Bacterial meningitis is a serious infection of the brain and the fluid that surrounds the brain. Bacterial meningitis is a life-threatening infection. Individuals who have a cochlear implant are at increased risk of bacterial meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated against the bacteria that commonly causes bacterial meningitis. Two types of bacteria have produced the majority of cases of meningitis after cochlear implantation: Streptococcus pneumoniae (Pneumococcus) and Haemophilus influenzae type b (Hib).
Vaccines against pneumococcus (‘pneumo’ vaccine) and Hib are widely available and aim to strengthen the body’s ability to protect against the common causes of bacterial meningitis. Some infections with pneumococcus are now not treatable with routine antibiotics and this is another reason why the vaccination is strongly recommended.
Pneumo vaccines
There are two types of pneumococcal vaccine, the Pneumococcal Conjugate vaccine (Prevenar®) and Pneumococcal Polysaccharide vaccine (Pneumovax®) Prevenar® is given as part of the routine infant immunisation schedule in Australia and would normally be administered at 2, 4, and 12 months of age. A dose of Prevenar® at 6 months of age is given for children who are ‘at medical risk’, which should include children receiving a cochlear implant. For children with cochlear implant(s), an extra dose of Pneumovax is recommended at 4 years. It is important to check that your child has received all doses of their Prevenar® and Pneumovax® series, and if not, to catch up.
Now that you or your child are considering a cochlear implant, you should check which vaccines against pneumococcus you or your child has received and obtain additional doses if you are not fully immunised, i.e.:
- Prevenar® at 2, 4 and 12 months as per the immunisation schedule
- Prevenar® at 6 months (if applicable)
- Pneumovax® at 4 years of age
- Pneumovax® at 15 years of age
- Pneumovax® over 50 years of age
- Pneumovax® over 65 years of age
For children 4 months to 4 years of age who have not received the full recommended doses:
See Centres for Disease Control and Prevention catch-up schedule https://www.cdc.gov/vaccines/schedules/downloads/child/job-aids/pneumococcal.pdf
For children 5 years of age or older who have not received the full recommended doses:
- Give Prevenar® with two doses, 8 weeks apart, if unvaccinated or received an incomplete series of Prevenar® (<3 doses).
- Give one dose of Prevenar® if received three doses of Prevenar® but none were given after 12 months of age.
- Give two doses of Pneumovax® after Prevenar® series is complete. Give the first dose at least 8 weeks after any prior Prevenar® dose, then give the second dose of Pneumovax® at least 5 years after the first.
- Further booster doses should be given at 15 years of age and again for those over 65 years of age.
If an adult or child did not receive Pneumovax® before their implant surgery, it is important for them to receive this vaccination now. The sooner the vaccine is given the sooner you or your child will be protected. It is never ‘too late’ after surgery to benefit from Pneumovax®. However, it is recommended that vaccinations are avoided 7 days prior and 7 days after cochlear implant surgery.
Most people can receive vaccinations such as Prevenar® and Pneumovax® from primary care providers such as family doctors or paediatricians. Further information on the availability of vaccinations is available through general medical clinics and hospitals or on the Department of Health website: www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/nips-ctn.
Hib vaccine
Haemophilus influenza type B (Hib) meningitis is most common among infants and young children. Cochlear implants may increase the risk of Hib meningitis, so it is essential that children are vaccinated against Hib disease because bacterial meningitis is life threatening whether you have a cochlear implant or not.
The Hib vaccine is part of the routine early childhood vaccination series is critical in protecting against bacterial meningitis in children with cochlear implants. It is usually given at 2, 4, 6, and 18 months of age.
The Hib vaccine is critical in protecting against childhood meningitis in young children with a cochlear implant. Adults and children over the age of 2 years do not require further Hib vaccinations.
Follow-up care
Cochlear implant recipients and their families should also be aware that vaccinations do not eliminate the risk of meningitis. Children and adults with cochlear implants who develop a middle ear infection (otitis media) or a fever should seek medical treatment and monitoring until the infection resolves.
Infections in a child or an adult with a cochlear implant should be taken seriously. Untreated middle ear and other infections may spread and sometimes progress to meningitis.
In addition, if a person with a cochlear implant develops discharge from the ear canal, or produces unusual ear symptoms or a watery nasal discharge, it is important to have that ear examined by the cochlear implant surgeon or another suitably experienced ear surgeon.
