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Risk groups and their relatives - advice and information
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The general infection control advice, such as staying home when you are ill and having good cough etiquette and hand hygiene, still applies to protect against infection from respiratory tract infections including COVID-19, see:
In addition, the risk of respiratory tract infections will be reduced by avoiding crowds and avoiding contact with people with respiratory tract diseases, especially when there is widespread transmission in society.
Most people who become infected with coronavirus (SARS-CoV-2) will experience mild respiratory tract symptoms that pass. Some groups are at particular risk of developing a more severe disease course (resulting in hospital admission, intensive care or even death), but even the majority of people in risk groups will experience mild symptoms.
The risk of a severe COVID-19 disease course rises with age and underlying medical conditions, with men being at greater risk than women.
The following advice applies to everyone in a risk group:
- Make sure you have the necessary medication available.
- Continue with regular medication, and only make changes in consultation with your own doctor.
- Attend planned health check-ups and examinations.
- Get vaccinated with a booster dose.
Vaccine against COVID-19
The purpose of vaccination against COVID-19 is to prevent disease or to make the course of the disease milder. Everyone who is recommended to take the COVID-19 vaccine are recommended to take it.
Vaccination and having had COVID-19 provide good protection against serious illness. Vaccinated people in risk groups can therefore generally live like everyone else by following the general infection control advice.
However, vaccination is no guarantee against reinfection with the COVID-19 virus or transmitting it to others.
Protection against infection may diminish over time. A COVID-19 vaccine booster dose is recommended for all persons 45 years or older, nursing home residents, and for people 18 years or older with underlying illnesses or conditions which increase the likelihood of severe COVID-19 disease. All employees in the health and care service are also recommended to have a booster dose. Otherwise healthy people aged 18-44 can receive a booster dose.
Elderly people who had their second dose more than 6 months ago are thought to have somewhat lower vaccine protection. When there is widespread transmission in the community, they should live more sheltered until 1 week after their booster dose to avoid infection.
Contact with others
People in risk groups must assess the risk of infection against the need of contact with others, and decide which measures are suitable to visit family and friends, based on one's own risk of a severe disease course from respiratory tract infections, how widespread local transmission is, how many social contact they have had recently, their vaccination status and whether they have newly arisen respiratory tract infections.
However, it is important to continue social contact with others, and not be completely isolated. Choosing a small group of people to interact with regularly will reduce the risk of transmission.
In times of widespread transmission in society, people in risk groups and those who are unvaccinated are recommended to use face masks where they cannot maintain a distance.
People with symptoms of a cold or respiratory tract infection are recommended to use face masks when caring for or visiting people in risk groups.
Risk groups for a severe COVID-19 disease course
Risk assessment applies at a group level, not to the individual. There will be considerable individual variations within each risk group. If necessary, speak to your doctor about your risk of a severe COVID-19 disease course.
Younger people are at a low risk of a severe COVID-19 disease course, but those with poorly managed diseases/conditions, or combinations of several underlying conditions, may be at greater risk.
Now, vaccination status is an important factor. The recommendation to keep a distance and wear a face mask does no longer apply to all people in risk groups.
The following people are recommended to consider shielding themselves in periods of widespread transmission in society, by for example limiting the number of close contacts:
- Unvaccinated people in risk groups (light-moderate/moderate-high risk), including unvaccinated pregnant women.
- People over 65 who are vaccinated with two doses, where more than 6 months have passed since the last dose, until 1 week after a booster dose.
- People vaccinated with two doses between 18-64 years with illnesses/conditions resulting in moderate risk* of severe COVID-19 disease course, where more than 6 months have passed since the last dose, until 1 week after a booster dose:
- chronic liver condition or considerably impaired liver function
- immunosuppressive therapy such as autoimmune diseases
- chronic liver condition including cystic fibrosis and severe asthma where high doses of inhalation steroids or steroid tablets have been used during the last year
- obesity with body mass index (BMI) at 35 kg/m2 or higher
- chronic cardiovascular disease (except high blood pressure) and stroke
- Down's Syndrome
- neurological conditions or muscle conditions resulting in reduced lung capacity or capacity to cough (for example ALS and cerebral palsy)
- chronic kidney illness or failure (see below for serious kidney failure)
- Patients (regardless of vaccine status) who have, or have undergone:
- organ transplant
- diagnosed with severe or moderate immune deficiency
- haematological cancer during the last five years
- other active cancer, ongoing or recently ended cancer treatment (especially immunosuppressive therapy, radiotherapy on lungs or chemotherapy
- serious kidney failure (stage 5) or on active dialysis
- patients who are considered to have significant immune deficiency by their doctor, and are not in any of the groups mentioned above
*NIPH is continuously monitoring new information and analysing Norwegian data, and these groups can be adjusted within a short time frame
Groups with slightly/ moderately increased risk:
- Age 65–69 years
- Age 50–64 years with one of the following chronic diseases:
- chronic liver disease
- immunosuppressive therapy with autoimmune diseases
- chronic lung disease, including severe asthma that has required the use of high dosage inhalation steroids or steroid tablets during the last year
- obesity with body mass index (BMI) of 35 kg/m2 or higher
- cardiovascular disease (except high blood pressure)
People under 50 years of age are at lower risk of developing severe COVID-19 disease. However, some people with poorly-regulated chronic conditions or a combination of several chronic diseases might be at increased risk.
Groups with moderate/ high risk
- Residents of nursing homes
- Over 70 years of age α
- Severe health conditions, regardless of age *:
- solid organ transplant
- haematologic cancer in the last five years
- other active cancer, ongoing or recently completed treatment for cancer (especially immunosuppressive therapy, radiotherapy targeted at the lungs or chemotherapy).
- neurological or muscular disease with impaired coughing strength or lung function (e.g. ALS and cerebral palsy)
- Down's Syndrome
- chronic kidney disease and renal failure
α There is an exponential (sliding) increase in risk from 70 years and over. Age is the most important independent risk factor.
* Other serious and/or chronic diseases that are not mentioned may also increase the risk of serious illness and death from COVID-19. This is assessed individually by a doctor.
* These diseases/conditions can result in a high risk of severe illness and even death, including amongst younger people.
Further information about risk groups
NIPH’s assessments may change as more knowledge becomes available. Here is an overview of the main risk factors. This assessment applies to people aged over 18 years.
The risk of developing severe COVID-19 illness rises significantly with age, and age appears to be the dominant risk factor regarding the development of severe illness and death. With advanced age, the incidence of chronic diseases also increases. It may be difficult to distinguish the risk caused by age from the risk caused by disease, but analyses that adjust for several risk factors show that age is an independent risk factor.
A person's risk should not be based solely on age, but also on an individual assessment of their general health.
Several studies show that people who have undergone organ transplantation have a significantly increased risk of a severe COVID-19 disease course. People on the waiting list for organ transplantation should preferably be vaccinated before transplantation. Organ transplantation shall not be postponed due to vaccination.
This group includes people with severe congenital or acquired immune deficiency conditions that can lead to significant immune deficiency and leads to high risk for severe COVID-19 disease course. The conditions include severe combined immunodeficiency, immunodeficiency associated with major defects (e.g., Wiskott-Aldrich syndrome), common variable immunodeficiency, immunodeficiency with predominant antibody deficiency (e.g., hypogammaglobulinemia) and some other types of severe immunodeficiency conditions. The group also includes HIV patients with low CD4 counts who should be considered for vaccination by their doctor.
People with sickle cell anemia also have an increased risk of a severe disease course.
People with active cancer, ongoing or recently discontinued treatment for cancer (especially immunosuppressive therapy, radiation therapy for the lungs or chemotherapy) have an increased risk of a severe COVID-19 disease course. Active cancer is defined as a cancer that has not been radically treated and assumed to be cured. Recently completed cancer treatment is defined as completed within the last 6 months.
When planning the start of cancer treatment, it should be considered whether patients can be vaccinated before starting. Vaccination should not delay the start of treatment. A large study from England indicates that people with blood cancer have a particularly high risk in the first five years after the diagnosis is made.
Neurological diseases or muscle diseases that cause impaired coughing or lung function
In this group we find people with cerebral palsy (CP), mental retardation, severe muscle diseases, spina bifida, as well as diseases that affect the brain in adults and the elderly (e.g., Parkinson's and ALS). In general for these diseases, people may have physical immobility (e.g., use a wheelchair) and / or reduced lung function and coughing power, risk of food or drink entering the respiratory tract, or they have a genetic condition that increases morbidity.
The risk of a severe disease course in people with CP depends on how severe their CP is, see text above. Milder degrees of CP will not pose any risk in themselves.
Several studies show that adults with Down's syndrome have a higher risk of a severe COVID-19 disease course. The risk increases with age. Down's syndrome can lead to an increased incidence of autoimmune diseases, diabetes, low metabolism, obesity, dementia and congenital heart disease.
Furthermore, people with Down's syndrome may have inappropriate immune responses in COVID-19, which further increases the risk of a severe course. All people with Down's syndrome who are 16 years and older are therefore given priority for vaccination.
Chronic kidney disease
Chronic kidney disease increases the risk of a severe COVID-19 disease course when you adjust for age and other risk factors. This is especially true for people with significantly impaired renal function. People with moderate / severe kidney failure are considered to have a significantly increased risk.
Chronic liver disease
Chronic liver disease also carries an increased risk, especially with significantly impaired liver function.
Immunosuppressive therapy in autoimmune diseases
Patients using immunosuppressive drugs may have an increased risk of severe disease course. It is probably the drugs themselves, and not the underlying disease, that increase the risk. Immunosuppressive drugs include TNF-alpha inhibitors, interleukin inhibitors, methotrexate, and more (see Felleskatalog). These drugs are used, among other things, for multiple sclerosis (MS), inflammatory joint diseases and inflammatory bowel diseases.
Diabetes has been reported as one of the most common underlying diseases in patients with a severe disease course. In studies that have been adjusted for age and other risk factors, patients with diabetes have a higher risk of severe COVID-19.
The duration of the diabetes disease and the incidence of late diabetic complications seem to increase the risk. Poor blood sugar control is a risk factor for a severe course, but diabetic patients with well-regulated blood sugar levels are also recommended to be vaccinated. All people with diabetes who are 18 years and older are therefore given priority for vaccination.
Chronic lung disease
People with chronic lung disease have increased risk of a severe COVID-19 disease course. This group includes people with severe asthma, who have used high-dose inhaled steroids or steroid tablets during the past year.
People with obesity have an increased risk of a severe disease course, and the risk increases with increasing body mass index (BMI).
Cardiovascular diseases include a range of diseases that may increase the risk of a severe COVID-19 disease course. There is evidence to suggest that the risk increases with the severity of the underlying disease. In studies that adjust for age and other risk conditions, high blood pressure does not appear to be an independent risk factor for hospitalisation or death from COVID-19.
Other chronic diseases
A number of studies suggest that dementia and stroke are independent risk factors for a severe COVID-19 disease course
Nursing home residents
Residents of nursing homes are considered to be at greater risk of a severe COVID-19 disease course, based on a combination of advanced age, frailty, multiple chronic diseases, impaired functions and low activity level.
Children and adolescents
The risk of serious COVID-19 disease course among children and adolescents is generally very low. This includes children and adolescents with serious and chronic illnesses or conditions, even though this group have a somewhat higher risk of hospital admissions. The total number of children with serious underlying illnesses who are admitted to hospital with COVID-19, is still very low and they have good prognosis.
Together with Norwegian Society of Pediatricians (Norsk Barnelegeforening) the NIPH recommend most children and adolescents with chronic illnesses and conditions to attend kindergarten and school as normal. It is very rare that siblings of children with rare underlying illnesses should be kept home from school and social arenas.
However, for some children with a serious illness, based on a general recommendation on protection against infectious illnesses, there will be a need to arrange adapted teaching and activity after assessment by the responsible paediatrician.
The vaccines are effective in order to protect against serious COVID-19 disease course, and even only one dose offers good protection.
Pregnant and breastfeeding women
Most pregnant women will get a mild disease course. Pregnant women with COVID-19 who develop symptoms still have a slightly higher risk of needing treatment in hospital, intensive care unit and with a respirator compared with non-pregnant women with COVID-19 of the same age.
The risk of severe progression increases if the pregnant woman has underlying diseases such as diabetes, cardiovascular disease and / or obesity. The risk for pregnant women increases with the length of pregnancy when they are infected. The NIPH therefore recommends that pregnant women should be vaccinated, read more here:
People with impaired immune systems
Patients with severely impaired immune systems should, even after vaccination with the third, and booster dose (4th), be aware that they may have lower protection than people with normal immune function and should therefore consider to live more sheltered when there is widespread transmission in society. In addition, it is important that close contacts in the same household are vaccinated.
Together with medical experts and the specialist health service, NIPH has prepared an overview of the diseases for, and medications used by, people who are recommended to have three doses, and a fourth booster dose:
Employees in risk groups who are not vaccinated or have not had COVID-19
The Norwegian Directorate of Health has prepared its own recommendations for employers in the health sector.
Should people in risk groups change ongoing treatment?
No. There is no reason to advise against starting or stopping ongoing immunosuppressant treatment. If people who use immunosuppressants become ill, they should contact their doctor for advice about medication, testing and examination.
What should you do if you become ill?
- Newly arisen respiratory tract symptoms
If you develop other acute symptoms that you would normally seek medical attention for, contact the healthcare service - your own doctor, or the out-of-hours medical service (116 117). With severe symptoms ring 113.
Advice for people in risk groups who are vaccinated or have had COVID-19
Most people in risk groups will be protected against infection with COVID-19 and a severe disease course after vaccination or infection, and will be able to live as other people and follow the general infection control advice. The full effect of the vaccine is achieved 1 week after primary vaccination. The protection decreases over time, so booster doses are being recommended to everyone over 45 years and those over 18 with underlying risk conditions. Others over 18 years may receive a booster dose if they wish. Those who have undergone infection are also recommended vaccination.
For vaccination of people with underlying conditions, see:
The advice about vaccination is updated regularly:
- Who can receive the coronavirus vaccine?
- Coronavirus vaccine– information for the general population
The Norwegian Institute of Public Health recommends that people in risk groups receive an influenza vaccine every year and a pneumococcal vaccine (against pneumonia) every ten years. These vaccines will not prevent infection with SARS-CoV-2.
The Norwegian Institute of Public Health receives an immense amount of enquiries about the coronavirus pandemic. Unfortunately, we do not have the capacity to reply individually to members of the public.
Our advisory service is primarily intended for Norwegian government agencies, the healthcare service and municipalities.
You will find general advice about coronavirus on this website and on helsenorge.no.
If you do not find the answer your to your question, you can ring the information helpline 815 55 015 that is open on weekdays from 08:00-15:30.
The Norwegian Directorate of Immigration has answers to many frequently asked questions about travelling to Norway, and a helpline 23351600 that is open on weekdays from 10:00-14:00.
The Ministry of Foreign Affairs also has answers to many frequently asked questions.
If you need acute medical attention, contact your doctor. If you cannot reach your doctor, contact the emergency out-of-hours clinic on 116117. If life is in danger, call 113.
For questions about the Smittestopp app, ring Helsenorge on 23 32 70 00.
For healthcare personnel
You will find information on these pages and at helsedirektoratet.no
If you are a healthcare professional who is responsible for infection control at their institution can ring Smittevernvakta.
For questions about whether or not you should attend work if you are a healthcare worker, contact the person who is responsible for infection control at your institution.
Contact your doctor or emergency out-of-hours clinic for questions about your personal health.