Over the past year, coronavirus vaccination recommendations have been regularly updated. So it can be difficult to keep track of how many doses of the vaccine you and your family members need.
This may sound confusing, but it’s actually a good way to go when dealing with a pandemic, especially when the virus continues to change. Let’s look at current Australian recommendations and why vaccination advice needs to evolve over time.
Read more: Do COVID boosters cause more or fewer side effects? How quickly does protection wear off? Answer your questions
Why do recommendations need updating?
The nature of the COVID pandemic has changed over the past two years and is likely to continue to change. Today’s virus is more contagious and less deadly than the 2020 virus.
The herd immunity of the Australian population has improved, thanks to the vaccination of most of us (95% of Austrians over 16 years of age have had two doses) and an increase in the number of infections at the beginning of this year.
A changing virus and rising levels of immunity in the population also mean that the benefits and risks of vaccination are changing.
The goal is to make sure that we use current vaccines in a way that offers the greatest benefit and the least harm.
Read more: Why are there so many new sub-variants of Omicron, such as BA.4 and BA.5? Will I get infected again? Is the virus mutating faster?
ATAGI recently recommended that the interval between initial doses (that is, the first two doses) should be eight weeks and that people should wait up to three months after they have had a natural infection before they get the next vaccine they deserve. The advisory group said the extended dose period was shown to improve the immune response to the vaccination and may reduce the risk of developing myocarditis and pericarditis.
Prevent serious disease
ATAGI’s COVID vaccination recommendations are designed to reduce the risk of serious illness in the individual being vaccinated.
Preventing the spread of the virus was of paramount importance last year. We have since learned that serious disease is less common with the Omicron variant and the ability of vaccines to prevent its spread is short-lived and limited.
ATAGI has now identified the prevention of serious illness and death as the primary role of vaccines at this stage of the pandemic.
However, a significant number of people are still seriously ill from Omicron and require hospital treatment. Fortunately, booster doses of COVID vaccines remain excellent at preventing severe infections.
Who needs a winter dose?
There are several groups of people for whom a ‘winter’ booster is recommended – given from four months after the booster or the third dose (whatever the season).
A person’s age is the greatest risk factor for severe COVID disease. The presence of immunosuppression or some other chronic health condition is also important, but age plays the most important role.
The risks of death and admission to intensive care units are higher among those 65 years of age or older. So the serious disease prevention benefits of a winter dose are most evident in this age group. A study from Israel showed a decrease in hospitalizations and deaths from the novel coronavirus after a second (fourth dose) booster dose in Israeli adults aged 60 years and over.
This case is reinforced because very rare and serious side effects of vaccination – such as myocarditis after mRNA vaccines – are uncommon in this age group. If you are over 65, you should plan your winter dose from four months after your booster dose. Accordingly, residents of aged care facilities are advised to take the winter dose, as well as those who have a residential disability.
People 50 years of age or older and anyone 16 years of age or older with severe immunosuppression are also advised to get a winter dose.
What about others between the ages of 16 and 64?
For most Australians aged 16 to 64, it is not clear that a IV ‘booster’ winter vaccination is needed.
UK data show that an initial course and a booster or third dose of the COVID vaccine was effective in preventing serious disease from Omicron, however suggest that immunity is also likely to be diminished by the booster dose.
Read more: Kids aged 16-17 can now get their own COVID boosters. Why not have young children?
Do children aged 5-15 years need another dose? How about less than 5 years old?
COVID vaccination is not recommended for infants and children under 5 years of age.
When it comes to children and young adolescents (who are not severely immunocompromised), we don’t have enough evidence for the additional benefit of a booster (third) dose.
What we do know is that serious illness in this age group, including those with severe immunodeficiencies and other medical conditions, is rare. Studies in the United States, South Africa, and the United Kingdom suggested that although there may be a higher rate of hospitalization with Omicron than with a delta infection, it was less severe (less likely to require ICU or ventilation or result in death).
We also know that the risk of vaccination, especially myocarditis, is rare in children under 11 years of age (but under active surveillance) and side effects are relatively greater in adolescents.
Currently, the benefits of vaccination are less than those of adults, and the majority of adolescents who have already been vaccinated do not have a serious illness.
Read more: The Moderna vaccine is now available for children 6 to 11 years old. Here’s what parents need to know
The latest advice from ATAGI is available as listed below. But as the benefit-risk equation continues to change, expect these recommendations to change as well. Remember, the goal remains the same: to prevent serious illnesses for you and our community.