Bacterial Meningitis Vaccines and the Prevention of Meningitis in Cochlear Implant Recipients

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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

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US Meningitis Vaccines

• Haemophilus influenzae Type b Conjugate (Hib)
  (several brands)
• Meningococcal Polysaccharide
• (Menomune)
• Pneumococcal Polysaccharide (Pneumovax)
• Pneumococcal Conjugate (Prevnar)

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US Vaccination Policy
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Recommended Childhood and Adolescent Immunization
Schedule, US 2003
http//www.cdc.gov/nip/recs/child-schedule.htm
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Haemophilus influenzae Type b (Hib) Vaccine

• Universal immunization for children aged lt5 years
  
• High-risk indications for persons aged 5 years
  
• Immune system disorders

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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

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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

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Chronic Medical Conditionswith PPV23 Indication

• Cardiovascular disease
• Pulmonary disease (not asthma)
• Diabetes mellitus
• Alcoholism
• Chronic liver disease
• Cerebrospinal fluid (CSF) leaks

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Pneumococcal Conjugate Vaccine (PCV7)

• Universal immunization for children aged lt2 years
• High-risk indications for children aged 2-4 years
  
• Moderate-risk considerations for children aged
  2-4 years

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PCV7 High-Risk Indications Children Aged lt5
Years

• Immune system disorders
• Chronic medical conditions
• Similar to PPV23, including CSF leaks

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PCV7 Vaccine SupplyNational Vaccine Shortage
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Public Health ResponseMeningitis Vaccination and
Cochlear Implant Recipients

• Reviewed meningitis vaccination recommendations
• Disseminated vaccination information to
  stakeholders
• Cochlear implant recipients
• State health departments
• Health care providers

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Immunization Response to Cochlear Implants and
Meningitis Association

• Could vaccination decrease the risk of meningitis
  among cochlear implant recipients?

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Review of Vaccination Policy

• Vaccine-preventable cause?
• Yes, pneumococcus
• Biological plausibility?
• Yes, potential anatomic pathways and other
  mechanisms

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Review of Vaccination Policy

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

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CDC Recommendation for Cochlear Implant
Recipients High-Risk Pneumococcal Vaccination
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Information ResourcesCochlear Implants and
Vaccination

• NIP Website
• General public
• http//www.cdc.gov/nip/issues/cochlear/cochlea
  r-gen.htm
• Health care provider http//www.cdc.gov/nip/issues
  /cochlear/
• cochlear-hcp.htm
• National Immunization Hotline
• English(800)232-2522
• Spanish [phone]
• TTY [phone]

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Pneumococcal Vaccination Schedule for
UnvaccinatedCochlear Implant Recipients
Age in Years PCV7 PPV23
lt2 v
2-4 v v
5 v
ACIP Age-appropriate high-risk schedules should
be followed PPV23 and PCV7 should be
administered 2 months apart.
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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

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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