Posts

Researchers continue to look for help for children and parents of children who suffer from the most common type of ear infection, called middle ear infection or otitis media (OM).

About 62 percent of children in developed countries will have their first episode of OM by the age of one, more than 80 percent by their third birthday, and nearly 100 percent will have at least one episode by age five. In the U.S. alone, this illness accounts for 25 million office visits annually with direct costs for treatment estimated at $3 billion. Health economists add that when lost wages for parents are included, the total cost of estimated treatments mount to $6 billion.

This is a big problem.

Treatments

The usual treatment options for children with middle ear infections include:

  • antibiotics; and
  • surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time.

What about vaccines?

A vaccine is a preparation administered to stimulate the body’s own defense system to combat specific bacteria or viruses. The first vaccine was introduced in the 18th century for the prevention of smallpox. Today, each vaccine is designed to resemble a particular virus or bacteria (or group of viruses and bacteria). When administered, the vaccine triggers the defense system without actually causing illness. This helps the body to develop a defense (antibodies) against the virus or bacteria so that if they enter the body, you will not get sick. Today, vaccines exist to combat a wide range of viruses and some bacteria.

One of the most common and potentially serious bacteria to cause ear and sinus infections and pneumonia and meningitis is the pneumococcus. Recently a vaccine was developed that is effective against several common strains of pneumococcus.

Your child’s physician will advise you on appropriate vaccines for your child. If the pneumococcal vaccine is offered to your child, you may want to know:

The conjugate pneumococcal vaccine: This latest advance in pediatric healthcare prevents diseases caused by seven of the most common types of pneumococcal bacteria. It is safe and effective. It protects against serious forms of the disease up to 97 percent of the time, depending on the person. The vaccine is given by a needle. The side effects, which are usually minor and temporary, include some redness, swelling or tenderness from the injection, and a mild fever. Serious side effects, including allergic reactions, are quite rare. It can be given to infants, and there is no other vaccine to prevent pneumococcal disease in children less than two years of age. In 2002 the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommended the vaccine for infants and toddlers under the age of five. See http://www.cdc.gov/vaccines for more information.

Conjugate vaccines are effective against otitis media in children under the age of five because they have a polysaccharide component linked to a protein component that an infant’s immature defense system can recognize. Children older than five, whose defense systems have matured, may receive a pneumococcal polysaccharide vaccine without the protein component.

How does this relate to otitis media? Here are issues to consider.

Streptococcus pneumoniae bacteria (commonly known as pneumococcus) are thought to cause 50 to 60 percent of cases of otitis media. Before this vaccine was available, each pneumococcal infection caused:

  • about five million ear infections;
  • more than 700 cases of meningitis;
  • 13,000 blood infections (septicemia); and
  • other health problems including pneumonia, deafness and brain damage.

Haemophilus influenzae (NTHi) and Moraxella catarrhalis vaccine are two other common bacteria that cause ear and sinus infections. Recently, the National Institutes of Health has issued a license for the first clinical trials for a nontypeable Haemophilus influenzae (NTHi) vaccine. Vaccines to prevent viral infections like the flu that can eventually lead to ear infections should be considered for children with recurring ear infections. These vaccines are usually administered in the fall.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What You Should Know

  • Children with cochlear implants are more likely to get bacterial meningitis than children without cochlear implants. In addition, some children who are candidates for cochlear implants have inner ear anatomic abnormalities that may increase their risk for meningitis.
  • Because children with cochlear implants are at increased risk for pneumococcal meningitis, the Centers for Disease Control (CDC) recommends that they receive pneumococcal vaccination on the same schedule that is recommended for other groups at increased risk for invasive pneumococcal disease. Recommendations for the timing and type of pneumococcal vaccination vary with age and vaccination history and should be discussed with a health care provider.
  • The Centers for Disease Control and Prevention (CDC) has issued pneumococcal vaccination recommendations for individuals with cochlear implants. These recommendations can be viewed in detail on the CDC website.
    • Children who have cochlear implants or are candidates for cochlear implants should receive PCV13. PCV13 is now recommended routinely for all infants and children (see Table 2 in the CDC March 12, 2010 MMWR issue located at the above website for the number of doses and dosing schedule).
    • Older children with cochlear implants (from age 2 years through age 5) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13 previously. If they have already completed the four-dose PCV7 series, they should receive one dose of PCV13 through age 71 months.
    • Children 6 through 18 years of age with cochlear implants may receive a single dose of PCV13 regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV23) (Pneumovax®).
    • In addition to receiving PCV13, children with cochlear implants should receive one dose of PPSV23 at age 2 years or older and after completing all recommended doses of PCV13.
  • The Centers for Disease Control and Prevention (CDC) has issued pneumococcal vaccination recommendations for adults with cochlear implants. These recommendations can be viewed in detail on the CDC website.
    • Adult patients (=19 yrs of age) who are candidates for a cochlear implant and those who have received a cochlear implant should be given a single dose of PCV13 followed by a PPSV23 at least 8 weeks later. A second dose of PPSV23 is recommended for those 65 years of age and older.
  • For those adults who previously have received 1 doses of PPSV23 should be given a PCV13 dose =1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
    For both children and adults, the vaccination schedule should be completed at two weeks or more before surgery.

Additional Facts

  • According to the Food and Drug Administration (FDA), as of April 2009, approximately 188,000 people worldwide have received cochlear implants. In the United States, roughly 41,500 adults and 25,500 children have received them. In the U.S., there are 122 known reports of meningitis in patients who have received cochlear implants with 64% of these cases having occurred in children.
  • Meningitis is an infection of the fluid that surrounds the brain and spinal cord. There are two main types of meningitis, viral and bacterial. Bacterial meningitis is the more serious type and the type that has been reported in individuals with cochlear implants. The symptoms, treatment and outcomes may differ, depending on the cause of the meningitis.
  • The vaccines available in the United States that protect against most bacteria that cause meningitis are:
    • 13-valent pneumococcal conjugate (PCV13) (Prevnar 13®)
    • 23-valent pneumococcal polysaccharide (PPSV) (Pneumovax®)
    • Haemophilus influenzae type b conjugate (Hib)
    • Tetravalent (A, C, Y, W-135) meningococcal conjugate (Menactra® and Menveo®)
    • Tetravalent (A, C, Y, W-135) meningococcal polysaccharide (Menomune®)
  • Meningitis in individuals with cochlear implants is most commonly caused by the bacterium Streptococcus pneumoniae (pneumococcus). Children with cochlear implants are more likely to get pneumococcal meningitis than children without cochlear implants.
  • There is no evidence that children with cochlear implants are more likely to get meningococcal meningitis, caused by the bacterium Neisseria meningitides, than children without cochlear implants. Health care providers should follow the CDC immunization guidelines for routine meningococcal vaccination.
  • The Haemophilus influenzae type b (Hib) vaccine is not routinely recommended for those 5 years of age or older, since most older children and adults are already immune to Hib. Available information does not suggest that older children and adults with cochlear implants require the Hib vaccine. However, the Hib vaccine can be given to older children and adults who have never received it. Children less than age 5 should receive the Hib vaccine as a routine protection, according to the CDC guidelines for childhood immunizations. Most children born after 1990 have received the Hib vaccine as infants.
  • Health care providers (family physicians, pediatricians and otolaryngologists) and families should review the vaccination records of current and prospective cochlear implant recipients to ensure that all recommended vaccinations are up to date.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery