Implications of bacterial load for vaccine efficacy and antibiotic treatment outcomes in high-risk populations

中耳炎(中耳疾病)是一种常见的儿童感染，是北领地偏远土著社区的主要关切。对于这些儿童来说，中耳炎在出生后的头几周就开始了，60%的儿童在12个月大的时候会发展成鼓膜穿孔。偏远原住民社区的儿童很少有正常的耳朵或听力，许多儿童有传导性听力损失，影响语言发展和教育。这些儿童的中耳炎是由肺炎链球菌、流感嗜血杆菌和卡他莫拉菌感染引起的。因此，我们正在使用抗生素治疗、肺炎链球菌疫苗接种和卫生干预措施来对抗耳朵疾病的高流行率。然而，我们担心这些儿童携带的大量细菌危及治疗和预防战略。目前的建议将检验这一假设，如果被发现是正确的，将对中耳炎的治疗产生影响。例如，抗生素治疗的剂量、频率和选择，以及疫苗计划的变化，包括早期剂量或加强剂量。

Otitis media (middle ear disease) is a common childhood infection, and a major concern in remote Aboriginal communities of the Northern Territory. For these children, otitis media commences within the first few weeks of life and progresses to perforation of the ear drum in 60% of children by 12 months of age. Few children in remote Aboriginal communities have normal ear status or normal hearing and many have conductive hearing loss, affecting language development and education. Otitis media in these children results from infection with the bacteria Streptococcus pneumoniae, Haemophilus influenzae and-or Moraxella catarrhalis. Therefore the types of interventions we are using to combat the high prevalence of ear disease are antibiotic therapy, Streptococcus pneumoniae vaccination, and hygiene interventions. However we fear that the high load of bacteria carried by these children compromises the treatment and prevention strategies. The current proposal will test this hypothesis, and if found to be true, there will be implications for the management of otitis media. For example, dose, frequency and choice of antibiotic treatment, and vaccine schedule changes including an early dose or a booster dose.