Cripps Allan W, Kyd Jennelle
Gadi Research Centre for Medical and Health Sciences, University of Canberra, Canberra, Australia.
Immunol Cell Biol. 2003 Feb;81(1):46-51. doi: 10.1046/j.0818-9641.2002.01141.x.
Otitis media is the most common reason for children less than 5 years of age to visit a medical practitioner. Whilst the disease rarely results in death, there is significant associated morbidity. The most common complication is loss of hearing at a critical stage of the development of speech, language and cognitive abilities in children. The cause and pathogenesis of otitis media is multifactorial. Among the contributing factors, the single most important are viral and bacterial infections. Infection with respiratory syncytial virus, influenza viruses, para-influenza viruses, enteroviruses and adenovirus are most commonly associated with acute and chronic otitis media. Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis are the most commonly isolated bacteria from the middle ears of children with otitis media. Treatment of otitis media has largely relied on the administration of antimicrobials and surgical intervention. However, attention has recently focused on the development of a vaccine. For a vaccine to be effective against bacterial otitis media, it must, at the very least, contain antigens that induce a protective immune response in the middle ear against the three most common infecting bacteria. Whilst over the past decade there has been significant progress in the development of vaccines against invasive S. pneumoniae disease, these vaccines are less efficacious for otitis media. The search for candidate vaccine antigens for non-typeable H. influenzae are well advanced whilst less progress has been made for M. catarrhalis. No human studies have been conducted for non-typeable H. influenzae or M. catarrhalis and the concept of a tribacterial vaccine remains to be tested in animal models. Only when vaccine antigens are determined and an understanding of the immune responses induced in the middle ear by infection and immunization is gained will the formulation of a tribacterial vaccine against otitis media be possible.
中耳炎是5岁以下儿童就医的最常见原因。虽然这种疾病很少导致死亡，但会引发严重的相关发病情况。最常见的并发症是在儿童言语、语言和认知能力发展的关键阶段出现听力丧失。中耳炎的病因和发病机制是多因素的。在促成因素中，最重要的单一因素是病毒和细菌感染。呼吸道合胞病毒、流感病毒、副流感病毒、肠道病毒和腺病毒感染最常与急慢性中耳炎相关。肺炎链球菌、不可分型流感嗜血杆菌和卡他莫拉菌是从患中耳炎儿童中耳中最常分离出的细菌。中耳炎的治疗很大程度上依赖于抗菌药物的使用和手术干预。然而，近来人们的注意力集中在疫苗的研发上。要使疫苗有效对抗细菌性中耳炎，它至少必须包含能在中耳诱导针对三种最常见感染细菌产生保护性免疫反应的抗原。虽然在过去十年中，针对侵袭性肺炎链球菌疾病的疫苗研发取得了重大进展，但这些疫苗对中耳炎的疗效较差。针对不可分型流感嗜血杆菌的候选疫苗抗原的研究进展良好，而针对卡他莫拉菌的研究进展较小。尚未对不可分型流感嗜血杆菌或卡他莫拉菌进行人体研究，三联细菌疫苗的概念仍有待在动物模型中进行测试。只有确定了疫苗抗原，并了解感染和免疫接种在中耳诱导的免疫反应，才有可能研制出针对中耳炎的三联细菌疫苗。
