Vaccine Immunity Against Pneumococcus in Children With Cochlear Implants

Background: This study aims to assess whether Swiss guidelines for pneumococcal vaccination in children with cochlear implants are followed and whether they elicit adequate pneumococcal vaccine immunity. Methods: We performed a retrospective analysis at the Western Switzerland University Cochlear Implants Center, reviewing data between January 2009 and December 2023. Vaccination records and serotype-specific pneumococcal IgG concentrations were extracted from computerized medical records. Results: Fifty children were included, with a median implantation age of 1.5 years. In children <2 years old, 82% (27/33) were up to date with routine pneumococcal vaccination (3 doses of the 13-valent pneumococcal conjugate vaccine administered at 2, 4 and 12 months), yet only 56% (15/27) achieved protective pneumococcal seroprotection. In contrast, among children ≥2 years of age, 24% (4/17) received both the age-appropriate routine schedule and the additional recommended dose of 13-valent pneumococcal conjugate before implantation, and all of these (100%) showed protective seroprotection. An overall decline in seroprotection was observed within 5 years postvaccination, particularly around 5 years of age. Vaccine-induced immunity differed by serotype; serotypes 6B, 14 and 19 elicited higher antibody levels, whereas serotypes 4, 9V and 18C produced lower responses. Notably, children 2–5 years of age tended to exhibit lower overall pneumococcal immunity. Conclusions: Our findings support the proactive administration of an additional pneumococcal vaccine dose at the time of planning cochlear implant surgery for children ≥2 years old. In addition, periodic monitoring of serotype-specific pneumococcal antibody levels (every 5 years) is recommended to determine the need for booster vaccinations.