Vaccinations

The Importance of Vaccinations in Cochlear Implant Users

Bacterial meningitis is a serious infection of the brain and the fluid that surrounds the brain. Bacterial meningitis is a life-threatening infection. Individuals who have a cochlear implant are at increased risk for bacterial meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated against the bacteria that can gain entry into the brain and commonly cause bacterial meningitis. Two types of bacteria have produced the vast majority of cases of meningitis after cochlear implantation: Streptococcus pneumoniae (“Pneumococcus”) and Haemophilus influenzae type b (“Hib”).

Cochlear implant users and their families should be aware that vaccines against pneumococcus (“pneumo” vaccine) and Hib are widely available. These vaccines strengthen the body’s ability to protect against the common causes of bacterial meningitis. Some infections with pneumococcus are now not treatable with routine antibiotics. This is another reason for being sure to get vaccinated.

"Pneumo" Vaccines

There are two types of pneumococcal vaccine, Prevnar® for children being vaccinated when they are less than 2 y of age and Pneumovax® for those being vaccinated when they are over 2 y of age. Prevnar® is part of the routine infant immunization schedule in the United States; therefore all children should have received this vaccine in infancy. It is important to verify that your child has received all doses of their Prevnar® series, and if not, to catch up.Now that you or your child has a cochlear implant you should verify which vaccines against pneumococcus you or your child has received and obtain additional doses if you are not fully immunized. Age at the time of vaccination will determine which type of pneumococcal vaccine should be received:

• Children under the age of 2 y: Vaccination with the Prevnar® series followed by Pneumovax® when the child reaches 2 y of age. (Pneumovax® is not effective in children under 2 y.)

• If an adult or child did not receive Pneumovax® before their implant surgery, it is important for them to receive this vaccination now.

• The sooner the vaccine is given the sooner you or your child will be protected.
• It is never “too late” after surgery to benefit from Pneumovax®.
• Second doses of Pneumovax: If it has been 5 or more yrs since the initial Pneumovax® vaccine, discuss a repeat vaccine with your physician. A second dose of Pneumovax® may provide additional coverage for some individuals, including young children and adults over the age of 65.
• Children 2 to 4 y of age: Complete the Prevnar® series if not fully vaccinated. Vaccinate with Pneumovax® at least 2 mos after the last Prevnar® dose.
• Children 5 y and older and all adults: Initial Pneumovax® vaccination

Most people receive vaccinations such as Prevnar and Pneumovax from primary care providers such as pediatricians, internists, or family physicians. Further informaiton on the availabilty of vaccinations is available through general medical clinics, sponsored state and local government, and by hospitals. Your cochlear implant center can provide more information.

Pneumococcal Conjucate vaccine 13 (PCV13)

The newest pneumococcal conjugate vaccine (PCV13) protects against the 13 most severe types of the 90 differenct types of pneumococcal bacteria. This is an update to PCV7 and children will need to have their immunizations updated in order to receive protection against the 13 strains.

• Children under two years should receive PCV 13 as a series of 4 doses.
• Children between 2 and 5 years who have not completed the PCV7 or PCV 13 series before age 2 should get one dose.
• Children between the 2nd and 6th birthdays who have a cochlear implant should get 1 dose of PCV 13 if they received 3 doses of PCV7 or PCV13 before age 2, or 2 doses of PCV13 if they received 2 or fewer doeses of PCV7 or PCV13.
• Children ages 6-18 who have a cochlear implant should receive a dose of PCV13, even if they have previously received PCV7.

Further information is available from this CDC handout: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-pcv.pdf
 

TIMELINE of Pneumo Vaccines:

Follow-up Care
Cochlear implant users and their families should also be aware that vaccinations do not eliminate the risk of meningitis. Children and adults with cochlear implants who develop a middle ear infection (otitis media) or a fever of uncertain cause should seek medical treatment and monitoring until the infection resolves. Infections in a child or an adult with a cochlear implant should be taken seriously. Untreated middle ear and other infections may spread to produce meningitis.

In addition, if an ear with a cochlear implant develops a discharge from the ear canal, or produces unusual ear symptoms or a watery nasal discharge, it is important to have that ear examined by the cochlear implant surgeon or another suitably experienced ear surgeon.