infancy was associated with a relative risk reduction (RRR) of all-cause AOM ranging from -5% in high-risk children (95% CI -25% to 12%) to 7% in low-risk children (95% CI 4% to 9%). Another 7-valent PCV with the outer membrane protein complex of Neisseria meningitidis (N. meningitidis) serogroup B as carrier protein, administered in infancy, did not reduce overall AOM episodes, while a precursor 11-valent PCV with Haemophilus influenzae (H. influenzae) protein D as carrier protein was associated with a RRR of all-cause AOM episodes of 34% (95% CI 21% to 44%). A 9-valent PCV (with CRM197 carrier protein) administered in healthy toddlers was associated with a RRR of (parent-reported) OM episodes of 17% (95% CI -2% to 33%). CRM197-PCV7 followed by 23-valent pneumococcal polysaccharide vaccination administered after infancy in older children with a history of AOM showed no beneficial effect on first occurrence and later AOM episodes. In a study in older children with a previously diagnosed respiratory tract infection, performed during the influenza season, a trivalent influenza vaccine combined with placebo (TIV/placebo) led to fewer all-cause AOM episodes than vaccination with TIV and PCV7 (TIV/PCV7) when compared to hepatitis B vaccination and placebo (HBV/placebo) (RRR 71%, 95% CI 30% to 88% vs. RRR 57%, 95% CI 6% to 80%, respectively) indicating that CRM197-PCV7 after infancy may even have negative effects on AOM.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes).

Ədəbiyyat

1. Fortanier AC, Venekamp RP, Boonacker CW et al. Pneumococcal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev 2014;4():CD001480. .