Abstract
BackgroundVaccines including conserved antigens from Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi) have the potential to reduce the burden of acute otitis media. Little is known about the antibody response to such antigens in young children with recurrent acute otitis media, however, it has been suggested antibody production may be impaired in these children.MethodsWe measured serum IgG levels against 4 pneumococcal (PspA1, PspA 2, CbpA and Ply) and 3 NTHi (P4, P6 and PD) proteins in a cross-sectional study of 172 children under 3 years of age with a history of recurrent acute otitis media (median 7 episodes, requiring ventilation tube insertion) and 63 healthy age-matched controls, using a newly developed multiplex bead assay.ResultsChildren with a history of recurrent acute otitis media had significantly higher geometric mean serum IgG levels against NTHi proteins P4, P6 and PD compared with healthy controls, whereas there was no difference in antibody levels against pneumococcal protein antigens. In both children with and without a history of acute otitis media, antibody levels increased with age and were significantly higher in children colonised with S. pneumoniae or NTHi compared with children that were not colonised.ConclusionsProteins from S. pneumoniae and NTHi induce serum IgG in children with a history of acute otitis media. The mechanisms in which proteins induce immunity and potential protection requires further investigation but the dogma of impaired antibody responses in children with recurrent acute otitis media should be reconsidered.
Highlights
Acute otitis media (AOM) is the most common reason for physician visits and the prescription of antibiotics for children in industrialised countries, where 80% of children will have an episode of AOM at least once before age 3 and infants spend a mean of 42 days on antibiotics in the first year of life [1]
Several protein antigens of S. pneumoniae and nontypeable Haemophilus influenzae (NTHi) have been demonstrated to be protective against otitis media in animal models [7,8,9], little is known about the antibody response to such antigens in young children with recurrent AOM (rAOM)
Our study showed that humoral immunity against S. pneumoniae and NTHi is not impaired in children with rAOM, which are important data when developing protein-based vaccines that aim to reduce the burden of AOM
Summary
Acute otitis media (AOM) is the most common reason for physician visits and the prescription of antibiotics for children in industrialised countries, where 80% of children will have an episode of AOM at least once before age 3 and infants spend a mean of 42 days on antibiotics in the first year of life [1]. The few studies investigating natural acquired humoral immunity against bacterial proteins in children with AOM are contradictory, with studies indicating that children with AOM produce antibodies against pneumococcal proteins [10,11,12,13,14], whereas others have shown impaired antibody production against pneumococcal and NTHi proteins in otitis-prone children, suggesting these children have a specific humoral immunodeficiency [15,16,17,18,19] Group sizes in these studies are generally small, have a wide age-range and/or do not include healthy age-matched controls. Little is known about the antibody response to such antigens in young children with recurrent acute otitis media, it has been suggested antibody production may be impaired in these children
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