Which children are at increased risk of invasive pneumococcal disease?

Regardless of risk, all children should receive routine vaccination with either PCV15 or PCV20 as age-appropriate. A child age 2 through 18 years with any of the conditions listed below may require additional pneumococcal vaccination depending on their age and prior vaccination status.

The conditions that increase the risk of pneumococcal disease and are indications for additional pneumococcal vaccine doses beyond the routine schedule are broken down into two categories: non-immunocompromising (non-IC) and immunocompromising (IC). Recommendations differ slightly under certain circumstances by IC or non-IC category.

Non-IC conditions include:

• Cerebrospinal fluid (CSF) leak
• Chronic heart disease (especially cyanotic congenital heart disease and heart failure)
• Chronic kidney disease (except as specified in the IC list below)
• Chronic liver disease
• Chronic lung disease (including moderate persistent or severe persistent asthma)
• Diabetes mellitus
• Cochlear implant

Immunocompromising (IC) conditions include:

• Kidney disease and on maintenance dialysis
• Kidney disease with nephrotic syndrome
• Asplenia or splenic dysfunction
• Congenital or acquired immunodeficiency, including B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
• Treatment with immunosuppressive drugs or radiation therapy (including treatment for Hodgkin disease, leukemias, lymphomas, malignant neoplasm, and solid organ transplant)
• HIV infection
• Sickle cell disease or other hemoglobinopathies

For timing of vaccination following hematopoietic stem cell transplant, see see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html

CDC guidance is available at www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html.

Immunize.org details all recommendations and options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens (www.immunize.org/wp-content/uploads/catg.d/p3086.pdf) and its shorter resource, Recommendations for Pneumococcal Vaccines use in Children and Teens (www.immunize.org/wp-content/uploads/catg.d/p2016.pdf).