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Open Access Highly Accessed Research article

Association between early bacterial carriage and otitis media in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia: a cohort study

Wenxing Sun1, Peter Jacoby1, Thomas V Riley23, Jacinta Bowman2, Amanda Jane Leach4, Harvey Coates5, Sharon Weeks6, Allan Cripps7, Deborah Lehmann1* and the Kalgoorlie Otitis Media Research Project Team

Author Affiliations

1 Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia

2 Department of Microbiology & Infectious Diseases, PathWest Laboratory Medicine (WA), Perth, Western Australia, Australia

3 Microbiology & Immunology, The University of Western Australia, Perth, Western Australia, Australia

4 Ear Health Research Program, Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia

5 University Department of Otolaryngology, Head and Neck Surgery, The University of Western Australia, Perth, Western Australia, Australia

6 Professional Hearing Services, South Perth, Western Australia, Australia

7 School of Medicine, Griffith University, Gold Coast, Queensland, Australia

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BMC Infectious Diseases 2012, 12:366  doi:10.1186/1471-2334-12-366

Published: 21 December 2012

Abstract

Background

Streptococcus pneumoniae (Pnc), nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are the most important bacterial pathogens associated with otitis media (OM). Previous studies have suggested that early upper respiratory tract (URT) bacterial carriage may increase risk of subsequent OM. We investigated associations between early onset of URT bacterial carriage and subsequent diagnosis of OM in Aboriginal and non-Aboriginal children living in the Kalgoorlie-Boulder region located in a semi-arid zone of Western Australia.

Methods

Aboriginal and non-Aboriginal children who had nasopharyngeal aspirates collected at age 1- < 3 months and at least one clinical examination for OM by an ear, nose and throat specialist before age 2 years were included in this analysis. Tympanometry to detect middle ear effusion was also performed at 2- to 6-monthly scheduled field visits from age 3 months. Multivariate regression models were used to investigate the relationship between early carriage and subsequent diagnosis of OM controlling for environmental factors.

Results

Carriage rates of Pnc, NTHi and Mcat at age 1- < 3 months were 45%, 29% and 48%, respectively, in 66 Aboriginal children and 14%, 5% and 18% in 146 non-Aboriginal children. OM was diagnosed at least once in 71% of Aboriginal children and 43% of non-Aboriginal children. After controlling for age, sex, presence of other bacteria and environmental factors, early nasopharyngeal carriage of NTHi increased the risk of subsequent OM (odds ratio = 3.70, 95% CI 1.22-11.23) in Aboriginal children, while Mcat increased the risk of OM in non-Aboriginal children (odds ratio = 2.63, 95% CI 1.32-5.23). Early carriage of Pnc was not associated with increased risk of OM.

Conclusion

Early NTHi carriage in Aboriginal children and Mcat in non-Aboriginal children is associated with increased risk of OM independent of environmental factors. In addition to addressing environmental risk factors for carriage such as overcrowding and exposure to environmental tobacco smoke, early administration of pneumococcal-Haemophilus influenzae D protein conjugate vaccine to reduce bacterial carriage in infants, may be beneficial for Aboriginal children; such an approach is currently being evaluated in Australia.

Keywords:
Otitis media; Aboriginal; Streptococcus pneumoniae; Haemophilus influenzae; Moraxella catarrhalis