Notice to Readers: Pneumococcal Vaccination for Cochlear Implant Recipients
CDC and the Food and Drug Administration, in collaboration with state health departments, are investigating the occurrence of bacterial meningitis among cochlear implant recipients (1,2). The implant, as a foreign body, and the design of the electrode are considered possible risk factors. Other potential risk factors for meningitis among cochlear implant recipients include a history of meningitis (a leading cause of sensorineural hearing loss), a history of recurrent otitis media, immunodeficiency, a pre-existing inner ear abnormality, and an occult cerebrospinal fluid leak.
As of October 4, 2002, a total of 53 cases of meningitis were reported in the United States among cochlear implant recipients (2). In the United States, approximately 21,000 persons have cochlear implants (3). Of the 23 cases for which bacterial culture results were available, 16 were caused by Streptococcus pneumoniae (pneumococcus) (2).
Vaccination against pneumococcal disease is recommended by the Advisory Committee on Immunization Practices (ACIP) for persons at increased risk for pneumococcal meningitis. Because preliminary data suggest a higher risk for pneumococcal meningitis in cochlear implant recipients, CDC recommends that all persons with cochlear implants receive age-appropriate vaccination against pneumococcal disease as recommended for other persons at high risk for invasive pneumococcal disease; recommendations will be reviewed after completion of the investigation. These persons should receive the 7-valent pneumococcal conjugate (Prevnar®) or 23-valent pneumococcal polysaccharide (Pneumovax® and Pnu-Imune®) vaccine, or both, according to ACIP schedules for persons at high risk (4,5). During the current pneumococcal conjugate vaccine shortage, children aged <5 years with cochlear implants should be given the same priority for available vaccine as children in other high-risk groups (6). Additional information on the use of vaccines for cochlear implant recipients is available from CDC's National Immunization Program at http://www.cdc.gov/nip/issues/cochlear/cochlear-hcp.htm.
- CDC. Cochlear implants and meningitis, frequently asked questions. Available at http://www.cdc.gov/ncbddd.
- Food and Drug Administration. Public health web notification: cochlear implant recipients may be at greater risk for meningitis. Available at http://www.fda.gov/cdrh/safety/cochlear.html.
- National Institute on Deafness and Other Communication Disorders. Health information, hearing and balance. Available at http://www.nidcd.nih.gov/health/pubs_hb/coch.htm.
- CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-9).
- CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8).
- CDC. Updated recommendations on the use of pneumococcal conjugate vaccine in a setting of vaccine shortage---Advisory Committee on Immunization Practices. MMWR 2001;50:1140--2.
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