Conditions associated with an increased risk of invasive pneumococcal disease in children and adolescents

Risk group	Condition
Immune-compromised children	Functional or anatomic asplenia (eg, sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia or splenic dysfunction)
	Congenital or acquired immunodeficiencies – Includes B- or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (except CGD)
	HIV infection
	Chronic renal failure
	Nephrotic syndrome
	Generalized malignancy (eg, metastatic disease treated with chemotherapy)
	Hematologic malignancy (eg, leukemia, lymphoma, Hodgkin disease, multiple myeloma)
	Iatrogenic immunosuppression (eg, solid organ transplant, long-term systemic glucocorticoids, tumor necrosis alpha inhibitors [eg, etanercept, infliximab], radiation therapy)
Immune-competent children with anatomic barrier defects	Cerebrospinal fluid leaks
Immune-competent children with anatomic barrier defects	Cochlear implant (or candidate for cochlear implant)
Immune-competent children with chronic conditions*	Chronic heart disease, particularly cyanotic congenital heart disease, cardiac failure, and cardiomyopathy
	Chronic lung disease (including asthma if treated with high-dose oral glucocorticoid therapy^¶)
	Diabetes mellitus
	Alcoholism
	Chronic liver disease

CGD: chronic granulomatous disease.
* Alaska Native/American Indian children age 24 through 59 months may also be at increased risk if they live in areas with an increased prevalence of invasive pneumococcal disease.
¶ High-dose oral glucocorticoid therapy is defined as ≥20 mg per day (or >2 mg/kg per day for patients who weigh <10 kg) of prednisone or equivalent for ≥14 days.

Data from:

Nuorti JP, Whitney CG, Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2013; 62:521.
Centers for Disease Control and Prevention (CDC). Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2022. Available at: www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed on February 22, 2022.
Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58:e44.

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