The COVID-19 vaccine and health conditions

Health conditions that put people aged 16 years and over at higher risk of COVID-19

Chronic respiratory disease

Individuals with a severe lung condition, including those with poorly controlled asthma and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
Poorly controlled asthma is defined as:

• 2 or more courses of oral cortisteroids (Tablets) in the previous 24 months or
• On maintenance oral cortisteroids or
• One or more hospital admissions for asthma in the previous 24 months

Chronic heart disease and vascular disease

Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.

Chronic kidney disease

Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.

Chronic liver disease

Cirrhosis, biliary atresia, chronic hepatitis.

Chronic neurological disease

Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological or neuromuscular disease (e.g. polio syndrome sufferers). This group also includes individuals with cerebral palsy, severe or profound and multiple learning disabilities (PMLD) including all those on the learning disability register, Down's syndrome, multiple sclerosis, epilepsy, dementia, Parkinson's disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes mellitus and other endocrine disorders

Any diabetes, including diet-controlled diabetes, current gestational diabetes, and Addison's disease.

Immunosuppression

Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma. Those who require long term immunosuppressive treatment for conditions including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, scleroderma and psoriasis.

Some immunosuppressed patients may have a suboptimal immunological response to the vaccine (see Immunosuppression and HIV).

Asplenia or dysfunction of the spleen

This also includes conditions that may lead to splenic dysfunction, such as homozygous sickle cell disease, thalassemia major and coeliac syndrome.

Morbid obesity

Adults with a Body Mass Index (BMI) ≥40 kg/m².

Severe mental illness

Individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment.

Younger adults in long-stay nursing and residential care settings

Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups above (for example learning disabilities). Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended. Younger residents in care homes for the elderly will be at high risk of exposure, and although they may be at lower risk of mortality than older residents should not be excluded from vaccination programmes (see priority 1 above).

Pregnancy

All stages (first, second and third trimesters).

Health conditions that put people aged 5 to 15 years at higher risk of COVID-19

• Chronic respiratory disease
• Chronic heart conditions
• Chronic conditions of the kidney, liver or digestive system
• Chronic neurological disease or condition
• Endocrine disorders
• Asplenia or dysfunction of the spleen
• Serious genetic abnormalities that affect a number of systems
• Immunosuppression 

Adults and children with a severely weakened immune system

The JCVI recommend that people aged 5 years and older with a severely weakened immune system should be offered a third primary dose of the vaccine.

This includes those who had or have:

• blood cancers (such as leukaemia or lymphoma)
• lowered immunity due to treatment (such as steroid medication, biological therapy, chemotherapy or radiotherapy)
• lowered immunity due to inherited disorders of the immune system
• an organ or bone marrow transplant
• diseases that affect the immune system such as poorly controlled HIV

If you're taking medication

You’ll be asked some questions at your vaccination appointment to make sure that there are no reasons for you not to have the vaccine.

You'll also have an opportunity to ask any questions or discuss concerns you may have.

People with bleeding disorders or taking medication to thin their blood or reduce bleeding

People taking medication to thin the blood, such as warfarin, can safely receive the COVID-19 vaccine as long as their treatment is stable.

You should let the person giving you the vaccine know what medication you are on.

Stable means you will have been taking the same dose for a while and if you are on warfarin, your:

• INR checks are up to date
• latest INR level was in the right range

People with bleeding disorders should consult their specialist or their individual care plan for advice on vaccination.

See also: Green Book Chapter 14a.