All cochlear implant users and all patients anticipating cochlear implantation should receive pneumococcal vaccination to reduce the risk of ear infections that can lead to pneumococcal meningitis.
Pneumococcal vaccination protects against Streptococcus pneumoniae (commonly referred to as pneumococcus), the bacteria most commonly responsible for meningitis after cochlear implant surgery. Although extremely rare, bacterial meningitis can be fatal and has been reported worldwide in 200 patients with cochlear implants since 1980. We therefore take this matter very seriously. To minimize the risk of infection, we require all cochlear implant uses and candidates to receive age-appropriate pneumococcal vaccination and to provide us with proof of vaccination. We take these precautions in accordance with guidelines established by the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and state health departments.
In early 2022, the CDC updated pneumococcal vaccination recommendations for adult cochlear implant patients to reflect approval of two new vaccines, called PCV20 and PCV15. The 2022 CDC guidelines for pneumococcal vaccination and cochlear implantation are:
2022 CDC Guidelines
CDC recommends pneumococcal vaccination for all children, including those with cochlear implants.
Children younger than 2 years old with cochlear implants should receive PCV13 according to the Childhood Immunization Schedule. If an older child with cochlear implants did not get the recommended shots as an infant and young child, they may need to receive PCV13. Children 2 years or older with cochlear implants should also receive PPSV23. Talk to your child’s doctor about when your child should get these vaccines.
Children should get all recommended shots of pneumococcal vaccines at least 2 weeks before cochlear implant surgery. This will provide maximum protection both during and after surgery. Children already up to date with pneumococcal vaccination do not need extra shots before surgery.
CDC recommends pneumococcal vaccination for adults (19 and over) with cochlear implants.
All adults (19 and over) with cochlear implants who have never received pneumococcal vaccines should receive 1 shot of PCV15 or PCV20. If PCV15 is used, it should be followed by 1 shot of PPSV23. Talk to your doctor about when you should get these vaccines.
Adults should get all recommended shots of pneumococcal vaccines at least 2 weeks before cochlear implant surgery. This will provide maximum protection both during and after surgery. Adults already up to date with pneumococcal vaccination do not need extra shots before surgery.
CDC recommends pneumococcal vaccination for people who have had pneumococcal meningitis in the past.
A past case of pneumococcal meningitis does not provide enough protection against getting this form of meningitis again. For this reason, people should receive pneumococcal vaccines according to CDC’s recommended schedules regardless of if they have had pneumococcal meningitis.
For children, the new (2022) guidelines are the same as the old (2021) guidelines, because PCV15 and PCV20 are not yet approved for children.
For adults, the new (2022) guidelines are simpler than before, because only one vaccine is required. For adults who have not already received any pneumococcal vaccine, we recommend a single dose of PCV20, which you can receive at one of your JHCIC visits or at a pharmacy or your primary care provider’s office.
Cochlear implant users and candidates who already completed all pneumococcal vaccinations recommended by the 2021 Johns Hopkins Cochlear Implant Center guidelines should not need PCV20 or PCV15. The old (2021) recommendations, which are still current for children are:
Old (2021) JHCIC Pneumococcal Vaccination Guidelines
- Young Children (younger than 2y) – A full schedule of Prevnar 13 vaccines should be administered as routinely required in the U.S.
- Young Children (older than 2y) – One dose of PPV23 or Pneumovax should be given at age 2 years. If the last dose of Prevnar 13 is given after age 2 years, then Pneumovax should be administered 8 weeks later.
- Adults (age 19y and older) who have NOT had any prior pneumococcal vaccinations now need one dose of Prevnar 13 followed 8 weeks later by PPV23 or Pneumovax. A Pneumovax booster is required at age 65 years.
- Adults (age 19y and older) who have had prior vaccination only with Pneumovax, now also need one dose of Prevnar 13 to be given 1 year of more after their Pneumovax shot. A Pneumovax booster is required at age 65 years.
- Adults over 65 need one dose of Prevnar 13 to be given at least 1 year after Pneumovax. If no pneumococcal vaccines given yet, get Prevnar 13 then Pneumovax 8 weeks later.
- Cochlear implant candidates must have completed at least part of the immunization requirements prior to surgery. Full compliance with the full immunization schedule must be documented as soon as possible.
We ask that the patient’s send proof of vaccination and return it to us via MyChart or fax 410-367-2365 to Barbara Gottschalk MSN CRNP at the Johns Hopkins Cochlear Implant Center. To avoid canceling your surgery or discovering a problem too late to fix it, please send vaccination confirmation as soon as possible and at least 3 weeks before a planned cochlear implant surgery date.
To avoid confusion, adults who plan to receive pneumococcal vaccination should specifically request PCV20, and parents of children who need pneumococcal vaccination should specifically request “pneumococcal vaccination according to CDC guidelines cochlear implant users”. If you ask a non-JHCIC provider for “a meningitis vaccine”, you may receive the wrong vaccine. For more information, please visit the CDC’s website on Use of Vaccines to Prevent Meningitis in Persons with Cochlear Implants.
If you have any questions, please contact:
- Barbara Gottschalk MSN, CRNP
- Rachel Hisim MSN, CRNP
Updated: April 2022