Pneumococcal Vaccine Is a Must for Cochlear Implant Patients

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July 2003 • Volume 37 • Number 7

News

30-fold higher risk in this population
Pneumococcal Vaccine Is a Must for Cochlear Implant Patients

Miriam E. Tucker
Senior Writer

ATLANTA — Patients who have received cochlear implants should be vaccinated against Streptococcus pneumoniae, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended at its summer meeting.

Data suggest that the risk of pneumococcal meningitis is increased about 30-fold in children with cochlear implants, and that S. pneumoniae is the most frequent etiology for both pediatric and adult postimplant meningitis cases.

A total of 52 cases of postimplant bacterial meningitis were reported over a 14-year period in the United States in recipients aged 18 months to 84 years.

Most of the postimplant bacterial meningitis patients have been under 7 years of age, Dr. Karen Broder of the CDC's Epidemiology Program Office, told ACIP.

Potential mechanisms include extension of middle ear pathogens into the inner ear and cerebrospinal fluid (CSF), foreign bodies, or the presence of other risk factors such as inner ear abnormalities associated with CSF leaks or a prior history of meningitis, Dr. Broder commented.

Given that information, ACIP approved three new recommendations (pending CDC approval) for use of both the 7-valent pneumococcal conjugate vaccine (PCV7) as well as the 23-valent pneumococcal polysaccharide vaccine (PPV23) in cochlear implant recipients:

Children aged 24-59 months should receive PCV7 vaccination if they have or are scheduled to receive a cochlear implant. For more information, go to www.cdc.gov/nip/issues/cochlear/cochlear-hcp.htm.
Persons aged 2-64 years should receive PPV23 if they have or are scheduled to receive a cochlear implant. Cochlear implant candidates and recipients should receive PPV23 vaccination according to the schedule used for persons with chronic illness. (See www.cdc.gov/mmwr/pdf/rr/rr4909.pdf for recommendations in children.)
Cochlear implant candidates and recipients aged 2 years or above who have completed the PCV7 vaccination series should receive one dose of PPV23 2 or more months after vaccination with PCV7.

The polysaccharide vaccine is recommended in addition to PCV7 because limited data suggest that at least some cases of postimplant pneumococcal meningitis are due to strains that are not included in PCV7.

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