Risk groups that are more likely to become seriously ill due to COVID-19

Medical risk groups

People aged 50 years and older with:

• a lung disease, such as asthma requiring anti-inflammatory medication, COPD (Chronic Obstructive Pulmonary Disease: chronic bronchitis or emphysema), or severe and long-term lung damage after COVID-19;
• a heart condition, such as after a heart attack, cardiac arrhythmias, or heart failure;
• type 1 or type 2 diabetes;
• a kidney disease;
• reduced immunity due to an illness (for example HIV), due to medical treatment such as chemotherapy or a bone marrow transplant, or due to medication that lowers the immune system;
• neurological and neuromuscular diseases (NNMD), such as people with a muscle disease or other disorders of the nervous system like Parkinson’s disease or ALS (Amyotrophic Lateral Sclerosis), people who have suffered a stroke, people with epilepsy, or children with psychomotor disorders (general developmental delay);
• dementia;
• a cochlear implant;
• an intellectual disability.

More information about these medical risk groups (the seasonal flu vaccine group aged 50+) is available on the website of the Dutch College of General Practitioners (NHG).

Adults in medical high-risk groups (18 years and older):

• People living in residential long-term care institutions, such as:
  • nursing homes,
  • residential facilities for people with intellectual disabilities,
  • supported housing in the mental healthcare system offering care or guidance.
• People with malignant disorders affecting the blood cells, bone marrow or lymph nodes (haematological cancers, such as leukaemia or lymphoma):
  • who were diagnosed within the past 5 years, or
  • who are living with chronic disease in this category.
• People with sickle cell anaemia.
• People with severe renal failure:
  • who are dependent on dialysis, or
  • who are being prepared for dialysis.
• People who have received an organ, stem cell or bone marrow transplant, or are on the transplant waiting list.
• Patients with a severe congenital immune disorder (primary immune deficiency).
• People suffering from muscle weakness caused by severe neurological disorders (for example affecting the brain, spinal cord or peripheral nervous system) that leads to respiratory problems. This includes people who need artificial respiration at home.
• People with malignant tumours (cancer) who were treated within the past 6 months with:
  • chemotherapy,
  • and/or radiotherapy.
• People with Down’s syndrome.
• People using medicines that significantly suppress the immune system, such as:
  • anti-CD20 therapy (such as rituximab, ocrelizumab),
  • strongly lymphopaenia-inducing medication: (such as fingolimod, cyclophosphamide),
  • mycophenolate mofetil in combination with one or more other immunosuppressants.
    If you are unsure if your medication is in these categories, please consult your treating physician.
• People who are very seriously overweight (BMI of 40 or higher). Note: Body Mass Index or BMI is simply a ratio of a person’s height in relation to their weight. BMI is frequently used as an indication of whether a person is considered underweight or overweight.

Children in medical high-risk groups (aged 6 months to 17 years)

Some children can become very ill from COVID-19 due to an underlying health condition or immunosuppressant medication, despite any previous vaccinations and/or SARS-CoV-2 infections. One vaccination in autumn is usually enough. However, the treating paediatrician can refer your child for an extra COVID-19 vaccination if necessary. The criteria for which children are in a medical high-risk group have been drawn up by the Dutch Association of Paediatrics (NVK) and are available online (in Dutch).

Risk groups in which one COVID-19 vaccination per year is not sufficiently effective

For most people in the risk groups, one annual COVID-19 vaccination every autumn is enough to boost existing immunity. However, some people with severely impaired immunity do not build up enough protection against COVID-19 after one vaccination. Moreover, their protection may not last as long as it would in people without severely impaired immunity. That means that they still have a higher risk of severe illness due to COVID-19. In such cases, an additional COVID-19 vaccination may be necessary. It is not yet possible to accurately predict whether vaccinations are sufficiently effective for each patient. The treating physician can refer a patient to the Municipal Public Health Service (GGD) for an extra COVID-19 vaccination or a new series of COVID-19 vaccinations. A new series is only advised for patients who have lost all immunity after some immunosuppressant treatments.