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COVID-19 Advice on Booster Vaccination for People with Liver Disease

Updated on: 12 Nov 2021   First published on 28 Sep 2021

Jointly agreed statements

A joint statement from the British Society of Gastroenterology, British Association for the Study of the Liver, and British Liver Trust on COVID-19 vaccination in people with liver disease:

  • People with chronic liver disease are considered to be at high risk from COVID-19.
  • The vaccine trials have not raised any safety concerns specific to people with chronic liver disease.
  • Although vaccines may be less effective in people with chronic liver disease and those post-liver transplant, they still provide significant protection.
  • We strongly support SARS-CoV2 vaccination for people with chronic liver disease.
  • We recommend that people with chronic liver disease, autoimmune hepatitis, and those post-liver transplant should consider vaccination for Sars-CoV2 with any of the available vaccines.

Based on recent JCVI advice on third dose primary vaccination and UK government announcement of the booster SARS-CoV2 vaccine program.

We recommend all people with chronic liver disease, especially those receiving immunosuppressive treatment, agree to either the third dose or booster dose of SARS-CoV2 vaccine when it is offered to them.

Third Primary Dose

  • We recommend a third primary dose of SARS-CoV2 vaccine for all eligible people with liver disease. These people are those who had received a solid organ transplant and were on immunosuppression prior to the completion of their first two doses, and some people on high dose immunosuppression for autoimmune liver disease before completion of their first two doses. This third dose of vaccine is due 8 weeks after the second dose, and so for many patients is due with immediate effect (at time of issuing; Sept 2021).
  • The flu vaccine is also strongly recommended at the same time if possible, or as soon as possible if not.

Booster Dose

  • We recommend a booster dose of vaccine for all people with chronic liver disease (and those who do not fall into the group above). This will be advised at 6 months after the second dose of the initial vaccine course. This includes, for example, patients with immune liver disease on lower dose immunosuppression and patients with chronic liver disease who have decompensated cirrhosis, a diagnosis of hepatocellular carcinoma or of a variceal bleed.
  • We further recommend this booster vaccine is taken with the flu vaccine.

People are currently confused about the difference between the third vaccine and booster vaccine and which ones they are eligible to receive.  People can find out more about the booster and third vaccine here: Update for people with liver disease on the Covid-19 vaccine – British Liver Trust


Existing BSG advice can be found at:

A joint statement on vaccination for Sars-CoV2 in patients with liver disease – The British Society of Gastroenterology (bsg.org.uk)

The new JCVI advice on who needs a third primary vaccine dose is in the link below, it excludes substantial groups of patients with liver disease including many with AIH:2


However, the UK Government booster program announcement does bring those missing groups into the recommendations for a booster vaccination. Although it does not overtly define younger people at risk, the earlier interim JCVI advice would certainly include those with liver disease who are on immunosuppressives or who are immunosuppressed because of advanced liver disease:

JCVI interim advice: potential COVID-19 booster vaccine programme winter 2021 to 2022 – GOV.UK (www.gov.uk)

Based on this and the possible need to reduce confusion among our members and patients with these two documents about 3rd primary vaccinations and booster vaccinations, it has been suggested we update our summary advice on the BSG website with the piece above.

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