Abstract
Patients who have a cochlear implant are considered to be at a higher risk of developing meningitis following otitis media. Whether this occurs along the electrode going from the middle ear into the cochlea or through a blood-borne pathway is unclear. The most prevalent organism in both children and adults remains Streptococcus pneumonia, also known as Pneumococcus.
Although there was a high incidence of implant-related cases of meningitis when an old implant design had a positioner placed along the intracochlear electrode to get it closer to the modiolus, other cochlear implant manufacturers had devices that suffered the same complication. This was an area of great concern that prompted international attention. In 2006, an aggressive awareness campaign was initiated by the American Academy of Otolaryngology-Head and Neck Surgery's Implantable Device Committee with full support of the manufacturers.
A few other factors might have contributed to the high incidence of meningitis besides the positioner design. For example, there was a greater number of cases in children with congenital anomalies. There was also a peak in the number of cases in Europe. Adoption of careful operative techniques and a vaccination program were deemed successful, resulting in fewer cases of meningitis related to cochlear implant prostheses.
Recently, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices issued new recommendations for vaccinations in both adults and children. The announcement was made through the CDC Web site (www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm) in October 2012.
The previous vaccination sequence began with pneumococcal 7-valent conjugate vaccine (PCV7) for pediatric patients and pneumococcal polysaccharide vaccine (PPSV23) for older children and adults. An updated vaccine, PCV13, contains additional antigenic strains that were not covered by the earlier series of vaccines. It is now recommended that all pending cochlear implant patients initially receive PCV13, followed by PPSV23 8 weeks later. It is also recommended that those who have a cochlear implant and who have received PPSV23 should still get the PCV13 vaccine.
A practical problem has arisen with these updated guidelines. The typical means for delivery of the vaccine is through the pediatricians or primary care physician's office. These critical providers may not be aware of the CDC recommendations. Our cochlear implant center has sent out a mailing to our existing cochlear implant recipients to get them updated on their immunization coverage. We provided a letter with an explanation and the link to the CDC Web site.
We understand that some facilities or providers cannot get the PCV13 vaccine or are unaware of the changes in the current guidelines. Nonetheless, we encourage patients to follow the advice of the CDC Advisory Committee and persist with this request. The CDC is taking every precaution to minimize the opportunity for this bacterial infection to cause significant morbidity.