Cochlear Implants & Meningitis Vaccination
Q&A For Healthcare Professionals
At a Glance
Persons with cochlear implants should be considered high-risk for pneumococcal meningitis. To help prevent meningitis for this group, review general and high risk recommendations for vaccines that prevent meningitis and consider the questions listed here.
What studies have documented a risk of bacterial meningitis among those with cochlear implants?
CDC and the Food and Drug Administration (FDA) carried out a study in 2002 to learn about a possible link between cochlear implants and bacterial meningitis in children. The study found that bacterial meningitis occurred more often in children with all types of cochlear implants than in children of the same age group in the general population. Those with cochlear implants may be at a particularly increased risk for pneumococcal meningitis. CDC recommends people with cochlear implants receive age-specific pneumococcal vaccination according to the high-risk schedules.
To learn more about the findings of this investigation, visit "The Early Hearing Detection and Intervention Program" (EHDI) web page about Cochlear Implants and Meningitis.
The results of this study did not assess whether a child with hearing loss and a cochlear implant has a higher chance of getting meningitis than a child with hearing loss without a cochlear implant. A recent study from Denmark reported an increased risk of meningitis among children with hearing loss as compared to those children without hearing loss (Parner, 2007). Further research is necessary to ascertain the risk of meningitis among these individuals.
What types of bacteria have caused meningitis among persons with cochlear implants?
The cochlear implant and meningitis investigation identified 24 episodes of bacterial meningitis with a known etiology. The following bacteria caused meningitis in these cases: Streptococcus pneumoniae (15), nontypeable Haemophilus influenzae (3), type b Haemophilus influenzae (Hib) (2), and other bacteria (4). No cases of meningitis caused by Neisseria meningitidis were identified in the study.
What should healthcare providers do for their patients who have or will receive a cochlear implant?
Healthcare providers should review the vaccination records of their patients who have cochlear implants and ensure that they are up-to-date on pneumococcal vaccination based on the schedule used for persons at high risk. Pneumococcal vaccination recommendations for people with cochlear implants can be viewed in this table. Additional guidance on pneumococcal vaccination for children up to 6 years of age and children 6 through 18 years of age is available. Providers should also ensure that Hib vaccination is up-to-date.
Persons scheduled to receive a cochlear implant should be up-to-date on vaccinations two or more weeks before surgery when possible. This includes pneumococcal vaccination for persons at high risk. A provider may also administer the Hib booster two or more weeks before cochlear implant surgery to children ages 12 through 59 months who have not completed their Hib series if the minimum interval between doses has been met.
For more information about minimum Hib intervals view the catch-up schedule.
When should persons with cochlear implants receive the pneumococcal vaccines (PCV13, PPSV23)?
The pneumococcal conjugate vaccine (PCV13) should be given at 2, 4, 6 and 12 through 15 months of age according to the Childhood Immunization Schedule. A single supplemental dose of PCV13 is recommended for all children up through 6 years of age who have received an age appropriate series with PCV7 only.
For children with cochlear implants who have completed all recommended doses of PCV13, these individuals should receive one dose of the pneumococcal polysaccharide vaccine (PPSV23) after they reach 2 years of age, and at least 2 months after the last dose of PCV13. In addition, a single dose of PCV13 should be administered to children aged 6 through 18 years with cochlear implants who have not received PCV13 or PPSV23 previously. PCV13 should be followed ≥ 8 weeks later by a dose of PPSV23. Children aged 6 through 18 years with cochlear implants who have not received PCV13 and who previously received ≥ 1 doses of PPSV23 should be given a single dose of PCV13 ≥ 8 weeks after the last PPSV23 dose, even if they have received PCV7.
Should persons with cochlear implants receive the Hib vaccine?
Most children born after 1990 received the Hib vaccine as infants. Those who have not received Hib vaccine and who are younger than 5 years of age should receive the vaccine. For those 5 years of age and older, Hib vaccine is not routinely recommended since most unvaccinated older children and adults are already immune to Hib.
Available information does not suggest children or adults 5 years of age or older with cochlear implants need Hib vaccination. There is no specific contraindication to using Hib vaccine in unvaccinated older children and adults, and healthcare providers may consider its use in cochlear implant recipients. However, there also are no data demonstrating clinical benefit of Hib vaccination for persons with cochlear implants outside the recommended age range. For more information about use of Hib vaccine read the MMWR article, Prevention and Control of Haemophilus influenzae Type b Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Should persons with cochlear implants receive the meningitis (meningococcal) vaccine?
Adolescents 11 through 18 years of age should receive 2 doses of meningococcal conjugate vaccine for routine protection, according to the Adolescent Immunization Schedule. Meningococcal vaccine protects against meningitis caused by some types of Neisseria meningitidis. There is no information to suggest that persons with cochlear implants are at increased risk for meningococcal meningitis. Therefore, meningococcal vaccine is not routinely recommended for persons with cochlear implants, unless they have other reasons to get this vaccine.
For addition information about meningococcal vaccines, see Vaccines Recommendations and Licensures.
Can the vaccines against meningitis be administered at the same time?
Hib and meningococcal vaccines may be given at the same time as the pneumococcal conjugate or pneumococcal polysaccharide vaccine. However, children with functional or anatomic asplenia are not recommended to receive Menactra® (meningococcal conjugate vaccine) until 2 years of age in order to avoid interference with the immunologic response to the infant series of pneumococcal conjugate vaccine. Infants 2 months through 23 months of age with functional or anatomic asplenia are recommended to receive one of the other meningococcal conjugate vaccines (Menveo® or MenHibrix®) or to wait until 2 years of age to receive Menactra®. The pneumococcal conjugate and pneumococcal polysaccharide vaccine should be given at least two months apart. Each vaccine should be administered using a separate syringe and given at a different site.
Should people with cochlear implants who have had bacterial meningitis in the past be vaccinated against meningitis?
A past case of pneumococcal meningitis does not provide adequate protection against contracting pneumococcal meningitis again, since there are more than 90 different serotypes of pneumococcus. Age-appropriate pneumococcal vaccination is indicated for persons with cochlear implants who have had any form of meningitis. Children who had Hib meningitis when they were younger than two years of age may need additional doses of Hib vaccine, depending on their current age. Children who are two years of age or older when they develop Hib meningitis are considered immune to Hib and do not need more Hib vaccinations. A past case of Haemophilus influenzae other than “type b” does not provide protection against Hib.
What side effects occur with vaccines that prevent meningitis?
The vaccines that protect against meningitis are considered safe. When side effects occur they are usually mild. Local reactions, such as a sore arm at the site of the injection and mild fever, are fairly common with some of the vaccines. More information about the side effects of these and other vaccines can be found on the vaccine side effects web page.
Is hearing loss a reason to receive meningitis vaccines?
The cochlear implant and meningitis investigation showed that children with cochlear implants were more likely to get bacterial meningitis than children in the general population. However, the results of this study did not assess whether a child with hearing loss and a cochlear implant has a higher chance of getting meningitis than a child with hearing loss without a cochlear implant. A recent study from Denmark reported an increased risk of meningitis among children with hearing loss as compared to those children without hearing loss (Parner, 2007). However, more research is needed to better understand if persons with hearing loss without cochlear implants are at greater risk for meningitis. Currently, hearing loss alone is not a reason to receive meningitis vaccination. There are no special recommendations for vaccinating people with hearing loss. Persons with hearing loss should receive the vaccines that are recommended for persons without hearing loss, based on age and other health conditions.
Limited evidence does indicate that some persons with hearing loss may be at higher risk for developing bacterial meningitis than the general public, even if they do not have a cochlear implant. Also, some persons with hearing loss have inner ear abnormalities that can be associated with an increased risk of meningitis. Persons with hearing loss and an ear abnormality who are known, or suspected by their otolaryngologist, to be at increased risk for meningitis should receive the pneumococcal vaccination based on the recommendations for cochlear implant recipients. However, there is not sufficient evidence at present to support using the high risk pneumococcal vaccination schedule routinely for all persons with hearing loss.
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