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 chronic granulomatous disease)
	HIV infection
	Nephrotic syndrome
	Dialysis-dependent chronic kidney disease
	Generalized malignancy (eg, metastatic disease, disease treated with chemotherapy or radiation therapy)
	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 medical conditions	Chronic heart disease, particularly cyanotic congenital heart disease, cardiac failure, and cardiomyopathy
	Chronic lung disease (including moderate or severe persistent asthma)
	Diabetes mellitus
	Chronic liver disease
	Chronic kidney disease (excluding children with nephrotic syndrome and/or dialysis dependence)

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