Children and adults with chronic conditions face significantly higher risks of severe respiratory infections, including pneumococcal disease and RSV. Recent data indicates that immunocompromised individuals, in particular, require targeted vaccination strategies and medical consultation to manage unique risks, as standard immunity responses are often diminished by underlying health issues or immunosuppressive medications.
Invasive Pneumococcal Disease Risk in Pediatric Patients
New research published in 2 Minute Medicine highlights that children and adolescents living with chronic medical conditions (CMCs) are at a substantially higher risk for invasive pneumococcal disease (IPD). A retrospective cohort study utilizing the JMDC longitudinal insurance claims database analyzed over 12.2 million individuals younger than 19 years between 2006 and 2022.
The findings show that the risk of IPD increases markedly with the number of comorbidities present. Immunocompromised children and those with two or more chronic conditions demonstrated the highest incidence rate ratios. While the risk of non-bacteremic pneumonia, acute otitis media, or sinusitis was also elevated, that risk did not scale as sharply with additional conditions as IPD did. The authors suggest that current routine early childhood immunization schedules may be insufficient for these vulnerable groups, indicating a need for expanded, targeted vaccination strategies.
For more on this story, see Why HPV Vaccination in Middle School is Critical: Doctor Warns of Rising Cancer Risks Among Teens.
Vaccination Complexities for Immunocompromised Adults
For adults with compromised immune systems—whether due to congenital conditions, acquired diseases like HIV, or autoimmune disorders such as rheumatoid arthritis and Crohn’s disease—vaccination requires a careful risk-benefit analysis. According to Cassandra Calabrese, DO, a rheumatologic and immunologic disease specialist at the Cleveland Clinic, the primary concern involves the type of vaccine administered.
“Live vaccines — such as the measles, mumps and rubella (MMR) vaccine — should generally be avoided in the setting of immunosuppression because they can cause infection. Most vaccines, however, aren’t live and are generally recommended for people who are immunocompromised. That said, certain immunosuppressive medications may reduce the effectiveness of vaccines.”
Cassandra Calabrese, DO, Cleveland Clinic
Because immunosuppressive drugs—including biologics used for cancer or inflammatory bowel disease—are designed to quiet the immune system, they can impede a patient’s response to a vaccine.
Respiratory Syncytial Virus (RSV) Complications in Older Populations
Respiratory syncytial virus (RSV) is often mischaracterized as a strictly pediatric illness, but it poses significant dangers to adults over 60 and those with chronic heart or lung diseases. Donald DeCoy, MD, a pulmonary medicine specialist, notes that RSV in adults often presents differently than in children.
Three RSV vaccines—Arexvy, Abrysvo, and mRESVIA—are currently approved for older adults. AARP reports that the Centers for Disease Control and Prevention (CDC) recommends the vaccine for adults 75 and older, as well as those 50 to 74 who reside in nursing homes or have high-risk underlying health conditions.
This follows our earlier report, How RSV Weakens the Immune Response in Respiratory Cells: Mechanisms, Risks & Protection Strategies.
Environmental and Demographic Factors Influencing Health Risks
Susceptibility to respiratory illness is not dictated by medical history alone; environmental factors, including air pollution, play a critical role. According to the American Lung Association, children are uniquely vulnerable because their airways are still developing and they inhale more air relative to their body size than adults. Furthermore, older adults and individuals with existing chronic diseases like asthma or cardiovascular disease face heightened risks from air pollution, which can trigger cellular injury and inflammation.
These health disparities are compounded by socioeconomic factors. Communities of color and low-income populations are more likely to live near pollution sources and often face restricted access to high-quality healthcare.
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