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

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
National
Institutes of
Health (NIH)
Food and Drug
Administration
(FDA)
Centers for Disease
Control and
Prevention (CDC)
Advisory Committee
on Immunization
Practices (ACIP)
Vaccine
Pre-licensure
Vaccine
Licensure
Vaccine
Recommendations
High-Risk
Groups
Persons with
Medical
Conditions
Universal AgeAppropriate
Persons with
Social/
Environmental
Risk Factors
Recommended Childhood and Adolescent
Immunization Schedule, US 2003
Age
Vaccine
Birth
HepB #1
1
mo
2
mos
4
mos
6
mos
12
mos
15
mos
18
mos
24
mos
4-6
yrs
11-12
yrs
only if mother HBsAg ( - )
HepB #2
Diphtheria,
Tetanus, Pertussis2
HepB #3
DTaP
DTaP
DTaP
Haemophilus
influenzae Type b3
Hib
Hib
Hib
Inactivated Polio
IPV
IPV
Measles, Mumps,
Rubella4
Varicella5
DTaP
DTaP
Hib
IPV
IPV
MMR #1
MMR #2
Varicella
PCV
PCV
PCV
Td
PCV
MMR #2
Varicella
PCV
PPV
Vaccines below this line are for selected populations
Hepatitis A7
Influenza8
13-18
yrs
HepB series
Hepatitis B1
Pneumococcal6
preadolescent assessment
catch-up vaccination
range of recommended ages
Hepatitis A series
Influenza (yearly)
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
<2
PCV7*
2-4
√
≥5
PPV23**
√
√
√
* 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