Reduced nontypeable Haemophilus influenzae lower airway infection in children with chronic endobronchial suppuration vaccinated with the 10-valent pneumococcal H. influenzae protein D conjugate vaccine. Issue 13 (20th March 2018)

• Record Type: Journal Article
• Authors: Hare, Kim M.; Smith-Vaughan, Heidi C.; Leach, Amanda J.; Pizzutto, Susan J.; McCallum, Gabrielle B.; Chang, Anne B.
• Is Part Of: Vaccine. Volume 36:Issue 13(2018)
• Page Start: 1736
• Page End: 1742
• Publication Date: 2018-03-20
• Subjects: BAL bronchoalveolar lavage -- CFU colony-forming units -- CI confidence interval -- CSLD chronic suppurative lung disease -- HR hazard ratio -- HRCT high-resolution computed tomography -- NP nasopharyngeal -- NT Northern Territory -- NTHi nontypeable Haemophilus influenzae -- OM otitis media -- OR odds ratio -- PBB protracted bacterial bronchitis -- PCV (7, 13) pneumococcal conjugate vaccine (7-valent, 13-valent) -- PHiD-CV pneumococcal NTHi protein D conjugate vaccine -- STGGB skim-milk tryptone glucose glycerol broth; Nontypeable Haemophilus influenzae -- Lower airway infection -- Protracted bacterial bronchitis -- Chronic suppurative lung disease -- Bronchiectasis -- Pneumococcal conjugate vaccine; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2018.02.054
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Chronic lower airway infections in children are under-studied. Non typeable Haemophilus influenzae (NTHi) is the main pathogen identified. We examined the impact of pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) . NTHi lower airway infection was reduced in children given ≥2 doses of PHiD-CV. PHiD-CV may improve outcomes in those at risk of chronic endobronchial infections. Abstract: Background: Nontypeable Haemophilus influenzae (NTHi), the most common bacterial lower airway infection in children with protracted bacterial bronchitis, is associated with progression to bronchiectasis. We determined whether vaccination with 10-valent pneumococcal NTHi protein-D conjugate vaccine (PHiD-CV) reduced NTHi lower airway infection compared to children not PHiD-CV-vaccinated. Our unique childhood vaccination schedule and prospective 9-year bronchoalveolar lavage (BAL) collection provided an exclusive opportunity to examine this hypothesis. Methods: Paired BAL fluids and nasopharyngeal (NP) swabs were collected from 543 children (2007–2016) undergoing bronchoscopy for chronic cough. Children who received a primary course of ≥2 doses of one pneumococcal conjugate vaccine (PCV) and <2 doses of another PCV were included in each vaccine group. Logistic regression determined associations between NTHi lower airway infection (≥10 4 colony-forming units/mL BAL) and age, sex, Indigenous status, antibiotic exposure, and PHiD-CV vaccination. Results: Of 262 PCV7-vaccinated, 53 PHiD-CV-vaccinated and 166 PCV13-vaccinated children (62 had mixed schedules, <2 PCV doses or missing vaccination data), NTHi lower airway infection was detected in 89 (34%), 9 (17%) and 47 (28%), respectively. On multivariate regression, significant independent factors associated with reduced NTHi lower airway infection were PHiD-CV vaccination (ORadjusted = 0.42, 95%CI 0.19–0.93), macrolide use (ORadjusted = 0.57, 95%CI 0.35–0.93) and increasing age (ORadjusted = 0.88, 95%CI 0.80–0.96). PHiD-CV vaccination had no impact on NTHi NP carriage. Conclusions: PHiD-CV-vaccinated children were significantly less likely to have NTHi lower airway infection than children not PHiD-CV-vaccinated. PHiD-CV is likely an effective intervention for reducing NTHi endobronchial infection in children at risk of chronic suppurative lung diseases.