title: Bacterial meningitis among children with cochlear implants beyond 24 months after implantation.
abstract: BACKGROUND
  More than 11000 children in the United States with severe-to-profound hearing loss have cochlear implants. A 2002 investigation involving pediatric cochlear implant recipients identified meningitis episodes from January 1, 1997, through September 15, 2002. The incidence of pneumococcal meningitis in the cohort was 138.2 cases per 100000 person-years, >30 times higher than that for children in the general US population. Children with implants with positioners were at higher risk than children with other implant models. This higher risk of bacterial meningitis continued for up to 24 months after implantation.
  
  
  OBJECTIVE
  To evaluate additional reported cases to determine whether the increased rate of bacterial meningitis among children with cochlear implants extended beyond 24 months after implantation.
  
  
  METHODS
  Our study population consisted of the cohort of children identified through the 2002 investigation; it included 4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002, and who were <6 years of age at the time of implantation. We calculated updated incidence rates and incidence according to time since implantation.
  
  
  RESULTS
  We identified 12 new episodes of meningitis for 12 children. Eleven of the children had implants with positioners; 2 children died. Six episodes occurred >24 months after implantation. When cases identified in the 2002 and 2004 investigations were combined, the incidence rate of > or =24-months postimplantation bacterial meningitis among children with positioners was 450 cases per 100000 person-years, compared with no cases among children without positioners.
  
  
  CONCLUSIONS
  Our updated findings support continued monitoring and prompt treatment of bacterial infections by health care providers and parents of children with cochlear implants. This vigilance remains important beyond 2 years after implantation, particularly among children with positioners. The vaccination recommendations for all children with implants, with and without positioners, and all potential recipients of implants continue to apply.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. kbiernath@cdc.gov
authors.forename: Krista R
authors.initials: KR
authors.lastname: Biernath
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.forename: Eric A
authors.initials: EA
authors.lastname: Mann
authors.forename: Pamela
authors.initials: P
authors.lastname: Costa
authors.forename: John
authors.initials: J
authors.lastname: Eichwald
authors.forename: Coleen
authors.initials: C
authors.lastname: Boyle
mesh_terms: D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants / Q000009:adverse effects*; D006801:Humans; D016920:Meningitis, Bacterial / Q000209:etiology*; D008586:Meningitis, Pneumococcal / Q000209:etiology