1. 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

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

3. US Vaccination Policy

4. 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

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

6. 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

7. 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

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

9. 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

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

11. PCV7 Vaccine Supply National Vaccine Shortage

12. 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

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

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

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

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

17. Information Resources Cochlear Implants and Vaccination
NIP Website
General public
Health care provider
cochlear-hcp.htm
National Immunization Hotline
English (800)
Spanish (800)
TTY (800)

18. 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.

19. 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

20. 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