November 10, 1994: Vol26n10: FINDINGS:  Kids & Ear Ailment

By LOIS BAKER
News Bureau Staff
Three recent studies conducted by pediatric researchers at UB in
conjunction with scientists from Japan have shed new light on how
middle-ear infections develop in young children and point to a
possible target for a vaccine against one of the causative organisms.
	The researchers report in October's Journal of Infectious
Diseases that the frequency of otitis media -- middle-ear infections
-- in young children is related directly to the presence of
nontypeable Haemophilus influenzae bacteria in their nasal passages
and the amount of antibody to the bacteria's P6 outer-membrane protein
secreted by the nasal mucosa.
	The findings indicate that many middle-ear infections
originate in  nasal passages, that a strong local antibody response to
the organism can thwart subsequent infections, and that the H.
influenzae P6 protein may be a likely target for a vaccine to prevent
initial infections.
	Research published by the team  in The Journal of Pediatrics
showed that children who consumed breast milk with high levels of the
anti-P6 antibody had fewer H. influenzae colonizations than babies
whose mother's milk had lower concentrations of antibody. These
findings suggest that the known protective effect of breast feeding
against infant ear infections may be due, in part, to the antibody's
inhibition of H. influenzae colonization in the nose.
	Another study by the team in The Journal of Infectious
Diseases showed a close association between otitis media and nasal
colonization by another organism -- Moraxella catarrhalis.
	The current publication reports results of a study of 157
children  followed from birth to 12 months. Eighty-two percent of
children from whom H. influenzae were recovered developed otitis
media, compared to 56 percent  in whom the bacteria were not present.
	Children in whom H. influenzae were colonized were four times
as likely to be classified as otitis prone than noncolonized children.
Those  developing recurrent otitis media were found to have lower
levels of antibodies specific to the bacteria in nasal mucous than
children who had no infection or only one episode.
	Howard S. Faden, professor of pediatrics at UB, co-director of
the Infectious Diseases Division at Children's Hospital of Buffalo and
lead U.S. investigator on the  studies, said the results suggest that
otitis-prone children may have immunologic abnormalities that prevent
them from producing antibodies against the infection-causing
organisms. He said these children do not respond normally to the P6
protein, considered a promising target for an otitis-media vaccine.
	"Previous studies have demonstrated widespread seropositivity
to P6 in the general population," Faden said, "but otitis-prone
children do not recognize P6 in a normal manner and fail to develop an
age-related rise in antibody concentration. Given this fact, normal
children likely will respond favorably to a P6 vaccine, while
otitis-prone children will respond less well."
n the study on human-milk anti-
	body, Faden's group followed 68 children who were fed human
milk for the first 12 months of life to determine if anti-P6 antibody
to H. influenzae in human milk could protect against nasal
colonization by the organism.	They measured the amount of anti-P6
antibody in the milk and tested the infants for colonization of the
organism and occurrence of otitis media. Results showed that human
milk fed to children who were not colonized by H. influenzae had
significantly higher levels of antibody than milk fed to children who
had multiple colonizations. Frequency of colonization by the organism
was directly related to episodes of otitis media.
	The researchers theorize that the human-milk antibody prevents
the bacteria from attaching to the nasal lining or, once attached,
inhibits growth of the organism.
	The relationship between the bacteria Moraxella catarrhalis
and otitis media was established through a study of 120 children
followed from birth to age 2. They were tested for colonization by the
organism and evaluated for otitis-media infection. 	Results showed
that while the bacteria were present at some point in more than
three-fourths of the children by age 2, colonization increased more
than twofold during episodes of otitis media. Researchers concluded
that a high rate of colonization by this organism is a risk factor for
developing otitis media.
	The research team also  included Linda Duffy, Judy Wolf,
Deborah Krystofik, UB; Yasuaki Harabuchi, Sapporo Medical College,
Japan;  Noboru Yamanaka, Wakayama Medical College, Japan. The projects
were supported by grants from the National Institute of Child Health
and Human Development.