Does the 23‐Valent Pneumococcal Vaccine Protect Cochlear Implant Recipients?

Hey, Christiane; Rose, Markus A.; Kujumdshiev, Sandy; Gstœttner, Wolfgang; Schubert, Ralf; Zielen, Stefan

doi:10.1097/01.mlg.0000171016.82850.41

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…38 H influenzae type b conjugate vaccine (Hib) is highly effective for prevention of invasive disease and colonization with this pathogen 39,40 and, presumably, is effective for prevention of acute otitis media attributable to H influenzae type b. Cochlear implant recipients have anticapsular antibody concentrations to H influenzae type b after immunization that are likely to be protective. 37,41 Hib vaccine does not prevent colonization or infection with non-serotype b strains; most H influenzae strains that cause acute otitis media are nontypeable strains, as were the isolates from most cases of H influenzae meningitis in implant recipients. 17 …”

Section: Use Of Pneumococcal and H Influenzae Type B Vaccines For Prementioning

confidence: 99%

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Rubin¹,

Papsin²

2010

Pediatrics

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The use of cochlear implants is increasingly common, particularly in children younger than 3 years. Bacterial meningitis, often with associated acute otitis media, is more common in children with cochlear implants than in groups of control children. Children with profound deafness who are candidates for cochlear implants should receive all age-appropriate doses of pneumococcal conjugate and Haemophilus influenzae type b conjugate vaccines and appropriate annual immunization against influenza. In addition, starting at 24 months of age, a single dose of 23-valent pneumococcal polysaccharide vaccine should be administered. Before implant surgery, primary care providers and cochlear implant teams should ensure that immunizations are up-to-date, preferably with completion of indicated vaccines at least 2 weeks before implant surgery. Imaging of the temporal bone/inner ear should be performed before cochlear implantation in all children with congenital deafness and all patients with profound hearing impairment and a history of bacterial meningitis to identify those with inner-ear malformations/cerebrospinal fluid fistulas or ossification of the cochlea. During the initial months after cochlear implantation, the risk of complications of acute otitis media may be higher than during subsequent time periods. Therefore, it is recommended that acute otitis media diagnosed during the first 2 months after implantation be initially treated with a parenteral antibiotic (eg, ceftriaxone or cefotaxime). Episodes occurring 2 months or longer after implantation can be treated with a trial of an oral antimicrobial agent (eg, amoxicillin or amoxicillin/clavulanate at a dose of approximately 90 mg/kg per day of amoxicillin component), provided the child does not appear toxic and the implant does not have a spacer/positioner, a wedge that rests in the cochlea next to the electrodes present in certain implant models available between 1999 and 2002. "Watchful waiting" without antimicrobial therapy is inappropriate for children with implants with acute otitis media. If feasible, tympanocentesis should be performed for acute otitis media, and the material should be sent for culture, but performance of this procedure should not result in an undue delay in initiating antimicrobial therapy. For patients with suspected meningitis, cerebrospinal fluid as well as middle-ear fluid, if present, should be sent for culture. Empiric antimicrobial therapy for meningitis occurring within 2 months of implantation should include an agent with broad activity against Gram-negative bacilli (eg, meropenem) plus vancomycin. For meningitis occurring 2 months or longer after implantation, standard empiric antimicrobial therapy for meningitis (eg, ceftriaxone plus vancomycin) is indicated. For patients with meningitis, urgent evaluation by an otolaryngologist is indicated for consideration of imaging and surgical exploration. BACKGROUNDA cochlear implant is an implanted electronic hearing device designed to produce useful hearing sensations to a person ...

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Section: Use Of Pneumococcal and H Influenzae Type B Vaccines For Prementioning

confidence: 99%

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Rubin¹,

Papsin²

2010

Pediatrics

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“…Studies in subjects without a cochlear implant have shown a gradual decline in specific antibody concentrations after a primary series of PPV23, and guidelines recommend booster immuniza- tion after 3 years in patients younger than 10 years and after 6 years in older patients. 23 However, antibody levels may fall below a protective threshold earlier, thus leaving some cochlear implant recipients unprotected before the booster dose. The immunologic memory for longterm protection against pneumococcal disease in implant recipients requires further research.…”

Section: Commentmentioning

confidence: 99%

Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation

Wei¹,

Robins-Browne²,

Shepherd³

et al. 2007

Arch Otolaryngol Head Neck Surg

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“…In a recent study, patients Ͻ7 years did not show adequate protection after PPV-23 vaccination and an alternative protocol (initial vaccination with PCV-7, followed after 4 weeks by PPV-23 booster) has been suggested. 28 Furthermore, the implantee population has shown a higher incidence of infectious diseases as the cause of death, which could possibly be explained by the fact that this susceptibility might cause, or might more frequently be associated with, deafness. 29 This susceptibility should induce greater precautions, in all deaf patients, in pre-, peri-, and postimplantation management.…”

Section: Discussionmentioning

confidence: 99%

Follow‐up of Cochlear Implant Use in Patients Who Developed Bacterial Meningitis Following Cochlear Implantation

et al. 2008

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Does the 23‐Valent Pneumococcal Vaccine Protect Cochlear Implant Recipients?

Abstract: With regard to the increased risk for bacterial meningitis, the authors recommend priming CI recipients younger than 8 years of age with pneumococcal conjugate vaccine followed by a PPV-23 booster.

Cited by 19 publications

References 19 publications

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation

Follow‐up of Cochlear Implant Use in Patients Who Developed Bacterial Meningitis Following Cochlear Implantation

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