The vaccines and health conditions

There are very few people who cannot get the coronavirus vaccine.

You should not get the coronavirus vaccine if you've had a confirmed anaphylactic reaction to:

  • any of the ingredients in the vaccine
  • a previous dose of the vaccine

The coronavirus vaccine is suitable for people with disorders of the immune system.

Children aged 12 to 15 with underlying health conditions

The Joint Committee on Vaccination and Immunisation (JCVI) has recommended children and young people aged 12 to 15 years old with specific underlying health conditions that put them at risk of serious coronavirus, are offered two doses of the Pfizer/BioNTech vaccine.

All other children and young people aged 12 to 17 years will be offered a first dose of the vaccine. The timing of a second dose will be confirmed later.

Health conditions that put young people aged 12 to 15 years old at highest risk of getting coronavirus and of suffering serious complications if they get coronavirus include:

Severe neuro-disabilities

Severe neuro-disabilities, including:

  • all forms of paralysis, hemiplegias, paraplegias etc
  • neurological cancers
  • neurological infections (including encephalitis, polio)
  • congenital disorders likely to affect nervous system
  • neuro-degenerative conditions
  • ataxias
  • motor neurone disease
  • demyelinating diseases including MS
  • cerebral palsy
  • supranuclear palsy
  • neuropathies
  • myaesthenia disorders
  • myotonic disorders
  • musculodystrophies
  • vascular disorders including intracranial haemorrhages, aneurysms, strokes, thrombosis, arteriris and dissections
  • spina bifida, hydrocephalus
  • neuro developmental disorders
  • congenital disorders
  • chromosomal abnormalities (although Downs syndrome a separate JCVI group for this vaccination group)

Epilepsy on its own is not a higher risk of coronavirus compared to non-epileptic people. Most people with well controlled epilepsy without any other neurological condition are not currently included in this this category as their immune and lung function should be normal like anyone else without epilepsy.

If anyone with a neuro-disability condition that impairs lung function contracts coronavirus it could cause severe complications.

Given the very high risk of exposure to infection and outbreaks in institutional settings, children with severe neuro-disabilities tend to get recurrent respiratory tract infections, particularly those who spend time in specialised residential care settings for children with complex needs.

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 neuroligical disease

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 (e.g. 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 e.g. methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
  • those with auto-immune diseases who may require long term immunosuppressive treatments

JCVI also recommends that children and young people aged 12 to 17 who live with an immunosuppressed person should be offered two doses of the vaccine. This is to indirectly protect their immunosuppressed household contacts, who are at higher risk of serious disease from coronavirus and may not generate a full immune response to vaccination.

Adults and young people with underlying health conditions

The Joint Committee on Vaccination and Immunisation (JCVI) recommended that the vaccine was offered first to those at highest risk of getting coronavirus and of suffering serious complications if they get coronavirus. Health conditions that put people aged 16 years and over at higher risk include:

Chronic respiratory disease

Severe lung conditions, including:

  • asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission (patients who are well controlled on asthma inhalers are not eligible in priority group 6 for coronavirus vaccination)
  • 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

Conditions such as:

  • stroke
  • transient ischaemic attack (TIA)
  • conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers)
  • cerebral palsy
  • severe or profound learning/intellectual disabilities
  • 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

Any diabetes, including diet-controlled diabetes and gestational diabetes.

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 (e.g. 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 with systemic lupus erythematosus and rheumatoid arthritis,
  • anyone with psoriasis who may require long term immunosuppressive treatments
  • anyone with Addison’s disease
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.

Adults and children with a weakened immune system

The Joint Committee on Vaccination and Immunisation (JCVI) recommended that people aged 12 years and over with a severely weakened immune system should be offered a third 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

This third dose may help to improve your immune response to the vaccine and give you better protection against coronavirus.

The third dose should be given at least 8 weeks after your second dose, but the timing will depend on any treatment you may be having. Your health specialist can advise on the best time to have your third dose.

At this time you will need this one extra dose to help improve your protection. Advice on whether you will need a further booster dose after this third dose will be confirmed later.

NHS Scotland will contact you to arrange your appointment for your third dose. If you’ve had a very severe reaction to a previous dose of the coronavirus vaccine, you should discuss this with your health specialist.

If you have symptoms of coronavirus or been told to self-isolate, you should rearrange your appointment. If you’ve recently tested positive for coronavirus, rearrange your appointment for at least 4 weeks after the date you tested positive.

If you have not had either your first or second dose, you should arrange to have them. You’ll still need the third dose but the timing of it will depend on any treatment you may be having. Your health specialist can advise on the best timing.

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
  • your 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.

Cancer treatment and the vaccine

It is recommended that all patients with cancer, including all those receiving systemic anti-cancer therapy (which includes cytotoxics, immunotherapy and targeted therapies), radiotherapy or steroids, should consider getting the coronavirus vaccine.

The Joint Committee for Vaccination and Immunisation (JCVI) consider the Pfizer BioNTech, AstraZeneca and Moderna coronavirus vaccines to be safe for patients with suppressed immune systems.

Immunosuppression may however reduce the effectiveness of vaccines.

Patients should not assume they are immune after receiving the vaccine, and strictly adhere to measures to reduce exposure to the virus.

This same advice is given to everyone receiving the vaccine.

If you’re about to receive planned immunosuppressive therapy, your doctor may advise you to get the vaccine before starting therapy (ideally at least two weeks before), when your immune system is better able to respond.

Where possible, it's preferable for your vaccine doses to be given before starting treatment. To provide maximum benefit, it's recommended that your second dose is given either 3 or 4 weeks after the first dose. But this will depend on the vaccine given. If you're eligible for a third dose, your specialist doctor will advise on the timing.