Higher risk of severe illness from COVID-19

A large part of the Dutch population has now been vaccinated against COVID-19. Vaccination offers protection against infection, and is especially effective in preventing severe illness. A severe illness means that a person has to be admitted to hospital, or that a person dies from the infection.

There are two groups of people who have an increased risk of developing a severe course of illness resulting from the disease COVID-19:

  1. People who are not vaccinated and are also in a risk group due to advanced age or underlying health conditions.
  2. People who have severely impaired immunity (immunocompromised patients) for whom the vaccination may not be sufficiently effective. These people received an invitation from their treating medical specialist to get a third vaccination. 

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 if they are not vaccinated. If you belong to one of these risk groups, it is especially important for you to get vaccinated against COVID-19. Vaccination generally offers effective protection against severe illness.

  • People over 70 years old   
    These people have a higher risk of severe illness from COVID-19. This has become apparent from international research. 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 people 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. 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.

If a child’s family member is in a risk group and is not protected by vaccination, then consult with the family member’s treating specialist and the school management and/or the Municipal Public Health Services (GGDs), about any precautions that may be needed for the child to attend school as usual.

Risk groups in which the vaccine may not be sufficiently effective

People in the risk groups listed below have severely impaired immunity. As a result, they may not have built up sufficient antibodies against COVID-19 after two vaccinations, and may not be well protected. If you belong to one of these risk groups, your specialist will invite you for a third vaccination. In that case, additional recommendations will also apply to prevent you from becoming infected with the coronavirus SARS-CoV-2 if at all possible. This includes 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*.
  • 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 (according to a defined list with indications provided by the Dutch Society for Internal Medicine ).
  • 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.