Dersleri yüzünden oldukça stresli bir ruh haline sikiş hikayeleri bürünüp özel matematik dersinden önce rahatlayabilmek için amatör pornolar kendisini yatak odasına kapatan genç adam telefonundan porno resimleri açtığı porno filmini keyifle seyir ederek yatağını mobil porno okşar ruh dinlendirici olduğunu iddia ettikleri özel sex resim bir masaj salonunda çalışan genç masör hem sağlık hem de huzur sikiş için gelip masaj yaptıracak olan kadını gördüğünde porn nutku tutulur tüm gün boyu seksi lezbiyenleri sikiş dikizleyerek onları en savunmasız anlarında fotoğraflayan azılı erkek lavaboya geçerek fotoğraflara bakıp koca yarağını keyifle okşamaya başlar


Influence of Pneumococcal Conjugate Vaccine on Otitis Media
ISSN: 2161-119X
Otolaryngology: Open Access

Like us on:

Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business
  • Short Communication   
  • Otolaryngol (Sunnyvale) 2016, Vol 6(3): 236
  • DOI: 10.4172/2161-119X.1000236

Influence of Pneumococcal Conjugate Vaccine on Otitis Media

Masaru Kunimoto1,2*, Sachio Takeno1, Katsuhiro Hirakawa1, Hirotoshi Sugino3 and Takahiro Sumiya4
1Department of Otolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Applied Life Sciences, Hiroshima University, Hiroshima City, Japan
2Kunimoto ENT Clinic, Hiroshima City, Japan
3Sugino Pediatric Clinic Hiroshima City, Japan
4Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima City, Japan
*Corresponding Author: Masaru Kunimoto, ENT Clinic, 7-59-28, Tomohigashi, Asaminamiku, Hiroshima City, 731-3164, Japan, Tel: 81-82-811-8133, Fax: 81-82-811-8032, Email:

Received: 09-May-2016 / Accepted Date: 23-May-2016 / Published Date: 30-May-2016 DOI: 10.4172/2161-119X.1000236

Otitis Media

Streptococcus pneumoniae is considered as the prime causative pathogen responsible for pneumonia, bacteremia, meningitis, acute sinusitis, acute otitis media (AOM), and specifically pneumococcal disease which are invasive in nature.

The vaccine developed for pneumococcal diseases is a heptavalent conjugate vaccine (PCV 7). This particular vaccine consists of capsular polysaccharides originated from seven different Streptococcus pneumoniae species along with the protein diphtheria crm197 as conjugate antigens. In a month time after inoculation in children this vaccine is able to increase the IgG level sufficiently to combat the pneumococcal infections.

There are many designed cohort studies that evaluate the effectiveness of PCV7 for IPD and otitis media. In those studies, PCV7 are significantly reducing the invasive pneumococcal disease especially under 1 year children [1]. But PCV7 effect for acute otitis media and otitis media with effusion shows the unexpected results.

First, almost all studies about PCV7 effects for AOM are evaluated with terms of changes in episodes and altogether visits with medical purpose done by the children to the physician.

In 2012, Taylor et al. [2] reported meta-analysis of PCV7 effects against AOM that PCV7 provides some protection against OM on allcause AOM (aAOM) episodes and physician visits.

In 2014, the Cochrane repository reported an update about a metaanalysis of PCV effects on AOM [3]. One of the author’s major conclusions is that the PCV7 had modest beneficial effects. In 2015, it is not meta-analysis but Lau et al report form the United Kingdom shows the 22% reduction in children aged <10 years old [4]. From those results, PCV7 does not consider to have strong effect for AOM prevention.

Rate of myringotomy for acute otitis media per 1,000 populationyears in age groups, according to year. Total number of cases is 1,916 in the Figure 1. Public funding for PCV7 was introduced in January 2011.


Figure 1: Rate of myringotomy for acute otitis media (modified figure originally come from Sugino H, et al. [19]).

The rate in 1 year old children was significantly lower in 2011 and 2012 compared to 2008, 2009 and 2010 with chi-squared tests and Ryan's multiple comparison tests (asterisks). This is a modified figure. The second, numerous studies have evaluated changes in the number of ventilation tube insertion (VTI) to treat the recurrent otitis media and otitis media with effusion after PCV7 introduction under a typical vaccination schedule [5-14]. In long-term observations, almost all articles demonstrated that the number of VTI performed in ≤ 2 year old children significantly decreased after the introduction of PCV7 under a typical vaccination schedule.

The rate of reduction is 13%-50% [5-13]. But it is remarkable that inoculation is started over 1 year old; there is no significant effect in suppressing VTI even with the combined usage of a 23-valent pneumococcal polysaccharide booster [15-17]. From those results, PCV7 started in infants consider to have strong effect to prevent the complex otitis media required VTI.

These two results lead the question how PCV7 inoculation started under 1 year old children reduce the VTI if PCV7 has any work for AOM. This is why the AOM progression should be evaluate after introduction of PCV7.

Stamboulidis reported decreased rate of visit to the emergency department of clinics by 38% (from 133 to 83) for the patients having AOM in combination with otorrhea after successful PVC7 immunization [18].

Based on the finding on local inflammation, Sugino et al. [19] described the requirement of proper evaluation with relation to the AOM post PCV7 introduction applying number of myringotomies executed.

According to the recommendation of Japanese medical guidelines, AOM associated with stark otoscopic outcomes are referred for myringotomy. Similar recommendation is done for cases with report of treatment-resistance. Similar type of judgment is not given for the bacterial exam [20].

A total of 895 myringotomies were performed for 1 year old infants. The rate of myringotomies per child-year performed for acute otitis media in 1 year old infants went down considerably within the 2 years after receiving of the public funding rather than the years prior to the introduction (p<0.000001). We expect many new reports about the change of AOM progression after PCV introduction. And those results will show that pneumococcal conjugate vaccine may help prevent AOM from magnification having serious clinical manifestations and it may present some hypothesis to reduction of VTI for complex otitis media.


This work was partly supported by JSPS KAKENHI Grant Number 16K11213.


  1. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. (2003) Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med. 1:1737-1746.
  2. Taylor S, Marchisio P, Vergison A, Harriague J, Hausdorff WP, et al. (2012) Impact of pneumococcal conjugate vaccination on otitis media: A systematic review.Clin Infect Dis 54: 1765-1773.
  3. Fortanier AC, Venekamp RP, Boonacker CW (2014) Pneumococcal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev 4.
  4. Lau WC, Murray M, El-Turki A, Saxena S, Ladhani S, et al. (2015) Impact of pneumococcal conjugate vaccines on childhood otitis media in the United Kingdom. Vaccine 33:5072-5079.
  5. Black S, Shinefield H, Fireman B, Lewis E, Ray P, et al. (2000) Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 19:187-195.
  6. Fireman B, Black SB, Shinefield HR, Lee J, Lewis E, et al. (2003) Impact of the pneumococcal conjugate vaccine on otitis media.Pediatr Infect Dis J 22: 10-16.
  7. O'Brien KL, David AB, Chandran A, Moulton LH, Reid R, et al. (2008) Randomized, controlled trial efficacy of pneumococcal conjugate vaccine against otitis media among Navajo and White Mountain Apache infants.Pediatr Infect Dis J 27: 71-73.
  8. Palmu AA, Verho J, Jokinen J, Karma P, Kilpi TM (2004) The seven-valent pneumococcal conjugate vaccine reduces tympanostomy tube placement in children.Pediatr Infect Dis J 23: 732-738.
  9. Poehling KA, Szilagyi PG, Grijalva CG. (2006) Effect of combined pneumococcal conjugate and polysaccharide vaccination on recurrent otitis media with effusion. Pediatrics. 117:603-608.
  10. Jardine A, Menzies RI, Deeks SL, Patel MS, McIntyre PB (2009) The impact of pneumococcal conjugate vaccine on rates of myringotomy with ventilation tube insertion in Australia.Pediatr Infect Dis J 28: 761-765.
  11. Gisselsson SM, Melhus A, Hermansson A (2011) Pneumococcal vaccination in children at risk of developing recurrent acute otitis media - a randomized study.ActaPaediatr 100: 1354-1358.
  12. Sarasoja I, Jokinen J, Lahdenkari M, Kilpi T, Palmu AA (2013) Long-term effect of pneumococcal conjugate vaccines on tympanostomy tube placements.Pediatr Infect Dis J 32: 517-520.
  13. van Heerbeek N, Straetemans M, Wiertsema SP, Ingels KJ, Rijkers GT, et al. (2006) Effect of combined pneumococcal conjugate and polysaccharide vaccination on recurrent otitis media with effusion.Pediatrics 117: 603-608.
  14. Dagan R, Pelton S, Bakaletz L, Cohen R. (2016) Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. Lancet Infect Dis. 16:480-492.
  15. Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, et al. (2003) Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study.Lancet 361: 2189-2195.
  16. van Kempen MJ, Vermeiren JS, Vaneechoutte M, Claeys G, Veenhoven RH, et al. (2006) Pneumococcal conjugate vaccination in children with recurrent acute otitis media: a therapeutic alternative?Int J PediatrOtorhinolaryngol 70: 275-285.
  17. van Heerbeek N, Straetemans M, Wiertsema SP, Ingels KJ, Rijkers GT, et al. (2006) Effect of combined pneumococcal conjugate and polysaccharide vaccination on recurrent otitis media with effusion.Pediatrics 117: 603-608.
  18. Stamboulidis K, Chatzaki D, Poulakou G, Ioannidou S, Lebessi E, et al. (2011) The impact of the heptavalent pneumococcal conjugate vaccine on the epidemiology of acute otitis media complicated by otorrhea. Pediatr Infect Dis J. 30 :551-555.
  19. Sugino H, Tsumura S, Kunimoto M, Noda M, Chikuie D, et al. (2015) Influence of pneumococcal conjugate vaccine on acute otitis media with severe middle ear inflammation: A Retrospective Multicenter Study.PLoS One 10: e0137546.
  20. Subcommittee of clinical practice guideline for diagnosis and management of acute otitis media in children (Japan Otological Society, Japan Society for Pediatric Otorhinolaryngology, Japan Society for Infectious Diseases in Otolaryngology) (2012) Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan. AurisNasus Larynx 39: 1-8.

Citation: Kunimoto M, Takeno S, Hirakawa K, Sugino H, Sumiya T (2016) Influence of Pneumococcal Conjugate Vaccine on Otitis Media. Otolaryngol (Sunnyvale) 6:236. Doi: 10.4172/2161-119X.1000236

Copyright: © 2016 Kunimoto M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.