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Patients presenting to other hospitals and referred to the

It is the most common cause of acute otitis media, sinusitis, bacteraemia, pneumonia, and meningitis.1Recognised risk factors for IPD in children include: anatomical or functional asplenia, congenital or acquired immunodeficiency, chronic renal disease, receipt of immunosuppressive chemotherapy, and ethnicity (for example, Native American, Australian aboriginal, and Polynesian children).1 3 More recently, reports have suggested that children attending day care and those with frequent episodes of otitis media may be at increased risk.1,4Although specific factors increase the risk of IPD for the individual child it is not known what proportion of children with IPD have an underlying abnormality. The reported percentage of children in developed countries with IPD and a preceding health problem ranges from 22% to 64%.5 9As well as children with primary and secondary immunodeficiency, children with central nervous system malformations, congenital heart disease, chromosomal abnormalities, and physical malformations appear in one or more of the series.5 9 To what extent these other preceding problems are associated with an increased risk of IPD is not known. Patients presenting to other hospitals and referred to the John Radcliffe were excluded.

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