Immunising Aboriginal mothers with pneumococcal polysaccharide vaccine to prevent infant ear disease and carriage

土著儿童的急性和慢性耳部感染率在世界上最高，造成永久性耳部损伤、听力损失和教育上的不利。这些感染主要是细菌性的，肺炎链球菌（肺炎球菌）是主要的病原体。肺炎球菌定植和感染在出生后数天内开始，比婴儿肺炎球菌结合疫苗预期的任何潜在免疫保护早数月。需要新的策略来消除或至少延迟这种早发性肺炎球菌定植。其中一种策略是给母亲接种肺炎球菌疫苗，通过提高经胎盘或母乳肺炎球菌抗体的滴度和/或减少母亲肺炎球菌的携带（和向婴儿的传播），可以保护新生儿。以前使用这种策略的小型研究令人鼓舞，但还没有研究正确评估婴儿的携带或疾病终点。目前建议北领地所有15岁或15岁以上的土著人和托雷斯岛民接种多糖肺炎球菌疫苗，但疫苗接种率很低。我们建议进行一项试点研究，以确定母亲接种这种疫苗，无论是在怀孕的第三个三个月或分娩后立即接种，都可以减少肺炎球菌携带和土著婴儿7个月大时中耳疾病的患病率。我们的目标是从达尔文和北领地顶端的偏远社区招募210名怀孕不复杂的土著妇女。每例受试者及其婴儿后代将在接种疫苗后和出生时、出生后1个月、2个月和7个月进行随访。

Aboriginal children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, many months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are needed to eliminate, or at least delay, this early-onset pneumococcal colonisation. One such strategy is the administration to the mother of pneumococcal vaccine, which may protect the newborn infant by leading to higher titres of transplacental or breast milk pneumococcal antibodies and-or by reducing carriage (and transmission to the infant) of maternal pneumococci. Previous small studies using this strategy have been encouraging, but there have been no studies properly evaluating carriage or disease endpoints in infants. The polysaccharide pneumococcal vaccine is currently recommended for all Aboriginal and Torres Islander persons aged 15 years or more in the Northern Territory but uptake of the vaccine has been poor. We propose to conduct a pilot study to determine if maternal immunisation with this vaccine, either in the third trimester of pregancy of immediately following delivery, can reduce pneumococcal carriage and the prevalence of middle ear disease among Aboriginal infants at seven months of age. We aim to recruit 210 Aboriginal women who have uncomplicated pregnancies from Darwin and remote communities in the Top End of the Northern Territory. Each subject and their infant offspring will be followed-up after vaccination and at birth, one , two and seven months after birth.