Children with planned cochlear implant surgery advised to get added PCV dose

The administration of an additional pneumococcal vaccine dose is recommended in children aged ≥2 years who are planning to undergo cochlear implant (CI) surgery, suggests a study.

“Clinicians managing children with CI must ensure that pneumococcal vaccination is up to date, ideally before implantation,” the researchers said. “We recommend the systematic administration of an additional pneumococcal vaccine dose as soon as CI surgery is planned.”

This retrospective analysis was conducted at the Western Switzerland University Cochlear Implants Center, reviewing data between January 2009 and December 2023. The researchers used computerized medical records to extract vaccination records and serotype-specific pneumococcal IgG concentrations.

Fifty children (median implantation age 1.5 years) were included. Twenty-seven of 33 (82 percent) children aged <2 years were up to date with their routine pneumococcal vaccination (3 doses of the 13-valent pneumococcal conjugate vaccine [PCV13] administered at 2, 4, and 12 months). Of these, only 15 (56 percent) achieved protective pneumococcal seroprotection. [Pediatr Infec Dis J 2026;45:187-193]

Among 17 children aged ≥2 years, four (24 percent) received both the age-appropriate routine schedule and the additional recommended dose of PCV13 implantation. All four children (100 percent) achieved protective seroprotection.

“Among children under 2 years of age, we found no clear association between vaccination status and overall seroprotection,” the researchers said. “However, in children 2 years old and older, all those with up-to-date vaccination demonstrated sufficient seroprotection, compared with only 46 percent among those who were not fully vaccinated.”

In Switzerland, specific data on the protective immunity status of children is limited, but vaccination coverage remains high, indicating a “robust level of population immunity against pneumococcal disease,” they added. [Microorganisms 2021;9:1078]

Booster dose

Notably, the researchers observed a decline in seroprotection within 5 years after vaccination, particularly around 5 years of age. Immunity benefits from vaccination also differed by serotype, with serotypes 6B, 14, and 19 producing higher antibody levels and serotypes 4, 9V, and 18C eliciting lower responses. In addition, children aged 2‒5 years showed lower overall pneumococcal immunity.

“[O]ur findings also reveal a gradual decline in pneumococcal seroprotection within the first 5 years after vaccination, with some children losing protective antibody levels as early as 2 years postimmunization,” the researchers said.

“These results support the need for an additional pneumococcal vaccine dose at around 2 years of age for at-risk children … [and] suggest that periodic serologic monitoring—approximately every 3 to 5 years—may be beneficial, with booster doses administered according to individual serology results,” they added.

“Nonetheless, additional prospective studies are needed to determine whether the risk of pneumococcal meningitis persists over time in CI recipients, as this remains a critical question for long-term patient management,” the researchers said.

As of 2025, the Federal Office of Public Health in Switzerland recommends the 15-valent PCV for the primary vaccination series, together with an additional “higher valent” vaccine dose for at-risk children who were already vaccinated with PCV13. [https://www.bag.admin.ch/bag/fr/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/schweizerischer-impfplan.html]