5.

Are you immunocompromised due to chemotherapy or a non-HIV infection?

yes no

6.

Are you HIV-positive?

yes no

7.

Do you have any of these conditions: heart disease, chronic lung disease, chronic alcoholism?

yes no

8.

Do you have asplenia (including elective splenectomy and persistent complement component deficiencies)?

yes no

9.

Do you have chronic liver disease?

yes no

10.

Do you have any of the following conditions: diabetes, kidney failure, end stage renal disease, or are you on dialysis?

yes no

11.

Do you work in a healthcare setting?

yes no

12.

Do you smoke cigarettes?

yes no