Related Experiment Video
Updated: May 23, 2026
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Optimizing pneumococcal vaccination for paediatric cochlear implant recipients using the cochlear implant
Andrew Moore1, Robert Harris, David Selvadurai
1St George's Healthcare NHS Trust, London, UK. andy.moore@doctors.org.uk
Insights
Many children receiving cochlear implants are not fully protected against pneumococcal meningitis. A new audit tool helps identify children needing further pneumococcal vaccinations, especially after UK guideline changes.
Area of Science:
- Medical Auditing
- Vaccinology
- Pediatric Otolaryngology
Background:
- Cochlear implant recipients face a higher risk of pneumococcal meningitis.
- Routine pre-surgical checks of pneumococcal vaccination are standard practice.
- Recent UK guideline updates may leave some children under-protected.
Purpose of the Study:
- To introduce a simple audit tool for assessing pneumococcal immunization status in pediatric cochlear implant recipients.
- To identify children at risk of suboptimal pneumococcal protection.
- To aid healthcare professionals in primary care and tertiary centers.
Main Methods:
- A flowchart-style audit tool was used to assess 63 pediatric cochlear implant recipients.
- Data collected included age at implantation and immunization history.
- The tool determined if further vaccinations were required post-surgery.
Main Results:
- 54% of children lacked optimal pneumococcal immunization before implantation.
- 70% of children required additional vaccinations after surgery.
- Incomplete immunization often resulted from not administering the 23-valent vaccine after age two.
Conclusions:
- The pneumococcal vaccination schedule for high-risk children is complex and challenging to interpret.
- Standardization of vaccine types and usage is lacking across the UK.
- An audit tool is essential for accurately assessing and managing vaccination status in cochlear implant programs, especially with evolving national guidelines.
Introduction:
Cochlear implant recipients are known to be at an increased risk of meningitis. It is routine practice to check that pneumococcal vaccinations have been received prior to surgery. Recent changes in United Kingdom national guidelines mean that children who were previously thought to be fully immunized may in fact not be optimally protected. We present a simple, robust audit tool that can be used in both primary care and tertiary centres to identify those children at risk.
Methods:
The pneumococcal immunization status of 63 paediatric cochlear implant recipients was assessed using a unique and comprehensive flowchart-style audit tool. The data collected included age at implantation, details of previous immunizations, and whether or not further vaccinations were required.
Results:
Fifty-four per cent of children were not optimally immunized prior to implantation. Seventy per cent of children required further vaccinations following surgery. The commonest reason for an incomplete immunization history was failure to administer the 23-valent vaccine after the second birthday.
Conclusion:
The pneumococcal immunization schedule for high-risk children is complicated and nationally available guidance can be difficult to interpret. There are multiple types of vaccines and their use is not standardized across the UK. Cochlear implant programmes may find that a large proportion of their patients are in fact not optimally vaccinated, particularly in light of recent changes in the national guidelines. Our audit tool allows health professionals, in both primary care and implant centres, to accurately assess the status and immunization requirements for both new and old patients.
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