Biomedical subjects

J Pukander

Publications and source records attributed to J Pukander.

51 records · Page 3Linked to original sources

PubMed1980

Pneumococcal vaccine and otitis media.

After an acute attack of otitis media 827 children aged 3 months to 6 years were assigned randomly to receive either 14-valent pneumococcal polysaccharide vaccine or a control vaccine (Haemophilus influenzae type b capsular polysaccharide). In children older than 6 months serum antibody responses to most of the vaccine polysaccharides were satisfactory. The response to type 6A was poor. Correspondingly, no clinical protection was seen below 6 months of age or against otitis media caused by group 6 pneumococci. Among the children more than 6 months old, the first 6 months after vaccination saw significantly (p < 0.001) fewer attacks caused by the pneumococal types represented in the vaccine (group 6 excepted) in those who received the pneumococcal vaccine than in those who received the control vaccine. Protection against type 19F was statistically significant (p < 0.01). The overall protective efficacy was 58%--somewhat better in children older than 2 years than in those younger. Previous attacks of otitis caused by pneumococci did not influence the protective efficacy of the vaccine.

Age Factors↗

PubMed1980

[Bad breath].

Explore the source record for details and available documents.

Halitosis↗

PubMedDate not supplied

Prevention of otitis media in children by pneumococcal vaccination.

A total of 3,340 infants, 95 per cent of them 7 to 9 months old, were randomly vaccinated in a double-blind fashion with either the 14-valent pneumococcal (Pn) polysaccharide vaccine or a saline placebo in three urban areas in Finland. The second dose of the vaccine was given 5 months later. Age and sex distribution, recruitment of infants, and their otitis-related treatment and follow-up were similar in the study areas. Side effects after vaccination were mild and fewer than among older children. Antibody responses to vaccine polysaccharides varied from type to type, but were generally poor, especially to types most prevalent in otitis media. After the first dose of vaccine, the occurrence of otitis visits among the Pn-vaccinated, as compared with controls, showed inter-area differences, but ranged from not more than a 30 per cent reduction at its best to an increase in some areas and in some clinical categories. The respective figures for children with acute otitis media were similar between the vaccination groups and the study areas. The effect of the vaccine on acute otitis media caused by specific Pn types/groups represented in the vaccine was variable but generally poor. Group 6 attacks especially seemed to behave problematically. The second dose of the vaccine did not give additional benefit serologically or clinically. The efficacy of currently available pneumococcal vaccine against otitis media seemed poor in infants.

Antibodies, Bacterial↗

PubMedDate not supplied

A study of the pneumococcal vaccine in prevention of clinically acute atttacks of recurrent otitis media.

A total of 827 infants and children three months to six years of age were vaccinated randomly after an attack of otitis media, with either the 14-valent pneumococcal vaccine or a control vaccine against Hemophilus influenzae type b. Clinically acute attacks of otitis media that occurred greater than or equal to 14 days after vaccination were analyzed by culture of the middle ear fluid. Children who had received the pneumococcal vaccine at the age of seven to 83 months experienced within the first six months after vaccination significantly fewer attacks of otitis media caused by Streptococcus pneumoniae than did children in the control group (50% overall reduction, p less than 0.01). The reduction of attacks was specific to those pneumococcal types/groups present in the vaccine that induced a good serum antibody response; the specific protection indicated for vaccine types/groups other than 6 (to which the antibody response was very poor) was 67% (P less than 0.001). No or very little protection was seen in infants younger than seven months or in any children later than six months after vaccination.

Acute Disease↗

PubMedDate not supplied

Efficacy of pneumococcal vaccination against recurrent otitis media. Preliminary results of a field trial in Finland.

For this study, 781 children, and 3 to 83 months, after presenting with acute otitis media, were immunized with either 14-valent pneumococcal or Haemophilus influenzae type b capsular polysaccharide vaccine. The vaccines were tolerated well. Antibody responses to the 14 pneumococcal polysaccharide types, measured by radioimmunoassay, were fair to good and increased with age, with the exception of types 1, 6 and 12 to which the responses were generally poor. During the follow-up of 1-17 months, average 13 months, 45 vaccine type (except type 6) pneumococcal recurrences were met among 456 pneumococcal-vaccinated and 45 among 288 H. influenzae-vaccinated children, at least six months old (P < .05). The corresponding protective efficacy by the pneumococcal vaccine was 37%, for the first six months, 51% (P < .01). No protection by the pneumococcal vaccine was seen against group 6 pneumococci, nor among 19 infants under six months of age. Nonvaccine type pneumococcal ad H. influenzae recurrences did not significantly concentrate in either of the vaccination groups. Thus, it seems that parenteral immunization of children can reduce the recurrence rate of otitis media caused by pneumococci of types (except type 6) present in the vaccine.

Antibody Formation↗

PubMedDate not supplied

Occurrence and recurrence of acute otitis media among children.

The occurrence and recurrence of acute otitis media among 37 570 Finnish children at risk who were under 15 years of age were studied. During a one-year period, 4 337 of the children experienced a total of 6 249 attacks of acute otitis media, giving an annual incidence rate of 16.6%. The highest incidence, 75.5%, was found among infants 6--11 months old. 50% of Finnish children had experienced at least one ear infection before their third birthday and 75% before the age of 10, and among this latter group the total number of otitis attacks per child-year during a lifetime was 0.71. Among children under 10, half of the index attacks were recurrences, and among children under 16, 28% of the index attacks were followed by recurrences during the study year. The highest relative recurrence rate was found during the second year of life. Before the second birthday both incidence and recurrence rates were significantly (p less than 0.001) higher among boys. Acute otitis media was most common in the higher social class families and the lowest incidence and recurrence rates were found among children of farmers.

Acute Disease↗

PubMedDate not supplied

Incidence of acute otitis media.

The occurrence of acute otitis media was studied over a one-year period in a total population of 146822 persons living in different parts of Finland. Of these 146822 persons, 4583 experienced a total of 6518 otitis attacks giving an annual incidence rate of 4.44% (4.48% in males and 4.07% in females, P less than 0.001). Acute otitis media was strikingly concentrated in the youngest age groups, with the highest annual incidence rates, in the order of 50%, found in infants younger than 2 years. Half of all the episodes occurred before the age of 33 months. The relative risk of getting acute otitis media was about 200 times higher during the first 2 years of life than as an adult. The occurrence of otitic episodes followed seasonal variations, and in urban areas the incidence was significantly (P less than 0.001) higher than in the countryside.

Acute Disease↗

PubMedDate not supplied

Haemophilus influenzae in acute otitis media.

We studied the occurrence of Haemophilus influenzae (Hi) in 2625 middle ear fluid (MEF) specimens obtained from 523 children with otitis media, aged 3 months to 6 years, between October 1977 and May 1979. In clinically acute cases 12.3% of the MEFs grew Hi; 6.3% (13/206) of the strains were of type b and 4.9% (10/206) were beta-lactamase producing. In the very first acute case of a child 8.0% (21/263) of the MEFs grew Hi, but in acute recurrences it was cultured in 17.0% (184/1082) (p less than 0.001). In non-acute persistent MEFs obtained during control visits Hi was found in no less than 21.7% (198/913); as many as 12.6% (25/198) of them were beta-lactamase producing. Both of these figures, but not the proportion of type b strains (8.6%), were significantly (p less than 0.001 and p less than 0.01, respectively) greater than in clinically acute MEFs. Hi was grown in 13.1% of the acute MEFs taken from children less than 4 years old, but in only 8.6% of the older children (p less than 0.05). The annual survey of all the 1816 Hi strains isolated from the MEFs of acute or subacute cases of otitis media in one laboratory in 1976-81 showed the proportion of beta-lactamase producing strains of all Hi strains to be gradually increasing from 8.0% (17/212) in 1976 to 15.2% (16/105) in 1981 (p less than 0.05).

Acute Disease↗

PubMedDate not supplied

Clinical features of acute otitis media among children.

The anamnestic and clinical data on all of the 2254 attacks of acute otitis media (AOM) registered among 14200 children (less than 16 years) at risk during a one-year period were analysed. On the basis of otoscopic findings AOM was classified into three grades: 25.0% of the cases were considered mild, 39.0% moderate and 36.0% severe. Spontaneous perforation was found in 4.6% of the cases. 76.2% of the attacks were preceded by a respiratory infection, but only 1.4% were sequelae of some epidemic childhood disease. Earache was present in 73.5% of the attacks; in 81.0% of these it had lasted less than 24 hours. 39.4% of all the attacks were bilateral; during the first 2 years of life the proportion was 53.7%, decreasing thereafter with increasing age, and being only 18.7% among those 10-15 years old. In unilateral attacks the right ear was affected slightly, but not significantly, more often.

Acute Disease↗

PubMedDate not supplied

Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children.

The factors affecting the occurrence and recurrence of acute otitis media (AOM) were studied among 471 2-3-year-old children in two cities in Finland. Of these children, 188 had experienced greater than or equal to 3 attacks of AOM, 76 had had 1-2 attacks and 207 no otitis attacks (= control group). The study showed that the risk of recurrent AOM was increased among those children attending day-care nurseries as well as among those who had several siblings. Proneness to rhinorrhea and exposure to passive smoking at home was associated with an increased risk of AOM, while prolonged breast-feeding (greater than 6 months) seemed to reduce it. No correlation was found between the risk of recurrent AOM and the place of residence or type of housing, the parental otitis history, or atopic diathesis of a child. Thus the study suggested that to protect a young child from AOM we should promote breast-feeding and home-care for babies as well as avoid smoking in the home.

Acute Disease↗

PubMedDate not supplied

Branhamella catarrhalis in acute otitis media.

A total of 5217 middle ear fluid (MEF) samples obtained from 1203 children with otitis media, aged 3 months to 6 years, were studied for the presence of Branhamella catarrhalis (Br) between Oct. 1977 and Sept. 1981. Br grew in 10.2% of 3497 MEFs of acute otitis media (AOM), with almost the same frequency in the very first and subsequent attacks. During the first 4 years of life the percentage did not vary much; among older children it seemed to decrease. The overall prevalence of Br in AOM did not change during the study period. Br alone grew in 72.4% of acute MEFs with Br; with other bacteria the respective figure was 82.9% (p less than 0.001). Acute attacks with bilateral Br were found in 22.8% of attacks with Br. In 1720 non-acute MEFs obtained at postacute control visits, Br was isolated in only 7.0%. The proportion of beta-lactamase-producing strains among the 2419 otitis-Br strains tested in two laboratories of the two study regions showed an increase from 27.1% and 21.1% in 1980 to 57.6% and 38.6% in 1983, respectively (p less than 0.001).

Acute Disease↗

PubMedDate not supplied

Incidence of acute otitis media up to the age of 1 1/2 years in urban infants.

The object of this prospective cohort investigation of 1,642 infants was to study the incidence of acute otitis media (AOM) in urban children during the first 18 months of life. The monthly incidence of AOM was greatest at the age of 10 months, and the largest proportion of children with AOM was also found in this 10-month age group. Before the age of 18 months, 56.7% of the infants had had at least one episode of AOM, while 26.9% had had one or two episodes and 29.8% three or more. The corresponding figures before the age of 12 months were: 45.3%; 26.8%; 18.5%, and before the age of 9 months: 30.5%; 22.1%; 8.4%. The AOM incidence, particularly as regards recurrent AOM, was rather higher in boys than in girls.

Acute Disease↗

PubMedDate not supplied

The Bayesian approach to the evaluation of risk factors in acute and recurrent acute otitis media.

A multivariant modelling method was used to analyse the risk, associated with 22 different factors, of contracting acute otitis media (AOM) in a prospective cohort of 1294 urban children followed up to the age of 17-32 (mean 25) months. By far the most important risk factor was the caring of the child at a day-care centre. The importance of this factor further increased with increasing recurrence of the attacks. Next in order came the existence of sibling(s) with AOM attacks during the follow-up. Prolongation of breastfeeding increased the protection against AOM during the first year of life. The frequency of AOM attacks was lowest around midsummer and highest in early winter.

Acute Disease↗

PubMedDate not supplied

Pneumococcal middle ear fluid antibodies after pneumococcal acute otitis media in infants.

Forty-one infants, who during their first (initial) acute otitis media (AOM) had culturable S. pneumoniae (Pn) in 57 middle ear fluids (MEFs) which prolonged or recurred during the follow-up, were observed for 7-15 months for the presence of Pn, Pn-antigens (Pn-ags) and initial-type/group Pn-antibodies (Pn-abs) in these MEFs. Initially, Pn-abs were found in only 3 MEFs. During the follow-up a total of 20 ears (35%) were, at various time-intervals, positive for Pn-abs; they belonged to all three major Ig-classes, but were often slight in quantity. Most regularly, and often with distinct positivity, Pn-abs were found to type 3, 9N and 14. Secretory abs were detected in 5 ears. Within one month after initial AOM, Pn-abs appeared in 9 of the 41 ears with MEF (22%); six of them cleared soon after that. MEFs with Pn-abs usually did not show initial-type Pn/Pn-ag, but new Pn/Pn-ag could later be simultaneously present in recurrent MEF. So, pneumococcal AOM may cause a local and/or systemically mediated immune response in the middle ear in infants. The response may protect the ear from homologous, but still be present in apparently non-homologous otitis media.

Acute Disease↗

PubMedDate not supplied

Esophagitis and findings of long-term esophageal pH recording in children with repeated lower respiratory tract symptoms.

Esophagoscopy was performed on 116 children with recurrent lower respiratory tract symptoms; esophagitis of various degrees was detected in 45% of the cases. The presence of verified esophagitis correlated with endoscopic findings of bile-stained gastric contents, suggesting a role of bile reflux in the pathogenesis. Esophageal pH recordings covering an 18-24-h period were performed on 22 patients with esophagitis and 19 patients without esophagitis. Gastroesophageal reflux (GER) during the sleeping period was detected in 95% of children with esophagitis, as compared to 42% in children with no esophagitis (p less than 0.001). The percentage of time with esophageal pH below 4 of the total registration time was significantly greater (p less than 0.05) in children with esophagitis (9.5%) than in those with no esophagitis (4.0%)--the difference being due to a greater share of nocturnal GER of the recording time. These criteria could be applied to a search for clinically significant GER in children with recurrent lower respiratory tract symptoms and to select patients for esophagoscopy.

Adolescent↗