title: Immunogenicity of pneumococcal vaccination of patients with cochlear implants.
abstract: BACKGROUND
  Pneumococcal meningitis is a rare but potentially fatal complication of cochlear implantation.
  
  
  METHODS
  A prospective study was conducted of the immunogenicity of pneumococcal vaccination in 174 patients with cochlear implants (CIs). The cohort was divided into groups of patients with impaired hearing due to meningitis (P(1)), cranial malformations (P(2)), or an unknown cause (P(3)) and was stratified by age as follows: <2 years (A(1)), 2-5 years (A(2)), and >5 years (A(3)). We determined immunoglobulin (Ig) levels for IgG subclasses 1-4 and serum concentrations of antibodies against pneumococci before and 4-6 weeks after vaccination. Group A(1) received the 7-valent pneumococcal conjugate vaccine (PCV-7), group A(2) received PCV-7 or the 23-valent pneumococcal polysaccharide vaccine (PPV-23), and group A(3) received PPV-23.
  
  
  RESULTS
  IgG, IgM, and IgG1 levels were significantly lower in group P(1), compared with the other patient groups and with historic data for healthy control subjects, suggesting a decreased antibody response. Group P(1) had lower levels of pneumococcal antibodies, compared with groups P(2) and P(3) before vaccination (P<.05, pneumococcal serotypes 4 and 9V). Irrespective of the underlying condition, all patients showed a sufficient antibody response after 1 dose of vaccine. In children 2-5 years of age, PCV-7 was significantly more immunogenic than PPV-23.
  
  
  CONCLUSIONS
  PCV-7 should be administered to all CI recipients younger than 6 years and older than 6 years who are at an increased risk for bacterial meningitis. CI recipients with a history of bacterial meningitis should undergo immunological evaluation.
authors.affiliation: Department of Pediatrics, J. W. Goethe University, Frankfurt/Main, Germany. markus.rose@kgu.de
authors.forename: Markus
authors.initials: M
authors.lastname: Rose
authors.forename: Christiane
authors.initials: C
authors.lastname: Hey
authors.forename: Sandy
authors.initials: S
authors.lastname: Kujumdshiev
authors.forename: Volker
authors.initials: V
authors.lastname: Gall
authors.forename: Ralf
authors.initials: R
authors.lastname: Schubert
authors.forename: Stefan
authors.initials: S
authors.lastname: Zielen
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000276:immunology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011446:Prospective Studies; D014611:Vaccination
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D007136:Immunoglobulins; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines