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People with severe immune deficiency should take a booster dose (4th dose)

The Norwegian Institute of Public Health considers that more people with severely impaired immune systems should take a booster dose of coronavirus vaccine to ensure continued good protection. So far, only about 6,000 people in need of a booster dose have had one.

The Norwegian Institute of Public Health considers that more people with severely impaired immune systems should take a booster dose of coronavirus vaccine to ensure continued good protection. So far, only about 6,000 people in need of a booster dose have had one.


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People with severely impaired immune systems, either due to illness or the use of immunosuppressive therapy, have a poorer response to vaccines compared to healthy people. This also applies to coronavirus vaccination. In addition, they also have a higher risk of a severe disease course if they are infected with coronavirus. In autumn 2021, some patients were therefore recommended to have an extra dose of coronavirus vaccine as part of their primary vaccination series, i.e. three doses instead of two. For this group, the booster dose would be dose number 4.

More than 4 out of 5 patients with severe immune deficiency have received the 3rd dose of coronavirus vaccine, but so far only about 6000 of these people have received a booster dose (4th dose).

"Anyone with a severely impaired immune system is advised to take a booster dose. This means that they will have a booster dose in addition to the 3rd dose in the primary vaccination series they were recommended this autumn. These people are extra vulnerable to infection and also need a booster dose to improve protection," says Geir Bukholm, Assistant Director-General at the Norwegian Institute of Public Health.

Bukholm is concerned that even though there are more than 75,000 users of immunosuppressive medication in Norway, only about 6,000 of the people with severely impaired immune systems who need a booster dose have so far received it. He encourages people with severely impaired immune systems to contact their municipality's vaccination centre to arrange for a booster dose.

When can those who need it get a booster dose?

For people with severely impaired immune systems, the booster dose can be given as early as three months after the last dose in the primary vaccination series, which would be three months after the third dose.

NIPH has informed the municipalities and the specialist health service about the importance of providing this service and that arrangements are being made for people with severely impaired immune systems to have quick access to a booster dose.

"It is not necessary to arrange a new assessment by a GP or specialist, or a new vaccine letter from the specialist health service in order to arrange a booster dose for this group. Patients can use the same documentation as last time, and the municipalities must be aware that this means that they will be offered a 4th dose," says Bukholm.

Which groups are offered four doses and what documentation is required?

The offer of a 4th dose applies to everyone who has previously been recommended three doses in the primary vaccination series. This will thus apply to everyone in group 1 below and some in group 2.

Group 1

  • Organ transplantation
  • Bone marrow transplantation in the last 2 years
  • Born with serious or moderate immune deficiency
  • Serious kidney failure (stage 5) or in active dialysis
  • Advanced or untreated HIV infection

Everyone who has a diagnosis according to the list for group 1 must show documentation of this, either in the form of a vaccine letter from the specialist health service, a copy of the medical record note or other equivalent written documentation.

Group 2

  • Patients undergoing treatment causing considerable immunosuppressive therapy for other reasons.
    • Patients who use immunosuppressive drugs that are on the list from the specialist medical environments can contact the municipality directly. The patient will have to provide supporting documentation, either through a vaccination letter from specialist healthcare service, medical records, a prescription, or medication packaging bearing the patient’s name.
  • Cancer patients who have active or have recently undergone, immunosuppressive therapy.
    • These patients must show a vaccine letter from the specialist healthcare service because they will need individual assessment to receive the best effect possible from the vaccine and avoid unwanted side effects.
  • Patients who, according to their specialist, have a severely impaired immune system and are not included in the above lists.
    • They will need a vaccine letter from the specialist healthcare service.