Transcript Document
Cochlear Implants and Meningitis: A Case for Collaborative Surveillance Krista Biernath/Pam Costa 2005 EHDI Conference Atlanta, Georgia March 3, 2005 Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities TM Background June 2002, FDA received first reports of bacterial meningitis in cochlear implant recipients. Subsequent investigation identified meningitis episodes from 1/1/97 – 9/15/03. Incidence of meningitis in children with cochlear implants caused by S. Pneumoniae was 30 times higher than general population. Post-implant meningitis was significantly associated with use of a positioner. TM Background (Continued) Models with the positioner were available from 1999– July 2002. On-going cases of post-implant bacterial meningitis among cochlear implant users prompted a new investigation. Need to be vigilant during post-operative period for all and long-term for children with positioners. Vaccine recommendations apply for all children with cochlear implants. http://www.cdc.gov/nip/recs/childschedule.htm TM The Concern Ongoing evidence that children with cochlear implants are developing meningitis Currently, state surveillance of these events is uncoordinated or not occurring Without accurate data, the potential public health question can not be adequately addressed TM Current Status-Infectious Disease Reporting States differ in what types of meningitis are reportable under their infectious disease requirements: some state comments ◊ “only meningitis cause by Neisseria meningitides and H-Flu” ◊ “bacterial and viral” ◊ “disease specific, including Neisseria, H-Flu, Strep. Pneumoniae, some viral-LaCrosse, West Nile) TM Infectious Disease Reporting Cont. States differ as to what data are collected on infectious reporting forms, with regard to cochlear implants ◊ Most states report cochlear implant status not collected routinely, if at all 2 years ago, asked “Could forms be changed?” ◊ Yes, no, not easily, probably-if there is evidence that it would be useful TM Current Status-EHDI systems Some EHDI systems are set-up to gather information about device type, including cochlear implants Unknown if any state EHDI systems currently collecting information about meningitis occurrence Few EHDI programs have on-going relationships with state infectious disease surveillance TM CDC Next Steps CDC EHDI will continue to be in contact with state epidemiologists CDC EHDI will be requesting that all states modify their infectious disease reporting forms to include at least two questions: ◊ Is the person deaf/hard of hearing ◊ Does the person have a cochlear implant TM State/Territorial Next Steps Encourage state/territory’s EHDI programs to collaborate with their infectious programs Learn what is reportable in your state/territory Determine if data can be shared Work with audiologists/medical home for other opportunities for reporting-Strep. Pneumoniae not reportable for many states/territories TM National Next Steps CDC EHDI will continue to work with FDA CDC EHDI will encourage states/territories to report cases (de-identified) to CDC EHDI ◊ Date of birth ◊ Type of meningitis ◊ Perhaps other common variables (?) Need for continued surveillance to address public health concern TM Further Information CDC-EHDI – http://www.cdc.gov/ncbddd/ehdi/ Recommended vaccination schedule – http://www.cdc.gov/nip/recs/child-schedule.htm TM