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Risk Factors

woman using an inhaler

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, lung (including asthma), liver, or renal disease
  • Cigarette smoking
  • 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, with some studies reporting rates more than 50 times higher than those among children of the same age without these conditions.

Rates are also increased among children of certain racial and ethnic groups, in particular Alaska Natives, 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 (which is also caused by an encapsulated bacterium). 

Attendance at a childcare 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 old. Children with a cochlear implant are also at increased risk for pneumococcal meningitis.

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