Skip Navigation LinksSkip Navigation Links
Centers for Disease Control and Prevention
Safer Healthier People
Blue White
Blue White
bottom curve
CDC Home Search Health Topics A-Z spacer spacer
Blue curve MMWR spacer

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail.

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


  1. CDC. Cochlear implants and meningitis, frequently asked questions. Available at
  2. Food and Drug Administration. Public health web notification: cochlear implant recipients may be at greater risk for meningitis. Available at
  3. National Institute on Deafness and Other Communication Disorders. Health information, hearing and balance. Available at
  4. CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-9).
  5. CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8).
  6. 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.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

Disclaimer   All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to

Page converted: 10/17/2002


Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A


Department of Health
and Human Services

This page last reviewed 10/17/2002