I thank Yves Jalbert for pointing out the error in my recent Health and Drug Alert on the risk of meningitis for cochlear implant recipients:1 the 12-year-old implant recipient in Quebec had meningitis caused by H. influenzae type f, not H. influenzae type b (Hib). Although neither the Canadian2 nor the US3 advisory specified the type of H. influenzae involved, the US Food and Drug Administration (FDA) has recorded meningitis cases due to Hib (Nancy Pressley, FDA: personal communication, 2003), and both advisories included recommendations favouring universal vaccination against Hib. I echoed this recommendation because the prevention of meningitis in cochlear implant recipients is often just targeted secondary prevention. As Blake Papsin points out, many recipients of cochlear implants became deaf in the first place because of bacterial meningitis, so broader primary prevention efforts may be advisable.
Universal Hib vaccination has proven highly successful, reducing rates of serious Hib disease, including meningitis.4,5 I thank Papsin and others who have “wrestled” to expand funding for pneumococcal vaccine coverage for cochlear implant recipients. We can only hope that aggressive “twisting of government arms” will soon lead to universal coverage of the cost of vaccination against common meningitis pathogens such as S. pneumoniae6 and Neisseria meningitidis.7
Eric Wooltorton Associate Editor CMAJ
References
- 1.Wooltorton E. Cochlear implant recipients at risk for meningitis. CMAJ 2002;167(6):670. [PMC free article] [PubMed]
- 2.FDA public health Web notification: cochlear implant recipients may be at greater risk for meningitis. Rockville (MD): US Food and Drug Administration; 2002 Jul 24 (updated 2002 Oct 17). Available: www.fda.gov/cdrh/safety/cochlear.html (accessed 2003 Jan 2).
- 3.Cochlear implant recipients may be at greater risk for meningitis [notice to hospitals]. Ottawa: Health Canada; 2002 Jul 29. Available: www.hc-sc.gc.ca/hpb-dgps/therapeut/zfiles/english/advisory/tpd/cochlear_implant_e.html (accessed 2003 Jan 2).
- 4.Scheifele DW. Recent trends in pediatric Haemophilus influenzae type B infections in Canada. Immunization Monitoring Program, Active (IMPACT) of the Canadian Paediatric Society and the Laboratory Centre for Disease Control. CMAJ 1996;154(7):1041-7. [PMC free article] [PubMed]
- 5.Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 1997;337(14): 970-6. [DOI] [PubMed]
- 6.Weir E. Streptococcus pneumoniae infection in children: vaccine implications. CMAJ 2002;166 (2):220. [PMC free article] [PubMed]
- 7.Weir E. Meningococcal disease: Oh no, not another childhood vaccine. CMAJ 2002;166(8): 1064-6. [PMC free article] [PubMed]