For children ≤5 years of age, recommendations for pneumococcal vaccination are the same whether the child’s condition is in Category A (the highest risk) or Category B (an increased risk).

For children >5 years of age, adolescents and adults, recommendations for pneumococcal vaccination depend on whether the person’s condition is in Category A (the highest risk) or Category B (an increased risk).

See also Vaccination for people who are immunocompromised for more recommendations for people who are immunocompromised, including specific revaccination recommendations for haematopoietic stem cell transplant recipients.

Category A: Conditions associated with the highest increased risk of invasive pneumococcal disease

Functional or anatomical asplenia, including:

  • sickle cell disease or other haemoglobinopathies
  • congenital or acquired asplenia (for example, splenectomy), or splenic dysfunction

Immunocompromising conditions, including:

  • congenital or acquired immune deficiency, including symptomatic IgG subclass or isolated IgA deficiency (note: children who need monthly immunoglobulin infusion are unlikely to benefit from vaccination)
  • immunosuppressive therapy (including corticosteroid therapy ≥2 mg per kg per day of prednisolone or equivalent for more than 1 week) or radiation therapy, where there is sufficient immune reconstitution for vaccine response to be expected
  • haematological and other malignancies
  • solid organ transplant
  • haematopoietic stem cell transplant
  • HIV infection (including AIDS)
  • chronic renal failure, or relapsing or persistent nephrotic syndrome

Proven or presumptive cerebrospinal fluid leak

  • Cochlear implants
  • Intracranial shunts

Category B: Conditions associated with an increased risk of invasive pneumococcal disease

Chronic cardiac disease:

  • particularly cyanotic heart disease or cardiac failure in children
  • excluding hypertension only (in adults)

Chronic lung disease, including:

  • chronic lung disease in preterm infants
  • cystic fibrosis
  • severe asthma in adults (requiring frequent medical consultations or the use of multiple medications)


Down syndrome


Chronic liver disease

Preterm birth at <28 weeks gestation

Tobacco smoking (not a medical condition, but associated with an increased risk of pneumococcal disease)

History of previous invasive pneumococcal disease in children.

Last updated: 
5 June 2018
Last reviewed: 
5 June 2018


acquired immunodeficiency syndrome