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BACKGROUND. More than 11 000 children in the United States with severe-to-profound hearing loss have cochlear implants. A 2002 investigation involving pediatric cochlear implant recipients identified meningitis episodes from January 1, 1997, through September 15, 2002. The incidence of pneumococcal meningitis in the cohort was 138.2 cases per 100 000 person-years, >30 times higher than that for children in the general US population. Children with implants with positioners were at higher risk than children with other implant models. This higher risk of bacterial meningitis continued for up to 24 months after implantation. OBJECTIVE. To evaluate additional reported cases to determine whether the increased rate of bacterial meningitis among children with cochlear implants extended beyond 24 months after implantation. METHODS. Our study population consisted of the cohort of children identified through the 2002 investigation; it included 4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002, and who were RESULTS. We identified 12 new episodes of meningitis for 12 children. Eleven of the children had implants with positioners; 2 children died. Six episodes occurred >24 months after implantation. When cases identified in the 2002 and 2004 investigations were combined, the incidence rate of [greater than or equal to] 24-months postimplantation bacterial meningitis among children with positioners was 450 cases per 100 000 person-years, compared with no cases among children without positioners. CONCLUSIONS. Our updated findings support continued monitoring and prompt treatment of bacterial infections by health care providers and parents of children with cochlear implants. This vigilance remains important beyond 2 years after implantation, particularly among children with positioners. The vaccination recommendations for all children with implants, with and without positioners, and all potential recipients of implants continue to apply. Key Words hearing loss, intervention, meningitis, bacterial infections Abbreviations FDA--Food and Drug Administration CDC--Centers for Disease Control and Prevention CSF--cerebrospinal fluid, CURRENTLY >11 000 CHILDREN in the United States with severe-to-profound hearing loss have a cochlear implant (James K. Kane, PhD, E-mail communication, 2005), a surgically implanted device that includes an [...]