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Nontypeable Haemophilus influenzae a common cause of respiratory tract infection in children
Nontypeable Haemophilus influenzae causes about one-third of otitis media episodes in children and is the most common cause of recurrent otitis media in this population.
In a clinical trial, researchers from the Czech Republic assessed the efficacy of an 11-valent vaccine in which pneumococcal capsular polysaccharides were conjugated to protein D of H. influenzae in prevention of acute otitis media.
Results from the study indicated that using theH. influenzae–derived protein D as a carrier protein for pneumococcal polysaccharides not only provided protection against pneumococcal otitis but also against AOM caused by nontypeable H. influenzae.
In an interview, Timothy F. Murphy, MD, distinguished professor of the departments of medicine and microbiology and chief of infectious diseases of the University at Buffalo, State University of New York, told Infectious Diseases in Children, “This research has reinvigorated the field of vaccine development for nonencapsulated H. influenzae ... It is important to recognize that H. influenzae is causing many of these infections because such knowledge may influence the choice of antibiotic therapy.”
Pediatr Infect Dis J. 2009;28:43-48.
A letter to the editor by Arguedas et al in The Lancet raises several issues regarding this study. It is likely that the Czech investigators did not use the same diagnostic criteria as we use in the United States for AOM and that some children with AOM never went from the general practitioners to the ENT collaborators for tympanocentesis. Nevertheless the data strongly suggest to me that protein D from non-typeable H. influenzae (NTHi) is immunogenic and does provide some protection against AOM caused by this organism.
This is good news and whether regulators give GSK an indication for protection against NTHi AOM or not, the results encourage further study of this antigen and other antigens in the pipeline as potential vaccine ingredients in a multicomponent NTHi vaccine.
Unfortunately the GSK vaccine does not contain pneumococcal serotype 19A and since serotype 19A is now the predominant serotype in AOM and invasive pneumococcal disease in the US, the vaccine may not prove as useful in our country. The new pneumococcal conjugate vaccine soon forthcoming from Wyeth does not contain any ingredient to prevent NTHi AOM but it does contain the 19A serotype.
– Michael E. Pichichero
Infectious Diseases in Children Editorial Board member