As we updated earlier this week, we are now offering COVID-19 vaccination to people aged 16-64, with an underlying health condition which puts them at increased risk. There are some subtle differences between this group and the similar cohort for ‘flu vaccination. As a result, some of you may receive an invitation for COVID-19 vaccination when you aren’t usually invited for a ‘flu jab. We would encourage everyone who is offered an appointment to attend it. Appointments are being sent in a phased manner over the next two weeks and will arrive in a distinctive blue envelope. Please be patient as we get appointments issued and please do not contact your GP if you are waiting for an appointment – they are not able to assist with COVID-19 vaccination appointments. Here is some additional information on the clinical risk groups, aged 16 years of age and over, who should receive COVID-19 immunisation:

Chronic respiratory disease
Individuals with a severe lung condition, including those with asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis, and bronchopulmonary dysplasia (BPD).

Chronic heart disease and vascular disease
Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.

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

Chronic liver disease
Cirrhosis, biliary atresia, chronic hepatitis.

Chronic neurological disease
Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). This includes individuals with cerebral palsy, severe or profound learning disabilities, Down’s Syndrome, multiple sclerosis, epilepsy, dementia, Parkinson’s disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes mellitus
Any diabetes, including diet-controlled.

Immunosuppression
Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals 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 for adults.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma and those with systemic lupus erythematosus and rheumatoid arthritis, and psoriasis who may require long term immunosuppressive treatments.

Most of the more severely immunosuppressed individuals in this group should already be flagged as Clinically Extremely Vulnerable (CEV) Individuals who are not yet on the CEV list but who are about to receive highly immunosuppressive interventions or those whose level of immunosuppression is about to increase may be therefore be offered vaccine alongside the CEV group, if therapy can be safely delayed or there is sufficient time (ideally two weeks) before therapy commences.
Some immunosuppressed patients may have a suboptimal immunological response to the vaccine (see Immunosuppression and HIV).

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

Morbid obesity
Adults with a Body Mass Index ≥40 kg/m2.

Severe mental illness
Individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment.

It is also the Scottish Government’s intention to expand group 6 to include people with mild or moderate learning/intellectual disabilities.

Adult carers
Those who are eligible for a carer’s allowance, or those who are the sole or primary carer of an elderly or disabled person who is at increased risk of COVID-19 mortality and therefore clinically vulnerable.

Younger adults in long-stay nursing and residential care settings
Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups above (for example learning disabilities). Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended.

Younger residents in care homes for the elderly will be at high risk of exposure, and although they may be at lower risk of mortality than older residents should not be excluded from vaccination programmes.