Adults 65 years or older are at increased risk for pneumococcal disease. Adults of all ages are also at increased risk for pneumococcal disease if they have: Alcoholism Cerebrospinal fluid leak (a health problem where fluid surrounding and protecting the brain and spinal cord leaks) Chronic heart, lung, kidney, or liver disease Cochlear implant (a small electronic device that is surgically implanted to help people with severe hearing loss be able to hear) Diabetes HIV infection, cancer, solid organ transplant, or another condition or taking medicine that weakens the immune system Nephrotic syndrome Sickle cell disease, a damaged spleen, or no spleen Adults who smoke cigarettes are also at increased risk for pneumococcal disease. Chronic lung illnesses that increase an adult’s risk for pneumococcal disease include chronic obstructive lung disease, emphysema, and asthma.