Who should receive what dose of COVID vaccination now?

Over the past year, COVID vaccination recommendations have been updated regularly. So it can be difficult to keep track of how many doses of vaccine you and your family members need.

This may sound confusing, but it’s actually a good approach to take when navigating a pandemic, especially when the virus keeps changing. Let’s take a look at the current Australian recommendations and why vaccine advice needs to evolve over time.

Why do the guidelines need to be updated?

The nature of the COVID pandemic has changed over the past two years and will likely 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 most of us get vaccinated (95% of Australians over 16 received two doses) and one ascend infections earlier this year.

A virus change and rising levels of immunity in the population mean the benefits and risks of vaccination change too.

The goal is to ensure that we use current vaccines in a way that offers the most benefit and the least harm.

Recently ATAGI advised the interval between primary doses (i.e. the first two doses) should be eight weeks and people should wait up to three months after having a natural infection before receiving the next scheduled vaccine. The advisory group said the extended dose interval has been shown to improve the immune response to vaccination and may reduce the risk of myocarditis and pericarditis.

Prevent serious diseases

ATAGI’s COVID vaccination recommendations are designed to minimize the risk of serious illness in the vaccinated person.

Preventing the spread of the virus was paramount last year. We have since learned that severe disease is less common with the Omicron variant and that the ability of vaccines to prevent its spread is ephemeral 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.

Nevertheless, a significant number of people still become seriously ill from Omicron and need hospitalization. Fortunately, booster doses of COVID vaccines stay great prevent serious infections.

Who needs a winter photo?

There are several groups of people for whom a “winter” booster dose is recommended – to be given from four months after the booster or the third dose (regardless of the season).

A person’s age is the main risk factor for severe COVID disease. The presence of immunosuppression or other chronic health conditions is also importantbut age plays the most important role.

The risk of death and admissions to intensive care units are upper among people aged 65 and over. Thus, the benefits of preventing serious illness with a winter dose are most evident in this age group. An Israeli study showed reduced COVID hospitalizations and deaths after a second booster (a fourth dose) in Israeli adults aged 60 and older.

This case is reinforced because the very rare but serious side effects of vaccination – such as myocarditis after mRNA vaccines – are rare in this age group. If you are over 65, you should plan for a winter dose starting four months after your booster. As a result, residents of aged care facilities are advised a dose of winter, as are those who are in residences for disabled people.

First Nations people age 50 and older and anyone age 16 and older with severe immunosuppression are also recommended for a winter vaccine.

What about others between the ages of 16 and 64?

For most Australians aged 16-64, it is not clear that a fourth ‘winter booster’ vaccine is needed.

UK Data shows that primary treatment and booster or third dose of COVID vaccination was effective in preventing severe illness from Omicron, but indicates that booster dose immunity is also likely to wane.

Do children aged 5 to 15 need another injection? And children under 5?

The COVID vaccination has not been recommended for babies and children under 5 years old.

For children and young adolescents (who are not severely immunocompromised), there is insufficient evidence of additional benefit from a (third) booster dose.

What we do know is that serious illnesses in this age group, including people with severe immunosuppression and other medical conditions, are 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 compared to Delta infection, they were less severe (less likely to need intensive care, ventilation or lead to death).

We also know the risk of vaccination, mainly myocarditisis rare in children under 11 years of age (but under active surveillance) and side effects are proportionally greater in teenagers.

At present, the benefits of vaccination are less than for adults and the majority of young adolescents who have been vaccinated do not suffer from a serious illness.

The most recent advice from ATAGI is available and illustrated below. But as the benefit/risk equation continues to change, expect these recommendations to change as well. Remember that the goal remains the same: to prevent serious illnesses for you and in our community.

This article was first published on The conversation and written by Associate Professor Nicholas Wood from the Faculty of Medicine and Health at the University of Sydney.

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