Higher risk of severe illness from COVID-19

A significant majority of the Dutch population has built up immunity against COVID-19 by means of vaccination and/or been infection. Research shows that COVID-19 immunity mainly protects against severe illness, and less well against infection. Severe illness is defined as an illness that requires hospital admission, or leads to death.

There are two groups of people who have an increased risk ofdeveloping severe illness resulting from COVID-19:

  1. People who are in a risk group due to advanced age or underlying health conditions, especially if they are not vaccinated.
  2. People who have severely impaired immunity (immunocompromised patients) for whom the vaccination may not be sufficiently effective. These people received an extra vaccination in the basic series, followed by 1 or more repeat vaccinations. Fortunately, many people who have an immune disorder have been able to build up protection against COVID-19 as a result.

Additional recommendations to prevent infection are applicable to these people. 

Risk groups for severe COVID-19 due to advanced age or underlying health conditions

People from the groups listed below have a higher risk of severe illness from COVID-19, especially if they have not built up immunity due to vaccinations and/or previous infection. If you belong to one of these risk groups, it is especially important for you to get vaccinated against COVID-19 and to get the repeat vaccination. The risk groups are:

  • People over 70 years old   
    These people have a higher risk of severe illness from COVID-19. This has become apparent from international research. Vaccine-induced protection against COVID-19 is likely to wane more quickly among older people. Additional recommendations to prevent infection are applicable to these people.
  • Adults (over 18 years old) with underlying health conditions
    This includes one or more of the following health conditions:
    • People with chronic respiratory or pulmonary problems that are being treated by a lung specialist.
    • Chronic heart patients who therefore qualify for a flu shot.
    • People with diabetes that is not fully controlled and/or involves complications.
    • People with kidney disease who need dialysis or are waiting for a kidney transplant.
    • People who are less resistant to infection because they are taking medication for an autoimmune disease, and/or who have had an organ transplant or stem cell transplant. That includes: people who have a blood disease; people who are less resistant to infection because they are taking medication that weakens the immune system; cancer patients during chemotherapy and/or radiation, or within 3 months after receiving such treatment; people with severe immune disorders for which they require treatment from a doctor. Please note: People who do not have a spleen, or who have a non-functioning spleen, are not at additional risk from severe COVID-19, but do have an added risk of a possible (secondary) infection with pneumococcal disease. 
    • People with an HIV infection who are not (or not yet) being treated by a doctor, or with an HIV infection with a cluster of differentiation 4 (CD4) below 200/mm2.
    • People with serious liver disease.
    • People who are very seriously overweight (morbid obesity).
    • People with Down’s syndrome.

No additional recommendations required for children

For most children with a chronic illness or health condition, there are no additional recommendations due to COVID-19. If a specific condition does require additional recommendations, the paediatrician will discuss that with the parents. Vaccination is recommended for children aged 12 years and up. 
Children aged 12 years and older who have one or more of the risk factors listed above can also be vaccinated.

Risk groups in which the vaccine may not be sufficiently effective

People who have severely impaired immunity may not build up sufficient antibodies against COVID-19 after vaccination,. If that happens, they may not be well protected. It is not yet possible to predict whether vaccinations are sufficiently effective for each individual patient. Immune disorders increase the risk that vaccination will be less effective. For that reason, an extra vaccination in the basic series is recommended for these patient groups. That means that the basic series consists of 3 vaccinations, rather than 1 or 2. For most of these people, this additional vaccination makes it possible to achieve protection against severe COVID-19. This includes people in one or more of the following situations:

  • Patients who have had an organ transplant.
  • Patients who have had a bone marrow or stem cell transplant (autologous or allogeneic)*.
  • Patients who are currently receiving or have recently received treatment for a malignant haematological disorder, including CAR-T cell therapy (chimeric antigen receptor therapy)*.
  • All patients with a haematological malignancy which is known to be associated with severe immune deficiency (e.g. chronic lymphocytic leukaemia, multiple myeloma, Waldenström macroglobulinaemia)*.
  • All cancer patients (solid tumours) who received chemotherapy and/or immune checkpoint inhibitors less than 3 months before their COVID-19 vaccinations.
  • All kidney patients, who are being monitored by a specialist, with eGFR <30ml/min^1.73m2 on immunosuppressants.
  • All dialysis patients.
  • Individuals who have primary immune deficiency whose specialist has indicated the need for a third vaccination.
  • Patients who are being treated with the following immunosuppressants:
    • B-cell depleting medication: anti-CD20 therapy, such as rituximab, ocrelizumab;
    • strongly lymphopaenia-inducing medication: fingolimod (or similar S1P agonists);
    • cyclophosphamide (both pulse therapy and high-dose oral);
    • mycophenolate mofetil in combination with long-term use of one or more other immunosuppressants.
  • Patients with neurological disorders accompanied by respiratory compromise.

* If patients are currently being treated for this, or have received such treatment in the past two years.