Latest recommendation updates
- Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines including updates to mRNA COVID-19 vaccine dose intervals and rates of myocarditis and pericarditis
- ATAGI clinical guidance for COVID-19 vaccine providers including updates to mRNA COVID-19 vaccine dose intervals and timing of vaccination post infection
Recent ATAGI considerations
On Wednesday 27 April 2022, ATAGI met to consider the latest developments relating to COVID-19 immunisation. As of 26 April 2022, over 57 million doses of COVID-19 vaccines have been administered in Australia.
ATAGI Advice on mRNA COVID-19 vaccine dose intervals
The recommended dose interval for the 2 doses of the primary course of mRNA COVID-19 vaccines was previously:
- 3 to 6 weeks for Comirnaty (Pfizer)
- 4 to 6 weeks for Spikevax (Moderna).
ATAGI now recommends the dose interval between primary doses should be extended to 8 weeks.
The extended dose interval of 8 weeks has been shown to improve the immune response to vaccination and therefore may improve effectiveness. A longer dose interval may also reduce the risk of myocarditis and pericarditis. The longer dose interval is particularly recommended for groups at higher risk of this side effect (those under the age of 40 years).
The dose interval can be reduced (to a minimum of 3 weeks for Pfizer or 4 weeks for Moderna) for people at higher risk of severe COVID-19 (including older adults and people with underlying medical conditions), in an outbreak setting, or prior to international travel.
The risk of myocarditis and pericarditis following Nuvaxovid (Novavax) vaccine is unknown.
Providers can consider extending the interval between 2 primary doses of Novavax to 8 weeks (from a minimum of 3 weeks) to potentially improve effectiveness and reduce any potential risk of myocarditis and pericarditis.
ATAGI Advice on COVID-19 vaccination post infection
ATAGI have updated their advice on when people who have had SARS-CoV-2 infection should receive a subsequent COVID-19 vaccine dose. It is now recommended that all people should wait for 3 months after confirmed SARS-CoV-2 (the virus that causes COVID-19) infection before they receive their next COVID-19 vaccine dose. The next scheduled dose should then be given as soon as possible after this period.
This updated advice reflects the lower risk of reinfection with the Omicron variant within the first 3 months following a confirmed infection, particularly if prior COVID-19 vaccine doses have been received. It also recognises the Delta variant is no longer circulating in Australia and in the past 3 months Omicron has been the dominant variant. This advice may change if future variants of SARS-CoV-2 emerge.
Waiting for a 3-month period after infection before COVID-19 vaccination is intended to optimise protection for that person. A longer gap between infection and vaccination is likely to lead to a better immune response and result in longer protection from reinfection.
This change in recommendation applies to all people who are recommended to receive COVID-19 vaccination (i.e., from 5 years and above), regardless of how many COVID-19 vaccine doses they have received. It does not apply to other vaccines (for example, influenza vaccinations) which can continue to be administered as usual.
ATAGI will continue to review the evidence on protection from vaccination and infection and may update advice if required, including if a new variant emerges or another circumstance arises to cause COVID-19 vaccination to become more urgent.
For more information see: www.health.gov.au/initiatives-and-programs/covid-19-vaccines/advice-for-providers/clinical-guidance.
Ongoing review of evidence and recommendations
As part of an ongoing review of current recommendations on the use of COVID-19 vaccines in Australia, ATAGI have been reviewing evidence relating to need for 4th (winter) doses of COVID-19 vaccine for at risk groups, including disability and those with certain co-morbidities and considerations will continue over the coming weeks.
Ongoing review of adverse events and safety information
The TGA Weekly 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:
- 29 April 2022: Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines
- 29 April 2022: ATAGI Clinical Guidance for COVID-19 vaccine providers
- 8 April 2022: ATAGI statement on use of booster doses in adolescents aged 12-15 years
- 25 March 2022: ATAGI recommendations on a winter booster dose of COVID-19 vaccine
- 2 March 2022: ATAGI updated advice on COVID-19 booster vaccinations
More information can be found on the Department of Health website, with resources for both providers and patients.