Some people have a higher risk of becoming seriously ill or dying from COVID-19, the disease caused by the coronavirus SARS-CoV-2.

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 have an increased risk of developing severe COVID-19 because they are not vaccinated in combination with 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 are receiving 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 over 70 years old   
    These people have a higher risk of severe illness from COVID-19. This has become apparent from international research.
  • 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.

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

Additional recommendations for people from high-risk groups

These additional recommendations – supplementing the basic rules – apply to people in the following risk groups:

Basic rules

  • Stay 1.5 metres apart from people outside your household (even when this is no longer mandatory).
  • Follow the general hygiene guidelines.
  • Ensure effective ventilation in your home.
  • Get tested if you have symptoms that could indicate COVID-19, and stay home until you get the results of the test.
  • Work from home as much as possible.

Additional recommendations

  • Avoid busy places: Avoid locations where it is difficult to stay 1.5 metres apart, such as supermarkets, building centres or busy shopping streets. Avoid large gatherings of people.
  • Work: Work from home as much as possible.
  • Transport: Avoid public transport as much as possible. If you do have to travel by public transport, wear a medical face mask that covers your mouth and nose.
  • Visitors: When you receive visitors in your home, stay 1.5 metres apart and follow the hygiene measures, ask your visitors to do a self-test if possible, and ask them the following health questions:
    • Do you or one of your household members have cold symptoms, such as a nasal cold, runny nose, sneezing, sore throat, mild cough, shortness of breath and/or elevated temperature?
    • Do you have any other symptoms, or are you feeling unwell?
    • Have you had any contact within the past 2 weeks with someone who has COVID-19?
    • Were you recently in a region or country with a ‘code red’ travel advisory, and did you return from that trip less than 14 days ago? Cancel the visit if the answer to any of these questions is yes.

Recommendations for household members of people in risk groups

If you are sharing a household with a person who is in a risk group, it is important that you follow the recommendations as closely as possible. When you are vaccinated against COVID-19, you reduce the risk of transmitting a coronavirus infection.