Acute bacterial rhinosinusitis and otitis media: Changes in pathogenicity following widespread use of pneumococcal conjugate vaccine

OBJECTIVE: Acute bacterial rhinosinusitis and acute otitis media are two of the most common respiratory tract infections. The common pathogenic bacteria associated with these infections are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. With the recent widespread use of pneumococcal conjugate vaccine, there is evidence that there is a shift of both the pneumococcal serotypes and the distribution of pathogenic bacteria. The purpose of this article was to investigate whether the literature supports changes in pathogenicity of acute bacterial rhinosinusitis and otitis media after widespread use of conjugate pneumococcal vaccine.

DATA SOURCES: MEDLINE search of the literature was performed between 1995 and 2007.

REVIEW METHODS: Literature review of changes in distribution of pathogens, resistance rates, and pneumococcal serotype changes before and after widespread use of conjugate pneumococcal vaccine.

RESULTS: There is evidence that the distribution of pneumococcal serotypes has changed after the widespread use of conjugate pneumococcal vaccine. There appears to be both less invasive and noninvasive pneumococcal disease and with childhood immunization there also appears to be a protective effect on adults (herd immunity). Increases in nonvaccine serotypes, some with high levels of resistance are being identified in some communities. There is also growing evidence that there may be an increasing prevalence of Haemophilus influenzae in these infections.

CONCLUSIONS: Widespread use of conjugate pneumococcal vaccine has led to decreasing incidence of pneumococcal otitis media and likely also acute bacterial rhinosinusitis, which may have implications for treatment recommendations for these infections.