Vaccines and Preventable Diseases:
Cochlear Implants & Meningitis Vaccination
Q&A For Healthcare Professionals
June 4, 2007 (originally published October 2002)
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 have the CDC and other government agencies done about persons with meningitis in cochlear implants?
CDC, state health departments, and the FDA have completed an investigation to learn about the association between cochlear implants and bacterial meningitis. This public health response was carried out very quickly to ensure that this concern was addressed promptly.
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 located at (www.cdc.gov/ncbddd/ehdi/cochlear/).
The results of this rapid public health response 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. To answer that question, CDC is working with a Danish university to conduct a follow-up study.
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), Haemophilus influenzae nontypeable (3), Haemophilus influenzae type b (Hib) (2), and other bacteria (4). No cases of meningitis caused by Neisseria meningitidis, also called meningococcus, 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 are up-to-date on pneumococcal vaccination based on the schedule used for persons at high risk and on Hib vaccination. Pneumococcal vaccination recommendations for people with cochlear implants can be viewed in the table within the July 31, 2003 [52;1-2] Early Release MMWR article
www.cdc.gov/mmwr/preview/mmwrhtml/m2e731a1.htm. See also Hib vaccination recommendations.
Persons scheduled to receive a cochlear implant should be up-to-date on vaccinations, including pneumococcal vaccination for persons at high risk, two or more weeks before surgery when possible. A provider may also administer the Hib booster two or more weeks before cochlear implant surgery to children ages 12-59 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.
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 should receive the vaccine. For those aged 5 years 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 aged 5 years or older with cochlear implants need Hib vaccination. There is no specific contraindication to using Hib vaccine in unvaccinated older children and adults, and health care 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. If Hib vaccine is used in persons aged 5 years of older, a single intramuscular injection is all that is needed. For more information about use of Hib vaccine visit this Jan. 11, 1991 [40(RR01);1-7] MMWR article located at www.cdc.gov/mmwr/preview/mmwrhtml/00041736.htm
Should persons with cochlear implants receive the meningitis (meningococcal) vaccine?
The meningococcal vaccine protects against meningitis caused by some types of Neisseria meningitidis, also called meningococcus. 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 the meningitis vaccines, see the May 27, 2005 [54(RR07);1-21] MMWR article "Prevention and Control of Meningococcal Disease" located at www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm
What schedule should be used for children with cochlear implants who missed doses of pneumococcal conjugate vaccine due to the national vaccine shortage?
The pneumococcal conjugate vaccine (PCV-7) shortage has been resolved and most communities should have vaccine available. Children aged less than 5 years with cochlear implants who missed doses of pneumococcal conjugate vaccine during the shortage should receive additional doses according to the catch-up schedule for children at increased risk. The recommended PCV-7 regimens are available in a table within this July 16, 2003 [52(19);446-447] Early Release MMWR article located at www.cdc.gov/mmwr/preview/mmwrhtml/mm5219a6.htm Children with cochlear implants aged 24-59 months should be vaccinated according to the high risk schedules.
Although it is preferred to complete the PCV-7 series in children aged less than 5 years before administering pneumococcal polysaccharide vaccine (PPV-23), during the PCV-7 shortage some children may have received PPV-23 before they completed the PCV-7 series. Children aged 24-59 months with incomplete PCV-7 vaccination who already received PPV-23 also should follow the post-shortage catch-up PCV-7 schedule above. An additional PPV-23 dose is not needed.
Can the vaccines against meningitis be administered at the same time?
The Hib and meningococcal vaccines may be given at the same time as the pneumococcal conjugate or pneumococcal polysaccharide vaccine. 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 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 under two years of age may need additional doses of Hib, depending on their current age. Children who are aged two years of 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 recent cochlear implant and meningitis investigation showed that children with cochlear implants were more likely to get bacterial meningitis than children in the general population. More research is needed to better understand if persons with hearing loss without cochlear implants are at greater risk for meningitis. CDC is working with a Danish university to study this issue further.
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. Some people with hearing loss have been made deaf by meningitis, and some people who have had meningitis are prone to it. Also, some persons with hearing loss have inner ear abnormalies 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 no evidence at present to support using the high risk pneumococcal vaccination schedule routinely for all persons with hearing loss.
How have the immunization recommendations for persons with cochlear implants recently changed?
Before the cochlear implant and meningitis investigation started, there were no special immunization recommendations for persons with cochlear implants. Early in the investigation, in October 2002, it was recognized that people with cochlear implants may be at increased risk for bacterial meningitis – especially pneumococcal meningitis. Since most pneumococcal meningitis is vaccine-preventable, CDC recommended people with cochlear implants receive age-appropriate pneumococcal vaccination according to the high risk schedules. These recommendations are supported by the findings of this investigation and were adopted by the U.S. Advisory Committee on Immunization Practices (ACIP) in June 2003. For more information on the ACIP recommendations please see the July 16, 2003 [52(19);446-447] Early Release MMWR article www.cdc.gov/mmwr/preview/mmwrhtml/mm5219a6.htm
Can vaccines prevent all meningitis in persons with cochlear implants?
Although most bacterial meningitis is vaccine-preventable in the general population, some cases of meningitis in persons with cochlear implants cannot be prevented by use of currently available vaccines. Some persons with cochlear implants had meningitis due to bacteria for which no vaccines are available, such as nontypeable Haemophilus influenzae. In addition, we do not know what proportion of meningitis in cochlear implant recipients were caused by vaccine-preventable strains of Streptococcal pneumoniae. Among the two children in the study with Streptococcus pneumoniae of known serotype, one had a serotype not covered in the current pneumococcal vaccinations. Finally, although vaccination is likely effective in preventing meningitis among persons with cochlear implants, there are no specific data about the efficacy of preventing meningitis caused by vaccine-preventable bacteria people with cochlear implants.
Return to main Meningococcal Vaccination page
Content last reviewed on June 4, 2007
Content Source: National Center for Immunization and Respiratory Diseases