1. Chronic respiratory disease: Including those with poorly controlled asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, cystic fibrosis, ciliary dyskinesias, bronchopulmonary dysplasia, previous tuberculosis 


2. Chronic heart conditions: Haemodynamically significant congenital and acquired heart disease, or less severe heart disease with other comorbidity. This includes: 

  • Single ventricle patients or those palliated with a Fontan (Total Cavopulmonary Connection) circulation 
  • Those with chronic cyanosis (oxygen saturations <85% persistently) 
  • Patients with cardiomyopathy requiring medication 
  • Patients with congenital heart disease on medication to improve heart function 
  • Patients with pulmonary hypertension requiring medication 


3. Chronic conditions of the kidney, liver or digestive system: 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 as well as renal and liver failure 


4. Chronic neurological disease: This includes: 

  • Neuro-disability and/or neuromuscular disease that may occur as a result of conditions such as 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 multiple learning disabilities (PMLD), Down’s syndrome, those on the learning disability register 
  • Neoplasm of the brain 


5. Endocrine disorders: Including diabetes mellitus, Addison’s and hypopituitary syndrome 


6. Serious genetic abnormalities that affect a number of systems: Including mitochondrial disease and chromosomal abnormalities


7. Immunosuppression: Due to disease or treatment, including:

  •  Those undergoing chemotherapy or radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients 
  • Genetic disorders affecting the immune system (e.g., deficiencies of IRAK-4 or NEML, complement disorder, SCID) 
  • Those with haematological malignancy, including leukaemia and lymphoma 
  • Those receiving immunosuppressive or immunomodulating biological therapy including transplant patients 
  • Those treated with or likely to be treated with high or moderate dose corticosteroids 
  • Those receiving any dose of non-biological oral immune modulating drugs e.g., methotrexate, azathioprine, 6- mercaptopurine or mycophenolate 
  • Those with auto-immune diseases who may require long term immunosuppressive treatments. 
  • Those living with HIV infection. 
  • Children who are about to receive planned immunosuppressive therapy should be considered for vaccination prior to commencing therapy 


 8. Asplenia or dysfunction on the spleen: Including hereditary spherocytosis, homozygous sickle cell the spleen including hereditary spherocytosis, homozygous sickle cell the spleen disease and thalassemia major


Please note: The vaccination of 5 to 11-year-old children will continue with the COMIRNATY® paediatric vaccines until 31 December 2023.