The following people are at higher risk of becoming seriously ill from COVID-19:

• People aged 60 and over;
• People aged 50–59 years who are invited to get the seasonal flu vaccine every year;
• Children and adults in the medical high-risk groups;
• Care workers who have direct contact with vulnerable patients.

RIVM will only send an invitation for the COVID-19 vaccination by post to people aged 60 years and older. People under 60 who are in a risk group will not receive a personal invitation from RIVM. This is because RIVM does not have any access to their medical records. These people can make their own appointment for a COVID-19 vaccination.

People living in residential care facilities will receive the vaccination through their care facility or from a GGD mobile vaccination team. 

Who receives an invitation for the COVID-19 vaccination

RIVM will only send an invitation for the COVID-19 vaccination by post to people aged 60 years and older. People under 60 who are in a risk group will not receive a personal invitation from RIVM. This is because RIVM does not have any access to their medical records. These people can make their own appointment for a COVID-19 vaccination.

People living in residential care facilities will receive the vaccination through their care facility or from a GGD mobile vaccination team.

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

People aged 50 years and older who are invited by their GP to get the seasonal flu vaccine every year are at higher risk for severe illness and death resulting from COVID-19. These people are in the medical risk group.

Another category has also been defined for people with specific health conditions: the medical high-risk group. People in this group have a health condition that significantly increases the risk of hospital admission and death.

Are you 50 years or older, and do you receive an invitation to get the flu vaccine every year? Or do you have a chronic illness and are you in the medical high-risk group? Then it is important to your health to get a COVID-19 vaccination in autumn.

One vaccination in autumn is usually enough. It is possible that your treating physician will refer you for an extra COVID-19 vaccination if necessary.

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 (human immunodeficiency virus)), 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.

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). 

Children often do not need any additional recommendations

For most children with a chronic illness or health condition, there are no additional COVID-19 vaccination recommendations. If a specific condition does require additional recommendations, the paediatrician will discuss that with the parents. Read more about COVID-19 vaccination for children.

Risk groups in which the vaccine may not be sufficiently effective

In principle, one COVID-19 vaccination is enough to boost existing immunity. However, people with severely impaired immunity sometimes do not have enough protection against COVID-19 after one vaccination. If that happens, they may not be well protected. It is not yet possible to accurately predict whether vaccinations are sufficiently effective for each individual patient. 

Your medical specialist will let you know if it is likely that one vaccination may not provide insufficient protection. If that is the case, your medical specialist will provide a referral letter so you can go to the Municipal Public Health Services (GGDs) for an additional COVID-19 vaccination or standard vaccine dose / basic series.

In the following groups of severely immunocompromised patients, the standard primary series of 2 vaccine doses may not provide sufficient protection. Since autumn 2021, these patients have been referred by their medical specialists for a third vaccine dose. If you are in one of the following patient groups, your medical specialist may consider referral for an additional vaccination.

• 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.