Use of Vaccines to Prevent Meningitis in Persons with Cochlear Implants

What You Should Know

• People with cochlear implants are more likely to get bacterial meningitis than people without cochlear implants. In addition, some people who are candidates for cochlear implants have anatomic factors that may increase their risk for meningitis. These factors include facial and cranial abnormalities, including of the temporal bone and cochlea.
• The bacteria Streptococcus pneumoniae (pneumococcus) causes most cases of meningitis in people with cochlear implants.
• Due to their increased risk, CDC recommends pneumococcal vaccination for people who have or are candidates for cochlear implants. Clinicians should follow the pneumococcal vaccine recommendations that apply to other groups at increased risk.
  ACIP Pneumococcal Vaccine Recommendations

  • Pneumococcal Vaccination for Cochlear Implant Candidates and Recipients
  • Use of PCV13 and PPSV23 Vaccines Among Persons Ages 6–18 Years with Immunocompromising Conditions
  • Licensure of PCV13 and Recommendations for Use Among Children
  • Use of PCV13 and PPSV23 for Adults with Immunocompromising Conditions
• Recommendations for the timing and type of pneumococcal vaccination vary with age and vaccination history. See Advisory Committee on Immunization Practices (ACIP) recommendations highlighted in the box to the right for details.

Pneumococcal Recommendations by Age and Vaccination History

CDC recommends pneumococcal conjugate vaccine (PCV13) for people who have or are candidates for cochlear implants. CDC also recommends pneumococcal polysaccharide vaccine (PPSV23) for people 2 years and older who have or are candidates for cochlear implants. Administer all recommended doses of PCV13 first and then administer PPSV23 according to ACIP recommendations:

• Childhood and adolescent immunization schedule
• Adult immunization schedule

See Pneumococcal Vaccination: Summary of Who and When to Vaccinate for more detail. Download the PneumoRecs VaxAdvisor Mobile App for Vaccine Providers for help determining which pneumococcal vaccines a patient needs and when.

Other Vaccines Can Help Protect against Meningitis

• Vaccines are available in the United States that can help protect against most of the bacteria that cause meningitis:
  • 13-valent pneumococcal conjugate (PCV13) (Prevnar 13®)
  • 23-valent pneumococcal polysaccharide (PPSV23) (Pneumovax®)
  • Haemophilus influenzae type b conjugate (Hib) (ActHIB®, Hiberix®, PedvaxHIB®, and Pentacel®)
  • Meningococcal conjugate (Menactra® and Menveo®)
  • Serogroup B meningococcal (Bexsero® and Trumenba®)
• There is no evidence people with cochlear implants are more likely to get meningococcal meningitis than people without cochlear implants. Neisseria meningitidis cause meningococcal meningitis.
• See Vaccine-specific ACIP Recommendations for information about how, when, and which pneumococcal and meningococcal vaccines can be given together.

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For More Information

• AAP: Policy Statement—Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitisexternal icon (2010)
• National Center on Birth Defects and Development Disabilities, Hearing Loss in Children, Treatment and Intervention Services

References

• Kahue CN, Sweeney AD, Carlson ML, Haynes DS. Vaccination recommendations and risk of meningitis following cochlear implantationexternal icon. Curr Opin Otolaryngol Head Neck Surg. 2014;22(5):359–66.
• Lalwani AK and Cohen NL. Does meningitis after cochlear implantation remain a concern in 2011?external icon Otol Neurotol. 2012;33(1):93–5.
• Lalwani AK and Cohen NL. Longitudinal risk of meningitis after cochlear implantation associated with the use of the positionerexternal icon. Otol Neurotol. 2011;32(7):1082–5.
• Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007external icon. N Engl J Med. 2011;364(21):2016–25.
• Cohen NL and Hirsch BE. Current status of bacterial meningitis after cochlear implantationexternal icon. Otol Neurotol. 2010;31(8):1325–8.
• Rubin LG, Papsin B, Committee on Infectious Diseases and Section on Otolaryngology-Head and Neck Surgery. Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitisexternal icon. Pediatrics. 2010;126:381.
• Hsu HE, Shutt KA, Moore MR, et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitisexternal icon. N Engl J Med. 2009;360(3):244–56.
• Mancini P, D’Elia C, Bosco E, et al. Follow-up of cochlear implant use in patients who developed bacterial meningitis following cochlear implantationexternal icon. Laryngoscope. 2008;118(8):1467–71.
• Biernath KR, Reefhuis J, Whitney CG, et al. Bacterial meningitis among children with cochlear implants beyond 24 months after implantationexternal icon. Pediatrics. 2006:117;2:284–89.
• Wilson-Clark SD, Squires S, Deeks S, Centers for Disease Control and Prevention (CDC). Bacterial meningitis among cochlear implant recipients–Canada, 2002. MMWR Morb Mortal Wkly Rep. 2006;55(Suppl 1):20.
• Cohen N, Ramos A, Ramsden R, et al. International consensus on meningitis and cochlear implantsexternal icon. Acta Otolaryngol. 2005;125:916.
• Cohen NL, Roland JT Jr, Marrinan M. Meningitis in cochlear implant recipients: the North American experienceexternal icon. Otol Neurotol. 2004;25(3):275–81.
• Nadol JB Jr Eddington DK. Histologic evaluation of the tissue seal and biologic response around cochlear implant electrodes in the humanexternal icon. Otol Neurotol. 2004;25(3):257–62.
• Reefhuis J, Honein M, Whitney C, et al. Risk of bacterial meningitis in children with cochlear implantsexternal icon. N Engl J Med. 2003:349;5:435–45.

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