Vaccinations can be less effective for some people with moderately or severely impaired immunity. That is why these people need more vaccinations than others. This page contains more information on vaccinating people who have moderately or severely impaired immunity, also known as immunocompromised patients.

Questions about repeat vaccination of people with impaired immunity

A repeat vaccination against COVID-19 is an extra dose of vaccine administered at least 3 months after the last COVID-19 vaccination.  Read more on the page about the repeat vaccination.

As a precaution, a repeat vaccination against COVID-19 will be offered again starting in autumn 2022. The repeat vaccination is mainly important for people aged 60 years and older, people in medical risk groups and care workers who have contact with patients. They were the first groups to be invited to get the repeat vaccination. This includes people with impaired immunity. For people with severely impaired immunity, this may be their sixth COVID-19 vaccination.

If you are aged 60 years and older, you will receive your invitation from RIVM based on your age. If you are under 60 years old, you will receive your invitation for the repeat vaccination from your GP in autumn 2022. 

Patients with cancer who have received chemotherapy or radiotherapy within the past 6 months for a solid tumour are in a medical risk group for which vaccination is recommended. It is not possible for the GP to effectively select all patients who have cancer. For that reason, there is a chance that your GP may not send you an invitation. You can ask your medical specialist to send you a personal invitation so you can get a repeat vaccination against COVID-19 from the Municipal Public Health Services (GGDs) in October. This is only possible if you received chemotherapy or radiotherapy due to cancer in the past 6 months. 

Yes, everyone aged 12 and over can get a repeat vaccination against COVID-19 in autumn 2022 with the updated vaccines. The repeat vaccination is specifically also recommended for household members and informal carers of people in medical risk groups, which includes people with severely impaired immunity. That reduces the risk of having someone who is ill present in their household.

Questions about vaccination of people with impaired immunity

For people with severely impaired immunity, even if they are under 60, COVID-19 often has serious consequences. The risk is not the same for the different groups of patients, since it depends heavily on the extent to which an individual’s immune system has been suppressed.

Yes, but in some specific groups of people with moderately or severely impaired immunity, vaccine-induced protection is sometimes less effective or does not last as long. Recent research on COVID-19 shows that some patient groups are only sufficiently protected against the serious consequences of COVID-19 after several vaccinations.

No, that is not yet relevant, since we do not know what levels of antibodies or immune cells would be needed to achieve protection. 

The immune system can handle vaccination very well. There is no reason not to get vaccinated. 

Contact the medical specialist who is coordinating your treatment as soon as the test result is known. The doctor can assess whether special recommendations are needed and whether there are any additional treatment options. Three months or more after the SARS-CoV-2 infection, you can get a repeat vaccination against COVID-19

Questions about the third vaccination in the basic series for people with severely or moderately impaired immunity

This involves more than 200,000 patients with severely impaired immunity, aged 12 years and older, who are being treated by a medical specialist and are in one or more of the following groups:

  • 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 defined list of 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.

A third vaccination can ensure that people who are insufficiently protected after two vaccinations still achieve better protection (‘building up an immune response’). For these people, the third vaccination is considered an additional part of the primary course of COVID-19 vaccinations. For most people, the basic series consists of 1 or 2 vaccinations.

A third vaccination gives an extra ‘boost’ to the immune system. It is intended is for people who built up sufficient protection after one or two vaccinations, but whose protection waned over time after that. 

The third vaccination is not a repeat vaccination, and will not be registered as such. 

People with moderately or severely impaired immunity are vaccinated with an mRNA vaccine (Pfizer or Moderna). You cannot choose which one.

Questions about revaccination

Some treatments may erase all or part of the protection that your body built up. This is the case after (allogeneic) stem cell transplants. If that happens, you will need to get all of your COVID-19 vaccinations again. This is called revaccination. If this applies to you, the medical specialist will let you know.

There are also special treatments that destroy all the healthy B cells (these are the cells that make antibodies). That means that your body will not build up enough antibodies if you are vaccinated during treatment. If it is possible to completely stop that form of treatment, you are advised to get revaccinated a few months later.
 

Everyone over 12 years old who needs to be revaccinated will get the same primary course of COVID-19 vaccinations: a basic series of 3 vaccinations. There is an interval of 4 weeks between each vaccination. The basic series is followed by a repeat vaccination, which is administered at least 3 months after the last vaccination. Children aged 5-12 years who need to be revaccinated can receive 2 vaccinations with an interval of 4 weeks.

You will receive an invitation from your medical specialist and you will be vaccinated by the Municipal Public Health Services (GGDs). The specialist may sometimes decide to have you or your child vaccinated in the hospital.