Version July 2025
| 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 |
| 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) |
