title: Optimizing pneumococcal vaccination for paediatric cochlear implant recipients using the cochlear implant pneumococcal vaccination flowchart.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: St George's Healthcare NHS Trust, London, UK. andy.moore@doctors.org.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Moore
authors.forename: Robert
authors.initials: R
authors.lastname: Harris
authors.forename: David
authors.initials: D
authors.lastname: Selvadurai
mesh_terms: D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control*; D009017:Morbidity; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000592:standards*; D017410:Practice Guidelines as Topic; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012985:Software Design; D006113:United Kingdom / Q000453:epidemiology
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines