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On 25 March 2022, ATAGI recommended an additional winter booster dose (4th dose for most people) for the highest risk groups: the elderly, residents of aged care or disability care facilities, people with severe immunocompromise, and Aboriginal and Torres Strait Islander people aged 50 years or above.
In ATAGI’s most recent advice, an additional winter booster is now also recommended for other people at increased risk, to be given 4 months after their first booster dose. This applies to people aged 16-64 who have:

  • A medical condition that increases the risk of severe COVID-19 illness
  • Any form of disability with significant or complex health needs, or multiple comorbidities that may worsen after COVID-19

Table of high-risk groups and examples

CATEGORY EXAMPLE
Cancer
  • Non-haematological cancer including those diagnosed within the past 5 years or on chemotherapy, radiotherapy, immunotherapy or targeted anti-cancer therapy (active treatment or recently completed) or with advanced disease regardless of treatment.
  • Survivors of childhood cancer.
Chronic inflammatory conditions requiring medical treatment with disease modifying anti-rheumatic drugs (DMARDs) or immune-suppressive or immunomodulatory therapies.
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Crohn’s disease
  • Ulcerative colitis
  • Similar cases who are being treated.
Chronic lung disease
  • Chronic obstructive pulmonary disease
  • Cystic fibrosis
  • Interstitial lung disease
  • Severe asthma
Chronic liver disease;

Severe chronic kidney disease (stage 4 or 5)

  • Cirrhosis
  • Autoimmune hepatitis
  • Non-alcoholic fatty liver disease
  • Alcoholic liver disease
Chronic neurological disease
  • Stroke
  • Neurodegenerative disease (e.g dementia, motor neurone disease, Parkinson’s disease)
  • Myasthenia gravis
  • Multiple sclerosis
  • Cerebral palsy
  • Myopathies
  • Paralytic syndromes
  • Epilepsy
Chronic cardiac disease
  • Ischaemic heart disease
  • Valvular heart disease
  • Congestive cardiac failure
  • Cardiomyopathies
  • Poorly controlled hypertension
  • Pulmonary hypertension
  • Complex congenital heart disease
People with disability with significant or complex health needs or multiple comorbidities which increase risk of poor outcome from COVID-19
  • Particularly those with trisomy 21 (Down Syndrome) or complex multi-system disorders.
Weight-related comorbidities
  • Severe obesity with BMI ≥ 40 kg/m2
  • Severe underweight with BMI < 16.5 kg/m2
Diabetes mellitus requiring medication

Comirnaty (Pfizer, from age 16 years) or Spikevax (Moderna, from age 18 years) are the preferred vaccines for a COVID-19 booster dose. Vaxzevria (AstraZeneca) can be used in people aged 18 or older when an mRNA vaccine is contraindicated, or where a person declines vaccination with an mRNA vaccine. Nuvaxovid (Novavax) can be used in people aged 18 or older if no other COVID-19 vaccine is considered suitable for that person.

“What about those not in the ATAGI list?”

ATAGI recommends that the following delay their 4th booster dose due to low risk factors:

  • Healthy people aged 16-64
  • Healthcare workers that are not at risk and deemed healthy
  • Pregnant women who do not have an additional risk factor for severe diseases included in the table above
  • Individuals that have had a recent confirmed COVID-19 infection (4th booster must be delayed until 3 months after infection)

ATAGI also encourages people to be vaccinated against Influenza. 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.

References:

  • https://www.health.gov.au/news/expanded-atagi-recommendations-on-winter-covid-19-booster-doses-for-people-at-increased-risk-of-severe-covid-19#:~:text=In%20this%20updated%20advice%2C%20an,Table%201%20for%20expanded%20groups).
  • https://www.health.gov.au/resources/publications/atagi-expands-recommendation-for-winter-covid-19-booster
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