Updated 02/10/2023: this page is up-to-date but we will continue updating it regularly. For more information on coronavirus, please visit our coronavirus page.

Should people with Addison's and adrenal insufficiency have a COVID vaccine?

Everyone with a steroid-dependent adrenal condition should get the coronavirus vaccine and boosters to reduce their risk of getting coronavirus. This is because people who are steroid-dependent are at increased risk of needing hospital care if they get coronavirus, due to the risk of adrenal crisis.

A vaccine is an effective way to prevent infection and lower your risk of becoming seriously ill from coronavirus. This is why we strongly encourage those eligible to receive the vaccine and boosters.

Stay up to date with the latest information in your area: 

UK COVID booster programmes

The booster programme aims to top up protection for those who are most vulnerable to becoming seriously ill from coronavirus. People who take steroids for Addison’s disease and adrenal insufficiency are not at significant increased risk of contracting coronavirus (i.e. have a severely weakened immune system) but may become more severely unwell, and possibly have an adrenal crisis, if they develop coronavirus.

New advice has been issued regarding people who will be eligible for a COVID booster vaccine in autumn 2023, from 11 September 2023. Addison’s disease is specifically named in the Clinical Risk Groups of the JCVI 'Green Book'. Therefore people living with Addison's are eligible for a booster vaccine, and this is also noted on the NHS COVID page as pictured below.

This advice applies across England, Wales, Scotland and Northern Ireland. The relevant health services for all four nations will each separately determine how and when eligible people can access the autumn booster vaccine.   

    If you're a healthcare professional, please visit the Society for Endocrinology for more information.

    How do I get the COVID vaccine?

    Getting your vaccines depends on where you live. You can check with your GP if you will be invited, or visit the NHS website and book your vaccination yourself.

    Book, cancel or change a COVID-19 vaccination appointment

    Use the links below to see the latest on how to get the booster where you are. 

    If you’re confused about what vaccines you’re entitled to or have any questions always speak to your healthcare team.

    Should I increase my glucocorticoid dose before having the COVID vaccine or booster?

    Our Addison's Clinical Advisory Panel (CAP) and Society for Endocrinology have advised that there is no need to routinely increase glucocorticoid dose in patients with adrenal insufficiency at the time of vaccination if no significant symptoms.

    If you are particularly anxious or stressed before, this will "use up" your cortisol so you should up-dose in response to how you feel. It's different for everyone, as every body is different - so please listen to your body and do what is right for you.

    But if you were to feel unwell after vaccination, increase your glucocorticoid, take paracetamol to help reduce your symptoms making them easier to manage, factor in plenty of time to rest and drink plenty of fluids, all as you would normally for the sick day rules

    What does it feel like to receive the COVID vaccine when you have Addison's or adrenal insufficiency? 

    It's different for everyone, as shown in the experiences shared by ADSHG members here on our website. But if you were to feel unwell after vaccination, do increase your glucocorticoid, take paracetamol to help reduce your symptoms making them easier to manage and drink plenty of fluids as you would normally for sick day rules

    Side effects are a sign that your immune system is kicking into action to protect you from COVID-19 - this is not a COVID-19 illness and the vaccine can’t give you coronavirus. At the same time, don’t worry if you don’t experience any of these effects after your vaccine. Your immune system will still be learning to respond to the virus.

    Can I have the COVID-19 booster and flu jab at the same time?

    It is safe to have both vaccines together, but it is advised to get them in different arms. It is important to take up the offer of both free NHS vaccines, to reduce your risk of becoming ill with coronavirus and flu at the same time. However, if you're aware from experience that your body requires extra rest after vaccines, you may wish to leave a couple of days between vaccine appointments to suit your circumstances. Visit our 'Flu jab and other vaccines' page to learn more about the flu jab.

    On our online forum, members have been sharing their experiences of receiving both vaccines. So if you'd find it reassuring to hear others' experiences direct, please visit our online forum to join the conversation.

    Are people with Addison's and adrenal insufficiency immunocompromised? 

    People with Addison’s and adrenal insufficiency are not classified as having a severely weakened immune system or being immuno-suppressed, unlike for example, those with conditions such as blood cancer.

    People with Addison’s and adrenal insufficiency are on a low dose of replacement steroids – rather than on a high dose of steroids for immune suppressive purposes. Therefore the replacement steroids do not make the individual immuno-suppressed as the steroids are replacing what the body would naturally produce. 

    Whilst there is some research suggesting patients with Addison’s disease have a small increased risk of infections, this is not to the same degree as patients who are immunocompromised.  

    However, it is important to remember that those with Addison’s and adrenal insufficiency are unable to mount a response to infection without extra steroid medication. This is why people with Addison's and adrenal insufficiency are eligible for the free NHS flu vaccine and are classified as "Clinical risk group" for COVID vaccines. People with Addison’s and adrenal insufficiency benefit hugely from the protection provded by these vaccines. 

    Can vaccines cause bad reactions?

    We are all different and some people may have a reaction. They might have an allergy to the ingredients. Always ask your healthcare professionals to discuss the ingredients with you to make sure you are comfortable with the ingredients. If you are poorly you are advised to rearrange your vaccination until have recovered so that you avoid complications. You can find out more about reactions to vaccines and the Yellow Card scheme for reporting them on the NHS website.

    All of the approved vaccines are shown to be safe. There are different COVID-19 vaccines that are being rolled out across the NHS in the UK. The Moderna, Oxford AstraZenica and Pfizer/BioNTech vaccines are available in the UK. Both these vaccines use mRNA to help your immune system respond to COVID and neither brand of vaccine contains any live virus.

    If you have concerns about a COVID-19 vaccination, check the NHS and HSE vaccine pages to see if your queries are answered. For any individual circumstances, for example any conditions you have alongside adrenal insufficiency you may need to talk to your GP. 

    Are people with adrenal insufficiency at greater risk of bad reactions to vaccines? 

    People with adrenal insufficiency are not at an increased risk of having bad reactions to vaccines - but everybody is different, so this will depend on your individual circumstances. Lots of factors at the time of having the vaccine may make it appear a bad reaction is related to the vaccine such as food poisoning or a stomach bug. As with all bouts of illness or physical stress on your body, you should follow the sick day rules

    Fludrocortisone and the COVID vaccines: Some members have been in touch concerned having read online that you should not have vaccinations if taking fludrocortisone. Our medics have confirmed these rumours are incorrect. When taking fludrocortisone as replacement therapy for Addison's or any form of adrenal insufficiency you should still receive vaccinations when offered by your healthcare professionals.

    I've been told I'm not eligible for the vaccine booster - what can I do? 

    Eligibility for the vaccine varies with each booster campaign. Due to Addison's and adrenal insufficiency being a rare disease, medical professionals don't always have the information they need to make certain decisions. 

    Please refer your healthcare professional to the full list of clinical risk groups on in Chapter 14a of the JCVI COVID-19 Green Book pages 19-20 where Addison's disease is specifically mentioned. Addison's disease is also noted on the NHS COVID page as pictured below. This guidance provides your healthcare professional with more information about the advice about the eligibility of people with Addison's disease and adrenal insufficiency to receive COVID vaccines and boosters.

    If you are refused a vaccine and you believe you are eligible, here is a guide to the next steps you can follow: 
    1. Endocrinologist Support Letter: Ask your Endocrinologist/ medical team to write a special covering letter/ email referencing the JCVI COVID-19 Green Book and send a copy to your GP. Points to include are noting your specific medical circumstances. Be sure to include the endocrinology secretary department as so many endocrinologists have faced larger workloads of late and may take time to read your message.  
    2. Next steps with GP inc PALs: After sending this email/letter from your endocrinologist to the GP –  if the GP still goes on to refuse - ask the GP to answer why they are going against the expert guidance of your Endocrinologist. Where a booster campaign includes people in clinical risk groups, remind your GP that the JCVI COVID-19 Green Book Chapter 14a (which provides COVID vaccination information for public health professionals), specifically mentions Addison's disease in its list of clinical risk groups. Having a response in writing from your GP will help to provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about potentially unsafe management of your Addison’s or adrenal insufficiency. 
    3. Care Opinion Website: It can help to post some informal feedback on the Care Opinion website as well as going through the formal trust process via PALs. Every comment on the Care Opinion website that mentions adrenal insufficiency or adrenal crisis – positive or negative – helps to put the needs of adrenal patients on the map, and all patient feedback on their site is searchable as a reference with the aim to contribute to improving standards of care in the future.  

    Some people are being asked to fill in a form before having the COVID vaccine, why is this?

    Just as for other vaccines, some centres offering vaccines use a form to help with checks for allergies, pregnancy and other risk factors before the vaccination goes ahead. Some vaccination providers vaccinate without a form. You can view the form being used for the COVID vaccination programme in England here as an example.

    How can I make sure I receive an automatic invitation for future COVID vaccines from my GP?

    It's not always possible to ensure you'll be included in upcoming vaccine programmes automatically. This can be the case even if you've requested to be included in a priority flu or coronavirus vaccine group previously. Many GP surgeries vary in the computer systems and procedures they use for issuing invitations for different vaccination programmes. As there is no single national system you'll need to ask about how things work at your local surgery.

    We appreciate this is a frustrating situation and adds to the admin of living with a long-term health condition. You may like to read our tips on working with your GP practice. As a charity we continue to work with our partners in umbrella organisations to highlight and resolve these system issues with the NHS. While this situation exists, we work to equip you our members with information and resources which you can use to influence your healthcare professionals directly to act on your behalf to improve your chance of getting the care you need. You can become a member to hear direct about our resources and updates.

    Are you a member of our charity? Whether you're newly diagnosed or have lived with the condition for years - please join our community and support our cause! You'll receive the latest expert advice, guidance and ADSHG news, whilst being part of our inspiring and supportive community.

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