Table 2.

Children at High Risk of Invasive Pneumococcal Infection

High risk (attack rate of invasive pneumococcal disease >150/100 000 cases/y)
 1.  SCD, congenital or acquired asplenia, or splenic dysfunction
 2.  Infection with HIV
Presumed high risk (attack rate not calculated)
 1.  Congenital immune deficiency: some B- (humoral) or T-lymphocyte deficiencies, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), or phagocytic disorders (excluding chronic granulomatous disease)
 2.  Chronic cardiac disease (particularly cyanotic congenital heart disease and cardiac failure)
 3.  Chronic pulmonary disease (including asthma treated with high-dose oral corticosteroid therapy)
 4.  Cerebrospinal fluid leaks
 5.  Chronic renal insufficiency, including nephrotic syndrome
 6.  Diseases associated with immunosuppressive therapy or radiation therapy (including malignant neoplasms, leukemias, lymphomas, and Hodgkin's disease) and solid organ transplantation
 7.  Diabetes mellitus
Moderate risk (attack rate of invasive pneumococcal disease >20 cases/100 000/y)
 1.  All children 24–35 mo old
 2.  Children 36–59 mo old attending out-of-home care
 3.  Children 36–59 mo old who are of Native American (American Indian and Alaska Native) or African American descent
  • * Guidelines for the use of pneumococcal vaccines for children who have received bone marrow transplants are currently undergoing revision (Centers for Disease Control and Prevention, personal communication, 2000).