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

1. People who are in a risk group due to advanced age (60 years or older) 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. 

   However, sometimes the immune disorder is so severe that COVID-19 vaccinations offer less effective protection against severe illness.

For children who are in a risk group due to an underlying health condition, more information is available on the RIVM page about COVID-19 vaccination for children.

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. A distinction is made between people who receive the seasonal flu vaccine and people in a medical high-risk group. If you belong to one of these risk groups, it is especially important for you to get vaccinated against COVID-19 in the autumn 2023 round. In principle, one vaccination is sufficient (even if you are in the seasonal flu vaccine group). However, if you are in a medical high-risk group, your medical specialist may also decide to refer to you for an additional dose of the vaccine.

Medical risk groups and seasonal flu vaccine group (18 years and older)

• People living in residential nursing homes
• Patients with chronic heart dysfunction
• Patients with conditions and disorders of the airways and lungs
• Patients with chronic renal insufficiency
• Patients with certain neurological and neuromuscular disorders (NNMD)
• Patients with diabetes
• Patients with dementia
• Patients with morbid obesity (BMI ≥40)
• People with cochlear implants
• Patients with impaired resistance to infections (due to an underlying health condition and/or medication use)
• People with an HIV infection
• Patients who have recently undergone a bone marrow transplant
• People with intellectual disabilities
• Pregnant people

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

• Everyone living in residential long-term care institutions
• Patients with haematological malignancy which was diagnosed in the last 5 years or is chronic
• Sickle cell disease
• Patients with severe renal failure (dialysis or preparation for dialysis).
• Patients who have received an organ, stem cell or bone marrow transplant (or are on the waiting list)
• Patients with a severe congenital immune disorder (primary immune deficiency) in a risk group as defined by the NVVI-NIV
• Patients with neurological disorders accompanied by respiratory compromise
• Patients with solid tumours treated with chemotherapy and/or radiotherapy within the last 6 months
• People with Down’s syndrome
• 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

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.