International Journal of Pediatric Otorhinolaryngology
Deficient IgA and IgG2 anti-pneumococcal antibody levels and response to vaccination in otitis prone children
Introduction
Acute otitis media (AOM) is the most common bacterial infection during childhood. Some 70–90% of children experience at least one episode of AOM before the age of 6 years. A total of 25% of children have had at least three periods of AOM at 3 years of age and 5–10% of all children can be classified as otitis prone with four or more periods of AOM per year [1].
Bacterial cultures of middle ear fluid yield Streptococcus pneumoniae in 40–59% of cases of AOM. Other important pathogens are non-typable Haemophilus influenzae species and Moraxella catarrhalis, which are found in 10–20% of AOM cases each. Involvement of pneumococci increases to 70–80% when culture-negative middle ear fluid is subjected to sensitive PCR based antigen detection methods [2].
The peak incidence of AOM is at 6–18 months of age. At this age, antibody levels are low because maternally derived antibodies have disappeared and the capacity to mount an antibody response to capsular polysaccharides has not yet developed. The decrease in incidence of AOM after 18–24 months parallels the development of antibodies against the capsular polysaccharides of S. pneumoniae. These data indicate that, apart from anatomical and other age-related factors, immunological factors can play a role in the etiopathogenesis of AOM [3]. Quantitative analysis of serum and mucosal IgG and IgA and their respective subclasses have shown no gross defects in otitis prone children [4], [5]. Compared to age matched control children and to adults, otitis prone children have low IgG antibody levels to pneumococcal serotypes 6A, 14, 19F and 23F [6], [7]. Relative little attention has been paid to IgG subclass distribution of anti-pneumococcal antibodies. IgG2 antibody levels to pneumococcal serotype 6A are decreased in otitis prone children compared to healthy children, while IgG1 antibody levels are normal [8].
In this study we have determined pneumococcal antibody levels and response to polysaccharide vaccination in otitis prone patients.
Section snippets
Patient population
Children, between 6 months and 4 years of age, undergoing adenoidectomy and tube placement for recurrent AOM were enrolled in the study. Appropriate informed consent was obtained and clinical research was conducted in accordance with guidelines for human experimentation as specified by the US Department of Health and Human Services and the authors’ institution. Recurrent AOM is defined as more than six episodes during the first 2 years of life, or more than four episodes during the first year
Results
IgA, IgG1 and IgG2 antibodies to seven different pneumococcal serotypes were determined in otitis prone children and age matched controls. IgG2 and IgA antibody levels to pneumococcal capsular polysaccharides were significantly lower in the recurrent AOM children than in the control population (Table 1, Fig. 1, Fig. 2, Fig. 3). The (geometric) mean IgG2 antibody levels against seven of seven pneumococcal serotypes and IgA antibodies against six of seven serotypes were lower in the patient
Discussion
This study indicates that pre-vaccination antibody levels to the capsular polysaccharides of S. pneumoniae (in particular IgG2 and to a lesser degree also IgA antibodies) are lower in patients with recurrent AOM compared to matched controls. It has been shown in several studies that the nasopharyngeal carriage rate of S. pneumoniae (as well as other potential otitis media causing pathogens) is significantly higher in otitis prone children compared with age-matched controls [16]. The low IgG2
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Immunological profiles of children with recurrent otitis media with or without spontaneous tympanic membrane perforation and of children with recurrent respiratory infections
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Normalized immunoglobulin patterns in adults with recurrent acute otitis media and low IgG2 levels during early childhood
2014, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :The analysis revealed that the IgG2 levels at 12 and 32 months of age were significantly lower in children with rAOM [11]. The low levels of IgG2 in rAOM-children has later been confirmed by other groups [12–15]. There is to date a lack of knowledge on how adults, with a history of rAOM during childhood, manage immunologically.
High pneumococcal serotype specific IgG, IgG1 and IgG2 levels in serum and the middle ear of children with recurrent acute otitis media receiving ventilation tubes
2013, VaccineCitation Excerpt :Pneumococcal infections are common in patients with primary antibody deficiency, which may indicate that children with recurrent AOM (rAOM) have an impaired immune response to S. pneumoniae [2,3]. Indeed, it has been shown that children with rAOM have lower levels of total IgG2 [4,5], the main IgG isotype induced by polysaccharides, and pneumococcal serotype specific IgG [6], IgG2 and IgA [7]. On the contrary though, others found normal levels of total IgG, IgA and its subclasses [8,9] or even higher IgG levels to pneumococcal polysaccharides in children with AOM [10,11].
Children with otitis media mount a pneumococcal serotype specific serum IgG and IgA response comparable to healthy controls after pneumococcal conjugate vaccination
2012, VaccineCitation Excerpt :An IgG titre ≥0.35 μg/ml is generally accepted as the minimal concentration required for protection against invasive pneumococcal disease [14], but the level required for protection against mucosal disease, such as AOM, is likely to be higher and varies between pneumococcal serotypes [7]. In addition, IgG and IgA responses to non-PCV7 serotypes have been described to be low [15–18] or increased [19,20] in otitis-prone children. Together this indicates that data on pneumococcal specific immunity in otitis-prone children is conflicting.
Pneumococcal conjugate vaccination in children with recurrent acute otitis media: A therapeutic alternative?
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