ATAGI update following weekly COVID-19 meeting – 6 July 2022

Latest recommendation updates

• ATAGI updated recommendations for a 4^th (winter) dose of COVID-19 vaccine including updated advice on groups recommended to receive a 4^th dose (winter booster).

Recent ATAGI considerations

On Wednesday 6 July 2022, ATAGI met to consider the latest developments relating to COVID-19 immunisation. As of 6 July 2022, over 60 million doses of COVID-19 vaccines have been administered in Australia.

ATAGI reviewed epidemiology, modelling, vaccine protection, and disease severity in healthy people aged 16 to 64 years (not currently recommended to receive an additional booster dose). As a result of this review, ATAGI recommended:

• All adults aged 50 years or older to receive a 4^th dose of a COVID-19 vaccine. 
• The interval between recent SARS-CoV-2 infection or the first booster dose and a winter dose is now 3 months.  

ATAGI also advised that adults aged 30 to 49 years who wish to reduce their risk of infection can also receive a 4^th dose of a COVID-19 vaccine. 

The Australian Government has accepted these recommendations and this change will take effect from 11 July 2022.

The primary goal of the Australian COVID-19 vaccine program is to minimise the risk of severe disease, including hospitalisation and death, from COVID-19.

As outlined in ATAGI statements on winter booster doses (25 March 2022 and 25 May 2022), ATAGI continue to review evidence on the need for booster doses for people outside of the currently identified groups.

ATAGI has updated its recommendations for a 4th dose of COVID-19 vaccine to help reduce severe disease from the emerging surge of Omicron BA.4 and BA.5 subvariant infections, and to reduce the burden on Australian hospitals and the healthcare system in coming months.

The number of people ill from respiratory virus infections, including from COVID-19, has increased over the past few months, placing an increased strain on the Australian healthcare system, particularly hospitals. In addition, the number of people in Australia infected with the SARS-CoV-2 is expected to rise in the coming weeks.

The additional groups as listed above are in addition to the groups already recommended to receive a winter COVID-19 booster:

• all adults over 65 years of age
• residents of an aged care or disability care facility
• people who are severely immunocompromised (this will be their 5th dose)
• Aboriginal or Torres Strait Islander people aged 50 years or older
• people aged 16 and over with a medical condition that increases the risk of severe COVID-19 illness
• people aged 16 and over with disability, significant or complex health needs, or multiple comorbidities which increase the risk of a poor outcome

ATAGI notes that coverage with the first booster and 4^th doses of COVID-19 vaccine in those people who are already eligible is suboptimal, and emphasises the importance of rapidly increasing vaccine uptake, particularly in older adults and older adults with complex medical needs. Adults aged 65 years or older who have not yet received a winter dose of COVID-19 vaccine should get this as soon as possible.  

Reaching a higher level of coverage of the COVID-19 winter booster dose in older adults, including those aged 50 to 64 years, is likely to reduce the number of COVID-19 related hospitalisations over the coming months.

ATAGI advises that other public health and social measures will have the greatest impact against the surge in infections. This may include increased use of masks, working from home and increasing the use of antiviral treatment in people diagnosed with COVID-19, including in people aged 50 years and above.

Reduction in interval between recent SARS-CoV-2 infection and booster dose

ATAGI recommends the 4^th dose be given 3 months after the first booster dose of COVID-19 vaccine or 3 months after a recent SARS-CoV-2 infection, whichever is the most recent.

This interval has been reduced from 4 months to 3 months to provide earlier protection from the additional vaccine over the coming winter months.

ATAGI also recommends everyone in Australia over the age of 6 months should receive an influenza vaccination. Influenza vaccinations can be given at the same time as COVID-19 vaccines and should not be delayed.

ATAGI will continue to monitor disease modelling and the epidemiology of COVID-19 and may recommend wider vaccination to combat rapid increases in disease transmission in the future if the need arises.

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.