Karen Broder, M.D. Epidemic Intelligence Service Officer

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Presentation transcript:

Bacterial Meningitis Vaccines and the Prevention of Meningitis in Cochlear Implant Recipients Karen Broder, M.D. Epidemic Intelligence Service Officer National Immunization Program Centers for Disease Control and Prevention February 24, 2003

US Meningitis Vaccines Haemophilus influenzae Type b Conjugate (Hib) (several brands) Meningococcal Polysaccharide (Menomune®) Pneumococcal Polysaccharide (Pneumovax®) Pneumococcal Conjugate (Prevnar®)

US Vaccination Policy

Recommended Childhood and Adolescent Immunization Schedule, US 2003 Vaccine Age Birth 1 mo 2 mos 4 Hepatitis B1 Diphtheria, Tetanus, Pertussis2 Haemophilus influenzae Type b3 Inactivated Polio Measles, Mumps, Rubella4 Varicella5 Pneumococcal6 Hepatitis A7 Influenza8 HepB #1 HepB #2 4-6 yrs 6 12 15 18 24 11-12 13-18 HepB #3 DTaP Td Hib IPV MMR #1 MMR #2 Varicella PCV Hepatitis A series Influenza (yearly) Vaccines below this line are for selected populations range of recommended ages catch-up vaccination HepB series PPV only if mother HBsAg ( - ) preadolescent assessment http://www.cdc.gov/nip/recs/child-schedule.htm

Haemophilus influenzae Type b (Hib) Vaccine Universal immunization for children aged <5 years High-risk indications for persons aged ≥5 years Immune system disorders

Meningococcal Vaccine Not universal immunization High-risk indications usually for persons aged ≥2 years Travel to endemic country Outbreak control College Freshman living in dorm (often optional) Immune system disorders

Pneumococcal Polysaccharide Vaccine (PPV23) Universal immunization for adults aged ≥65 years High-risk indications for persons aged 2-64 years Immune system disorders Residence in special environments or social settings Chronic medical conditions

Chronic Medical Conditions with PPV23 Indication Cardiovascular disease Pulmonary disease (not asthma) Diabetes mellitus Alcoholism Chronic liver disease Cerebrospinal fluid (CSF) leaks

Pneumococcal Conjugate Vaccine (PCV7) Universal immunization for children aged <2 years High-risk indications for children aged 2-4 years Moderate-risk considerations for children aged 2-4 years

PCV7 High-Risk Indications Children Aged <5 Years Immune system disorders Chronic medical conditions Similar to PPV23, including CSF leaks

PCV7 Vaccine Supply National Vaccine Shortage

Public Health Response Meningitis Vaccination and Cochlear Implant Recipients Reviewed meningitis vaccination recommendations Disseminated vaccination information to stakeholders Cochlear implant recipients State health departments Health care providers

Immunization Response to Cochlear Implants and Meningitis Association Could vaccination decrease the risk of meningitis among cochlear implant recipients?

Review of Vaccination Policy Vaccine-preventable cause? Yes, pneumococcus Biological plausibility? Yes, potential anatomic pathways and other mechanisms

Review of Vaccination Policy Applicable ACIP high-risk indication? Yes, pneumococcal vaccination for persons with CSF leaks Accessibility concerns? Yes, national PCV7 vaccine shortage

CDC Recommendation for Cochlear Implant Recipients: High-Risk Pneumococcal Vaccination

Information Resources Cochlear Implants and Vaccination NIP Website General public http://www.cdc.gov/nip/issues/cochlear/cochlear-gen.htm Health care provider http://www.cdc.gov/nip/issues/cochlear/ cochlear-hcp.htm National Immunization Hotline English (800)232-2522 Spanish (800)232-0233 TTY (800)243-7889

Pneumococcal Vaccination Schedule for Unvaccinated Cochlear Implant Recipients Age in Years PCV7* PPV23** <2 √ 2-4 ≥5 * ACIP Age-appropriate high-risk schedules should be followed ** PPV23 and PCV7 should be administered ≥ 2 months apart.

Vaccination for Cochlear Implant Recipients Four bacterial meningitis vaccines covering three causes of meningitis No initial specific vaccination recommendations Current pneumococcal vaccination recommendations Following study need to reevaluate vaccination recommendations

Acknowledgments Cochlear Implant Team including: J. Reefhuis, M. Honein, S. Chamany, K. Biernath, C. Whitney, E. Mann, S. Manning, S. Avashia, M. Victor, B. Culpepper, P. Costa, and C. Boyle Immunization Team including: J. Moran, B. Schwartz, T. Murphy, K. Bisgard, M. Wharton, L. Pickering, M. Bailey, the State Immunization Coordinators and the National Immunization Hotline