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

土著儿童经历了世界上最高的急性和慢性耳朵感染，导致永久性耳朵损伤、听力丧失和教育方面的劣势。这些感染主要是细菌感染，肺炎链球菌(肺炎球菌)是主要病原体。肺炎球菌的定植和感染在出生几天内就开始了，在婴儿肺炎球菌结合疫苗可能产生任何潜在的免疫保护之前许多个月就开始了。需要新的战略来消除或至少推迟这种早发性肺炎球菌的定植。一种这样的策略是给母亲接种肺炎球菌疫苗，这可能会通过提高经胎盘或母乳中肺炎球菌抗体的滴度和-或通过减少母亲肺炎球菌的携带(并将其传播给婴儿)来保护新生儿。以前使用这一策略的小规模研究令人鼓舞，但还没有研究适当地评估婴儿的携带者或疾病终点。目前建议对北领地15岁或以上的所有土著和托雷斯岛民接种多糖肺炎球菌疫苗，但疫苗接种率很低。我们建议进行一项初步研究，以确定在分娩后立即怀孕的第三个三个月期间使用这种疫苗进行母体免疫是否可以减少7个月大的土著婴儿携带肺炎球菌和中耳疾病的患病率。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。每名受试者及其婴儿在接种疫苗后、出生时、出生后1个月、2个月和7个月后将接受随访。

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.