Clinical Risk Groups - Examples (decision based on clinical judgement)

Chronic respiratory disease

  • Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
  • Asthma - with disease which requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.
  • Children who have previously been admitted to hospital for lower respiratory tract disease.

Chronic heart disease

  • Congenital heart disease.
  • Hypertension with cardiac complications.
  • Chronic heart failure.
  • Individuals requiring regular medication and/or follow-up for ischaemic heart disease.

Kidney disease

  • Chronic kidney disease.
  • Nephrotic syndrome.
  • Renal transplantation.

Chronic liver disease

  • Cirrhosis.
  • Biliary atresia.
  • Chronic hepatitis.

Chronic neurological disease

  • Stroke.
  • Transient ischaemic attack (TIA).


  • Type 1 diabetes.
  • Type 2 diabetes requiring insulin or oral hypoglycaemic drugs.
  • Diet-controlled diabetes.


  • Immunosupression due to disease or treatment.
  • Patients undergoing chemotherapy leading to immunosuppression.
  • Asplenia or splenic dysfunction.
  • HIV infection.
  • Individuals treated with, or likely to be treated with, systemic steroids for more than a month at a dose equivalent to prednisolone at 20 mg or more per day (any age) or, for children under 20 kg, a dose of 1 mg or more per kg per day.
    Some immunocompromised patients may have a suboptimal immunological response to the vaccine.


  • All pregnant women should receive the trivalent seasonal influenza vaccine.


Do I Need To Be Protected Against Pneumococcal Infection?

Everybody aged 65 and over should now be immunised to help protect them against pneumococcal infection which can cause diseases such as pneumonia, septicaemia (blood poisoning) and meningitis. Please phone the surgery to make an appointment if the above applies to you.