The coronavirus (COVID-19) vaccine and health conditions

• adults undergoing chemotherapy or radiotherapy
• solid organ transplant recipients
• bone marrow or stem cell transplant recipients
• adults with HIV infection (at all stages)

Genetic disorders affecting the immune system

For example:

• deficiencies of IRAK-4 or NEMO
• complement disorder
• SCID

Immunosuppressive or immunomodulating biological therapy

Including, but not limited to:

• anti-TNF
• alemtuzumab
• ofatumumab
• rituximab
• adults receiving protein kinase inhibitors or PARP inhibitors
• adults treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil

Steroid medication

• adults treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day

This also includes conditions that may lead to splenic dysfunction, such as homozygous sickle cell disease, thalassemia major and coeliac syndrome.

Adults who require long term immunosuppressive treatment for conditions including, but not limited to:

• systemic lupus erythematosus
• rheumatoid arthritis
• inflammatory bowel disease
• scleroderma
• psoriasis

Adults with haematological malignancy, including leukaemia, lymphona and myeloma.

Conditions such as:

• congenital heart disease
• hypertension with cardiac complications
• chronic heart failure
• adults requiring regular medication and/or follow-up for ischaemic heart disease
• atrial fibrillation
• peripheral vascular disease
• history of venous thromboembolism

Conditions such as:

• chronic kidney disease at stage 3, 4 or 5
• chronic kidney failure
• nephrotic syndrome
• kidney transplantation

Conditions such as:

• cirrhosis
• biliary atresia
• chronic hepatitis

Conditions such as:

• stroke
• transient ischaemic attack (TIA)
• conditions in which respiratory function may be compromised due to neurological or neuromuscular disease (for example polio syndrome)
• cerebral palsy
• severe or profound and multiple learning disabilities (PMLD)
• Down’s Syndrome
• multiple sclerosis
• epilepsy
• dementia
• Parkinson’s disease
• motor neurone disease and related or similar conditions
• hereditary and degenerative disease of the nervous system or muscles
• severe neurological disability

Severe lung conditions, including:

• asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission
• chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema
• bronchiectasis
• cystic fibrosis
• interstitial lung fibrosis
• pneumoconiosis
• bronchopulmonary dysplasia (BPD)

Any diabetes, including diet controlled diabetes, current gestational diabetes and Addison’s disease. 

Adults with a Body Mass Index (BMI) greater than or equal to 40kg/m².

All stages (first, second and third trimesters).

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Conditions such as schizophrenia, bipolar disorder, or any mental illness that causes severe functional impairment.

• children undergoing chemotherapy or radiotherapy
• solid organ transplant recipients
• bone marrow or stem cell transplant recipients

Genetic disorders affecting the immune system, for example:

• deficiencies of IRAK-4 or NEMO
• complement disorder
• SCID

Children with haematological malignancy, including leukaemia and lymphoma.

Children receiving immunosuppressive or immunomodulating biological therapy.

Children treated with or likely to be treated with high or moderate dose corticosteroids.

Children receiving any dose of non-biological oral immune modulating drugs, for example:

• methotrexate
• azathioprine
• 6-mercaptopurine
• mycophenolate

Children with auto-immune diseases who may require long term immunosuppressive treatments.

Children who are about to receive planned immunosuppressive therapy should be considered for vaccination before starting commencing therapy.

Including hereditary spherocytosis, homozygous sickle cell disease and thalassemia major.

Haemodynamically significant congenital and acquired heart disease, or less severe heart disease with other co-morbidity. This includes:

• single ventricle patients or those palliated with a Fontan (Total Cavopulmonary Connection) circulation
• children with chronic cyanosis (oxygen saturations <85% persistently)
• children with cardiomyopathy requiring medication
• children with congenital heart disease on medication to improve heart function
• children with pulmonary hypertension (high blood pressure in the lungs) requiring medication

This includes children with:

• neuro-disability and/or neuromuscular disease including cerebral palsy, autism, epilepsy and muscular dystrophy
• hereditary and degenerative disease of the nervous system or muscles, other conditions associated with hypoventilation
• severe or profound and multiple learning disabilities (PMLD)
• Down’s syndrome
• neoplasm of the brain

Including those associated with congenital malformations of the organs, metabolic disorders and neoplasms, and conditions such as severe gastro-oesophageal reflux that may predispose to respiratory infection.

Including children with poorly controlled asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission.

Cystic fibrosis, ciliary dyskinesias and bronchopulmonary dysplasia.

Poorly controlled asthma is defined as any of the following:

• 2 or more courses of oral corticosteroids in the last 24 months
• on maintenance oral corticosteroids
• 1 or more hospital admission for asthma in the last 24 months

Including diabetes mellitus, Addison’s and hypopituitary syndrome.

All stages (first, second and third trimesters).

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Including mitochondrial disease and chromosomal abnormalities.