Latest recommendation updates
ATAGI have not published any updated advice or recommendations since 7 July 2022.
Recent ATAGI considerations
On Wednesday 13 July 2022, ATAGI met to consider the latest developments relating to COVID-19 immunisation. As of 11 July 2022, over 60 million doses of COVID-19 vaccines have been administered in Australia.
Impact of COVID-19 vaccination on children aged 6 months to 4 years
ATAGI have continued reviewing data on the impact of COVID-19 vaccination on children aged 6 months to 4 years, including the burden of disease in this age group in both Australian and international contexts.
Currently, there are no TGA-approved vaccines for use in this age group.
Reinfection and timing of COVID-19 vaccine doses
ATAGI notes there is now a difference between the interval that defines re-infection (4 weeks) and the recommended minimum interval between infection and subsequent vaccine doses (3 months) as per the 8 July 2022 statement from the Australian Health Protection Principal Committee (AHPPC).
Evidence suggests that BA.4/5 is associated with a higher re-infection rate compared to previous variants, and this is likely to be due to immune evasion.
However, there are few data on the additional protection provided by boosters if given soon after infection. Immunologically, a longer time interval between vaccines enhances the ‘booster response’ and subsequent clinical protection, particularly against severe COVID-19 disease. The COVID-19 vaccines have a modest, short duration of impact against infection and as the primary aim of the program is optimising protection from severe disease, a 3-month interval therefore remains optimal. There is also some evidence that vaccine doses given at a shorter interval may be associated with a higher rate of pericarditis and myocarditis, but the relevance of this for the interval between infection and vaccination is not yet known. More information is available in the guidance on myocarditis and pericarditis following COVID-19 vaccination.
ATAGI is therefore still recommending a 3-month minimum interval between infection and subsequent doses, noting this is also consistent with the advice from other countries, which are generally recommending intervals of between 3 and 6 months.
ATAGI continues to monitor evidence regarding these intervals and may update recommendations as further information becomes known.
Use of a 4th dose in pregnancy
Pregnant women aged 30 years and over are now eligible to receive a 4th dose of COVID-19 vaccine. Similar to non-pregnant adults in this age group ATAGI does not specifically recommend the vaccine but encourages a discussion with their regular medical provider to review their individual health needs and the benefits and risks of a 4th dose.
While there are no particular maternal or fetal safety concerns from use of COVID-19 vaccines in pregnant women, ATAGI notes that there is limited experience with 4th doses in pregnant women at this time.
Studies have shown that unvaccinated pregnant women are at higher risk of severe outcomes compared to non-pregnant women, although these studies were from early in the pandemic. There are a paucity of data on severe outcomes during the Omicron wave in vaccinated pregnant women. ATAGI’s previous winter dose advice recommended that anyone aged 16 years or more with a medical risk factor should receive a 4th dose, this includes women who are pregnant or planning pregnancy. The Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy will be updated in due course.
Ongoing review of adverse events and safety information
The TGA Fortnightly Report provides a detailed breakdown of adverse events following immunisation, including Australian rates of myocarditis and pericarditis.
Resources and recent statements
More information can be found in the following resources:
- 7 July 2022: ATAGI updated recommendations for a winter dose of COVID-19 vaccine | Australian Government Department of Health and Aged Care
- 9 June 2022 – on the use of a first booster dose in adolescents aged 12-15 years
- 25 May 2022 – expanded ATAGI recommendations on winter COVID-19 booster doses for people at increased risk of severe COVID-19
- 8 April 2022 – on use of booster doses in adolescents aged 12-15 years
More information can be found on the Department of Health and Aged Care website, with resources for both providers and patients.