Summary
ATAGI recommends an additional booster dose of COVID-19 vaccine to increase vaccine protection before winter for selected population groups (see Table 1) who are at greatest risk of severe illness from COVID-19 and who have received their primary vaccination and first booster dose. These groups are:
- Adults aged 65 years and older
- Residents of aged care or disability care facilities
- People aged 16 years and older with severe immunocompromise (as defined in the on the use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised)
- Aboriginal and Torres Strait Islander people aged 50 years and older.
The additional winter booster dose can be given from 4 months or longer after the person has received their first booster dose, or from 4 months after a confirmed SARS-CoV-2 infection, if infection occurred since the person’s first COVID-19 booster dose.
ATAGI recommends that the rollout of the additional booster dose for these groups starts from April 2022, coinciding with the rollout of the 2022 influenza vaccination program.
Influenza vaccine can be co-administered with the additional booster dose of COVID-19 vaccine. However, if a person is not yet eligible for their additional booster dose, influenza vaccine could be given ahead of the additional booster dose.
Comirnaty (Pfizer) or Spikevax (Moderna) are the preferred vaccines for COVID-19 booster doses including the additional winter booster dose. Vaxzevria (AstraZeneca) can be used when an mRNA vaccine is contraindicated or a person declines vaccination with an mRNA vaccine. Nuvaxovid (Novavax) can be used if no other COVID-19 vaccine is considered suitable for that person.
For other groups not listed above, there is insufficient evidence of the benefits of an additional booster dose to make recommendations at this time. This includes people younger than 65 years with medical conditions that may increase their risk of COVID-19, individuals with disability and ³Ô¹ÏÍøÕ¾ Disability Insurance Scheme (NDIS) recipients who are not in residential disability care, Aboriginal and Torres Strait Islander people aged 16 to 49, workers at health care or residential care facilities, or younger healthy adults. ATAGI will continue to monitor emerging evidence and may recommend an additional dose for these groups in the future.
Prevention of severe illness from COVID-19 remains the primary goal of the ongoing COVID-19 vaccination program. These recommendations for an additional booster dose focus on protecting the most vulnerable groups against severe disease and reducing the potential burden on the healthcare system over the coming months.
The secondary aims of the COVID-19 vaccination program are preventing infection and preventing transmission of the virus. There is limited evidence at this stage for additional booster doses to prevent transmission. Emerging evidence in relation to prevention of transmission by vaccination will continue to be monitored and additional booster doses may be recommended in additional groups in the future.
All people aged 16 years and older are recommended to receive a first booster dose of COVID-19 vaccine after completing their primary course. For most people, this will be a third dose. The booster dose is important to maintain protection against COVID-19.
For any person aged 16 and older who has not received their first booster yet, ATAGI recommends they receive it as soon as possible.
Protection against infection wanes after the first booster dose. However, protection against severe disease (rather than all infection) is relatively well maintained, especially in young healthy populations.
Target group | Recommendation for additional booster dose | Comments/information gaps/next steps |
|---|---|---|
People aged ≥65 years | Recommended | Recommended from 4 months after the previous booster dose, or from 4 months after previous SARS-CoV-2 infection if this occurred since the previous booster dose. |
Residents of aged care or disability care facilities | Recommended | Includes people with disability in group residential care facilities. Includes people in residential aged care or disability care who are aged Recommended from 4 months after the previous booster dose, or from 4 months after previous SARS-CoV-2 infection if this occurred since the previous booster dose. |
People who are severely immunocompromised aged ≥16 years | Recommended for people with severe immunocompromise, as defined in the on use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised | This will be a 5th dose as this group is recommended to receive 3 primary doses. Recommended from 4 months after the previous booster dose, or from 4 months after previous SARS-CoV-2 infection if this occurred since the previous booster dose. |
Aboriginal and Torres Strait Islander people aged ≥50 years | Recommended | Recommended from 4 months after the previous booster dose, or from 4 months after previous SARS-CoV-2 infection if this occurred since the previous booster dose. |
People aged [1] | Not currently recommended. Remains under active consideration | Complete primary schedule. Promote first booster dose, if not already given. ATAGI will continue to evaluate emerging evidence over the coming weeks. |
Health care, aged care and disability care workers | Complete primary schedule. Promote first booster dose, if not already given. ATAGI will continue to evaluate emerging evidence over the coming weeks. Maximise up to date vaccination of patients under care. | |
All others aged 16-64 years | Complete primary schedule. Promote first booster dose, if not already given. ATAGI will continue to evaluate emerging evidence over the coming weeks. | |
All others aged 5-15 years | Complete primary schedule. ATAGI will evaluate emerging evidence over the coming weeks regarding the first booster dose. | |
Introduction
The virus that causes COVID-19 (SARS-CoV-2) is now endemic in Australia. The Omicron SARS-CoV-2 variant of concern has become the dominant strain globally.
The first booster doses of COVID-19 vaccine were rolled out in November 2021. The interval between the last primary dose and the booster dose was reduced from 6 months to 3 months by 31 January 2022 as evidence emerged and to maximise the number of people who could be vaccinated with booster doses as the Omicron wave evolved.
While the original BA.1 Omicron wave is now past its peak, the BA.2 subvariant is rapidly replacing BA.1. This subvariant is more transmissible and likely to cause a resurgence of cases.1 The severity of disease and protection after vaccination appear to be similar between BA.1 and BA.2.2,3
As of 13 March 2022, cumulative uptake of the thirddose (the first booster dose for most people, except for severely immunocompromised people) is 65.6% of those eligible.4 ATAGI emphasises the importance of a first booster dose of COVID-19 vaccine for all people aged 16 years and older.
There have been approximately 3 million cases of COVID-19 since 5 December 2021, and the vast majority of cases have been mild in severity.5,6 Some degree of immunity is to be expected after infection, although the level and duration of this in the context of Omicron infection and protection against future variants is unknown.
Prevention of severe illness from COVID-19 remains the primary goal of the ongoing COVID-19 vaccination program. There is a need to consider how best to use COVID-19 vaccines to protect those most at risk of severe disease, hospitalisation and death. Vaccination program priorities may continue to change in the future based on the emergence of new variants and/or new vaccines.
ATAGI has reviewed the available evidence on the duration of protection given by COVID-19 vaccines (including booster doses) and the epidemiology of SARS-CoV-2, to assess the benefit from and optimal timing of further booster doses in people who are currently up to date with COVID-19 vaccination. ATAGI acknowledges that uncertainties remain regarding the potential for new variants; the benefits, safety and optimal timing of additional doses in different groups; and the potential development of new COVID-19 vaccines.
Recommendations
Based on currently available evidence, ATAGI recommends an additional booster dose of COVID-19 vaccine to increase vaccine protection for winter. This winter booster dose should be available from April 2022 for specified populations who are at increased risk of severe disease. These groups are:
- Adults aged 65 years and older
- Residents of aged care or disability care facilities (including those under 65 years)
- People aged 16 years and older with severe immunocompromise as defined in the on use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised)
- Aboriginal and Torres Strait Islander adults aged 50 years and older.
There is currently insufficient evidence to recommend additional booster doses for other population groups, including:
- People with medical risk factors
- Individuals with disability and ³Ô¹ÏÍøÕ¾ Disability Insurance Scheme (NDIS) recipients who are not in residential disability care
- Aged care, disability care and healthcare workers
- Healthy individuals aged 16 to 64 years.
- Aboriginal and Torres Strait Islander people aged under 50 years.
ATAGI will actively monitor emerging evidence about booster vaccination in these groups and provide updated advice if needed.
Timing of the additional COVID-19 vaccine booster dose for high-risk populations
The additional booster dose can be given from 4 months or longer since the first COVID-19 booster dose. In people who have had a confirmed SARS-CoV-2 infection (by PCR or rapid antigen test) after receiving their first booster dose, the additional dose should be given from 4 months after the confirmed infection, as infection has been shown to boost immunity. ATAGI recommends that the additional booster dose can be received from April 2022, coinciding with the rollout of the 2022 influenza vaccination program.
In special circumstances, individuals may be vaccinated at a shorter interval from their last dose or infection. Examples include vaccination outreach programs to aged care or disability care facilities, remote communities, or delivering vaccination services in the context of natural disasters, where some flexibility of the minimum interval may facilitate vaccination of a larger proportion of individuals.
The additional booster dose should not be administered less than 3 months from the previous booster dose or SARS-CoV-2 infection.
