Additional clinical considerations for COVID-19 vaccination
Read the latest clinical advice for COVID-19 vaccination, including advice from the Australian Technical Advisory Group on Immunisation.
ATAGI clinical guidance
The Australian Technical Advisory Group on Immunisation (ATAGI) maintains clinical guidance on COVID-19 vaccine in Australia for immunisation providers and program staff.
The Australian Government strongly recommends that people who are immunocompromised receive the COVID-19 vaccination. Some severely immunocompromised people may receive 3 doses as part of their primary course.
If you have received three primary doses, it is also recommended to have a booster dose in line with the timing for the general population. From 4 January, the interval will be three months after your primary course, and three months when practical.
ATAGI has produced guides to help providers:
- Provider guide to COVID-19 vaccination of people with immunocompromise
- Shared decision making guide for people with immunocompromise
- Recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised
People who have received a first dose of COVID-19 vaccine not yet available in Australia
Some people returning to Australia from overseas will have received a first dose of a COVID-19 vaccine that is not available in Australia.
You can offer them a different vaccine brand to complete their primary vaccination course.
ATAGI recommend the second dose is given 4 to 12 weeks after the first dose. A longer gap is acceptable if the second dose cannot be given during this period.
Vaccination after testing positive for COVID-19
Everyone in Australia aged 5 years and over should wait 3 months between testing positive for COVID-19 and their next recommended vaccine dose.
This is to optimise vaccine protection. A longer gap between infection and vaccination is likely to lead to a better immune response and result in longer protection from reinfection.
The next scheduled dose of COVID-19 vaccine should be given as soon as possible after 3 months.
You should still have all the recommended doses for your age and health needs.
People might choose to be vaccinated earlier than 3 months if they:
- are significantly immunocompromised and may be at greater risk of getting COVID-19 again
- have a job that requires them to be vaccinated
- have a job that puts them at greater risk of being exposed to COVID-19.
People should delay vaccination until they have recovered from the acute illness.
People with prolonged symptoms from COVID-19 beyond 3 months should be vaccinated on a case by case basis.
More information is available in ATAGI's Expanded Guidance on temporary medical exemptions for COVID-19 vaccines.
You can also seek further advice from a specialist immunisation service if required.
Timing of COVID-19 vaccination with tuberculin skin test
You can give a tuberculin skin test on the same day or visit with a COVID-19 vaccine. Do each one on a different limb.
There is no specific time interval restriction between a tuberculin skin test and receiving a COVID-19 vaccine. Inhibition of response to tuberculin in skin testing is not expected following administration of the COVID-19 vaccines.
A tuberculin skin test should not interfere with the immune response or potentiate adverse effects with a COVID-19 vaccine.
Surgery and vaccination timing
General principles for timing administration of vaccines, including for COVID-19, around surgeries are in the Australian Immunisation Handbook.
Recent or imminent surgery is not a contraindication to vaccination, and vice versa.
Schedule COVID-19 vaccination at least one week before or after surgeries. This will reduce the chance that adverse events following the vaccination (such as fever) are attributed as surgical complications (such as wound infection).
If you suspect possible TTS in the 42 days after vaccination (for example, thrombocytopenia on pre-operative screen), you should perform investigations for TTS. You should defer surgery until either:
- TTS is ruled out, or
- the patient recovers fully from confirmed TTS.