Mechanisms of recurrent otitis media: importance of the immune response to bacterial surface antigens.

Otitis-prone children experience recurrent episodes of otitis media due to nontypeable H. influenzae (NTHI). A protective immune response occurs following infection, but this immune response is specific for the infecting strain, leaving the child susceptible to infection by other strains of NTHI. Little is known about the mechanism by which a strain-specific antibody response occurs to nonencapsulated bacteria. To explore the mechanism by which this strain-specific response occurs, animals were inoculated with whole bacterial cells and the antibody response was studied. The antibody response was predominantly directed to a highly strain-specific, immunodominant surface loop on the major outer membrane protein. This exquisitely restricted immune response leaves the host susceptible to recurrent infections by many strains of NTHI. The ability of the bacterium to direct the host to make a strain-specific antibody response has important implications in understanding the immune response to otitis media due to NTHI and in designing strategies for vaccine development.