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Risk Factors

Conditions that increase the risk of invasive pneumococcal disease among adults include:

  • Decreased immune function from disease or drugs
  • Functional or anatomic asplenia
  • Chronic heart, pulmonary (including asthma), liver, or renal disease
  • Smoking cigarettes
  • Cerebrospinal fluid leak

Children with functional or anatomic asplenia, particularly those with sickle cell disease, and children with HIV infection are at very high risk for invasive disease.

Rates are also increased among children of certain racial and ethnic groups, in particular those of Alaska Native, African American, and certain American Indian groups. The reason for this increased risk by race and ethnicity is not known with certainty but was also noted for invasive Haemophilus influenzae infection (also an encapsulated bacterium).

Attendance at a child-care center has been shown to increase the risk of invasive pneumococcal disease and acute otitis media 2–3-fold among children younger than 59 months of age. Children with a cochlear implant are also at increased risk for pneumococcal meningitis.


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