The coronavirus (COVID-19) vaccine and health conditions

There are health conditions that put people aged 16 years and over at higher risk of coronavirus (COVID-19).

Chronic respiratory disease

Severe lung conditions, including:

  • asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission (does not include patients with well controlled asthma)
  • chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema
  • bronchiectasis
  • cystic fibrosis
  • interstitial lung fibrosis
  • pneumoconiosis
  • bronchopulmonary dysplasia (BPD)
Chronic heart disease and vascular disease

Conditions such as:

  • congenital heart disease
  • hypertension with cardiac complications
  • chronic heart failure
  • individuals requiring regular medication and/or follow-up for ischaemic heart disease
  • atrial fibrillation
  • peripheral vascular disease
  • venous thromboembolism
Chronic kidney disease

Conditions such as:

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

 

Conditions such as:

  • cirrhosis
  • biliary atresia
  • chronic hepatitis
Chronic neurological disease or condition

Conditions such as:

  • stroke
  • transient ischaemic attack (TIA)
  • conditions in which respiratory function may be compromised due to neurological or neuromuscular disease (for example polio syndrome sufferers)
  • cerebral palsy
  • severe or profound and multiple learning disabilities (PMLD)
  • those on the learning disability register
  • Down’s Syndrome
  • multiple sclerosis
  • epilepsy
  • dementia
  • Parkinson’s disease
  • motor neurone disease and related or similar conditions
  • hereditary and degenerative disease of the nervous system or muscles
  • severe neurological disability
Diabetes mellitus and other endocrine disorders

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

Immunosuppression

Conditions or treatments such as:

  • immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression
  • 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 (for example IRAK-4, NEMO, complement disorder, SCID)
  • receiving immunosuppressive or immunomodulating biological therapy including, but not limited to anti-TNF, alemtuzumab, ofatumumab and rituximab
  • receiving protein kinase inhibitors or PARP inhibitors
  • being treated with steroid-sparing agents such as cyclophosphamide and mycophenolate mofetil
  • being 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

This also includes:

  • anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma
  • anyone requiring long-term immunosuppressive treatment for conditions including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, scleroderma and psoriasis
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) greater than or equal to 40.

Severe mental illness

Conditions such as schizophrenia, bipolar disorder, or any mental illness that causes severe functional impairment.

Pregnancy

All stages (first, second and third trimesters)

Children aged 5 to 15 with underlying health conditions

Chronic respiratory disease

Including those with poorly controlled asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, cystic fibrosis, ciliary dyskinesias and bronchopulmonary dysplasia.

Poorly controlled asthma is defined as any of the following:

  • 2 or more courses of oral corticosteroids in the last 24 months
  • on maintenance oral corticosteroids
  • 1 or more hospital admission for asthma in the last 24 months
Chronic heart conditions

Haemodynamically significant congenital and acquired heart disease, or less severe heart disease with other co-morbidity. This includes:

  • single ventricle patients or those palliated with a Fontan (Total Cavopulmonary Connection) circulation
  • those with chronic cyanosis (oxygen saturations <85% persistently)
  • patients with cardiomyopathy requiring medication
  • patients with congenital heart disease on medication to improve heart function
  • patients with pulmonary hypertension (high blood pressure in the lungs) requiring medication
Chronic conditions of the kidney, liver or digestive system

Including those associated with congenital malformations of the organs, metabolic disorders and neoplasms, and conditions such as severe gastro-oesophageal reflux that may predispose to respiratory infection.

Chronic neurological disease or condition

This includes those with:

  • neuro-disability and/or neuromuscular disease including cerebral palsy, autism, epilepsy and muscular dystrophy
  • hereditary and degenerative disease of the nervous system or muscles, other conditions associated with hypoventilation
  • severe or profound and multiple learning disabilities (PMLD), Down’s syndrome, those on the learning disability register
  • neoplasm of the brain
Endocrine disorders

Including diabetes mellitus, Addison’s and hypopituitary syndrome.

Asplenia or dysfunction of the spleen

Including hereditary spherocytosis, homozygous sickle cell disease and thalassemia major.

Serious genetic abnormalities that affect a number of systems

Including mitochondrial disease and chromosomal abnormalities.

Immunosuppression

Immunosuppression due to disease or treatment, including:

  • those undergoing chemotherapy or radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients
  • genetic disorders affecting the immune system (for example deficiencies of IRAK-4 or NEMO, complement disorder, SCID)
  • those with haematological malignancy, including leukaemia and lymphoma
  • those receiving immunosuppressive or immunomodulating biological therapy
  • those treated with or likely to be treated with high or moderate dose corticosteroids
  • those receiving any dose of non-biological oral immune modulating drugs for example methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
  • those auto-immune diseases who may require long term immunosuppressive treatments
  • children who are about to receive planned immunosuppressive therapy should be considered for vaccination prior to commencing therapy

The Joint Committee on Vaccination and Immunisation (JCVI) also recommends that people aged 5 years and older who share living accommodation on most days with someone with a weakened immune system should be offered 2 doses of the vaccine, given at least 8 weeks apart. This is to indirectly protect their household contacts with a weakened immune system, who are at higher risk of serious disease from coronavirus and may not generate a full immune response to vaccination.

Pregnancy

All stages (first, second and third trimesters).

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 coronavirus 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.

Last updated:
26 August 2022