Children and adults with these risk conditions are at increased risk of pneumococcal disease and would benefit from additional doses of pneumococcal vaccine.

Many children and adults with these risk conditions are eligible for funded doses of 13vPCV and 23vPPV under the National Immunisation Program (NIP). However, some people with risk conditions for whom the vaccine is recommended are not eligible to receive funded vaccine doses. This is because the incidence of pneumococcal disease for these risk conditions is not sufficient to meet cost-effectiveness thresholds. 

Vaccine doses for people with the risk conditions in this list are funded under the NIP unless otherwise noted. 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. 

  • Previous episode of invasive pneumococcal disease
  • Functional or anatomical asplenia, including
    • sickle cell disease or other haemoglobinopathies
    • congenital or acquired asplenia (for example, splenectomy) or hyposplenia
  • Immunocompromising conditions, including
    • congenital or acquired immune deficiency, including symptomatic IgG subclass or isolated IgA deficiency
    • haematological malignancies
    • solid organ transplant
    • haematopoietic stem cell transplant
    • HIV infection
    • immunosuppressive therapy, where sufficient immune reconstitution for vaccine response is expected; this includes those with underlying conditions requiring but not yet receiving immunosuppressive therapya
    • non-haematological malignancies receiving chemotherapy or radiotherapy (currently or anticipated)a
  • Proven or presumptive cerebrospinal fluid (CSF) leak, including
    • cochlear implants
    • intracranial shunts
  • Chronic respiratory disease, includingb
    • suppurative lung disease, bronchiectasis and cystic fibrosis
    • chronic lung disease in preterm infants
    • chronic obstructive pulmonary disease (COPD) and chronic emphysemaa
    • severe asthma (defined as requiring frequent hospital visits or the use of multiple medications)a
    • interstitial and fibrotic lung diseasea
  • Chronic renal disease 
    • relapsing or persistent nephrotic syndrome
    • chronic renal impairment – eGFR <30 mL/min (stage 4 disease)c
  • Cardiac disease, including b
    • congenital heart diseased
    • coronary artery diseased
    • heart failured
  • Children born less than 28 weeks gestationd
  • Trisomy 21d
  • Chronic liver disease, includingb
    • chronic hepatitisa
    • cirrhosisa
    • biliary atresiaa
  • Diabetesa
  • Smoking (current or in the immediate past)a
  • Harmful use of alcohol (consuming on average ≥60 g of alcohol (6 Australian standard drinks) per day for males and ≥40 g of alcohol (4 Australian standard drinks) per day for females)a

a. Not funded under the NIP
b. Individual conditions listed beneath or those that are similar based on clinical judgment
c. Funded under the NIP for eGFR <15 mL/min only (including patients on dialysis)
d. Funded under the NIP for children <5 years only

Last updated: 
27 May 2020
Last reviewed: 
27 May 2020


13-valent pneumococcal conjugate vaccine
23-valent pneumococcal polysaccharide vaccine
cerebrospinal fluid