People with medical conditions that increase their risk of severe illness from COVID-19 are recommended to receive further doses of COVID-19 vaccine
For people with relevant medical risk conditions, COVID-19 vaccine dose recommendations vary based on age and the presence of severe immunocompromise (which may reduce the immune response to vaccination). See Table. Example conditions associated with increased risk of severe outcomes from COVID-19, Table. COVID-19 vaccine primary and further dose recommendations for people with medical conditions that increase their risk of severe illness and Table. Examples of severely immunocompromising conditions for which additional primary doses of COVID-19 vaccine are recommended or can be considered.
Table. Example conditions associated with increased risk of severe outcomes from COVID-19
This table is not exhaustive, and providers should use their judgement to vaccinate people with conditions not listed.
| Condition | Example medical condition |
|---|---|
| Immunocompromising condition | Immunocompromise due to disease or treatment, asplenia or splenic dysfunction, HIV infection, malignancy, solid organ transplant, haematopoietic stem cell transplant, CAR T-cell therapy *Individuals with severe immunocompromise are recommended additional COVID-19 vaccines doses. See Table. Severely immunocompromising conditions for which additional doses of COVID-19 vaccine are recommended. |
| Cardiac disease | Congenital heart disease, congestive heart failure, coronary artery disease |
| Chronic respiratory condition | Severe asthma (requiring frequent medical consultations or the use of multiple medications), cystic fibrosis, bronchiectasis, suppurative lung disease, chronic obstructive pulmonary disease, chronic emphysema |
| Chronic neurological condition | Hereditary and degenerative CNS disease, seizure disorder, spinal cord injury, neuromuscular disorder, conditions which impair respiratory or airway function |
| Chronic metabolic condition | Type 1 or 2 diabetes, amino acid disorder, carbohydrate disorder, cholesterol biosynthesis disorder, fatty acid oxidation defect, lactic acidosis, mitochondrial disorder, organic acid disorder, urea cycle disorder, vitamin/cofactor disorder, porphyria |
| Chronic kidney disease | Chronic renal impairment – eGFR <30 mL/min (stage 4 or 5) |
| Haematological disorder | Sickle cell disease or other haemoglobinopathy |
| Chronic liver disease | Conditions with progressive deterioration of liver function for more than 6 months, including cirrhosis and other advanced liver diseases |
| Chromosomal abnormality | Trisomy 21 or other genetic condition that increases the risk of severe disease |
| Obesity | Body mass index ≥30 kg per m2 |
Table. COVID-19 vaccine primary and further dose recommendations for people with medical conditions that increase their risk of severe illness
“Recommended”: benefits of vaccination outweigh the risks for the defined population.
“Consider”: shared decision making between an individual and their healthcare provider.
| Age group | Level of immunocompromise | Primary course recommendations | Further (booster) dose recommendations |
|---|---|---|---|
| Age 6 months to <5 years | Medical risk condition without severe immunocompromise | Consider 2 doses, at least 8 weeks apart | Not recommended |
| Severe immunocompromise | Consider 2-3 doses, at least 8 weeks apart | Not recommended | |
| Age 5 years to <18 years | Medical risk condition without severe immunocompromise | Consider 1 primary dose | Not recommended |
| Severe immunocompromise | Consider 1-2 primary doses, at least 8 weeks apart | Consider 1 further dose every 12 months | |
| Age 18–64 years | Medical risk condition without severe immunocompromise | Recommended 1 primary dose | Consider 1 further dose every 12 months |
| Severe immunocompromise | Recommended 2 primary doses and consider a 3rd, at least 8 weeks apart | Recommended 1 further dose every 12 months but can be considered every 6 months | |
| Age 65–74 years | Medical risk condition without severe immunocompromise | Recommended 1 primary dose | Recommended 1 further dose every 12 months but can be considered every 6 months |
| Severe immunocompromise | Recommended 2 primary doses and consider a 3rd, at least 8 weeks apart | Recommended 1 further dose every 12 months, but can be considered every 6 months | |
| Age ≥75 years | Medical risk condition without severe immunocompromise | Recommended 1 primary dose | Recommended 1 further dose every 6 months |
| Severe immunocompromise | Recommended 2 primary doses and consider a 3rd, at least 8 weeks apart | Recommended 1 further dose every 6 months |
Table. Examples of severely immunocompromising conditions (Ref 10-26) for which additional doses of COVID-19 vaccine are recommended or can be considered
The example conditions and therapies listed are not exhaustive, and providers may include conditions or therapies similar to those below based on clinical judgement.
| Condition | Example conditions or treatments |
|---|---|
| Haematological malignancies (untreated, during or < 6months after therapy completion) | leukaemia, lymphoma, other lymphoproliferative disorder, plasma cell dyscrasia |
| Malignancy, solid organ transplantation, autoimmune, and inflammatory conditions currently treated with: |
|
| HIV infection |
Infants (<12 months): CD4+ <750 cells/μL Children (1–5 years): CD4+ <500 cells/μL Adults and children >5 years: CD4+ <200 cells/μL |
| Inborn errors of immunity (primary immunodeficiency) | Severe antibody (B-cell) deficiencies, severe combined immunodeficiency (SCID/complete DiGeorge) |
| Chronic kidney disease on dialysis |
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