Pneumococcal meningitis caused by non-vaccine serotype 34 after vaccination with the 20-valent pneumococcal conjugate vaccine in a child with inner ear malformations and bilateral cochlear implants: A case report

Although pneumococcal conjugate vaccines have reduced invasive pneumococcal disease (IPD) in children, infections caused by non-vaccine serotypes remain a significant clinical concern. Children with congenital inner ear malformations and cochlear implants (CIs) face an elevated risk of bacterial meningitis, due to potential abnormal communication between the inner ear and subarachnoid space....

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No immediate change to vaccination protocols is warranted from a single case report, but clinicians should remain vigilant for meningitis symptoms in cochlear implant recipients even when fully vaccinated, as non-vaccine serotypes can still cause infection.

Cochlear implant recipients are at elevated meningitis risk, and this case demonstrates that expanded pneumococcal vaccines do not eliminate that risk when non-covered serotypes circulate.

1. 01Meningitis was caused by serotype 34, which is not included in the 20-valent pneumococcal conjugate vaccine (PCV20).
2. 02The child had bilateral cochlear implants and inner ear malformations — both known meningitis risk factors.
3. 03Vaccination with PCV20 did not protect against this non-vaccine serotype.
4. 04The case underscores the need for ongoing surveillance of serotype distribution in cochlear implant populations.
5. 05Published as a single case report in IDCases; findings cannot be generalized.

PMID

42787865

DOI

10.1016/j.idcr.2026.e02760.

Journal

IDCases

Publication type

case_report

Evidence level

4

Sample size

1

Population

A child with bilateral cochlear implants and inner ear malformations who received PCV20

Intervention

20-valent pneumococcal conjugate vaccine (PCV20)