ATAGI recommendations on the first booster dose in adolescents aged 12-15 years

Date published:

June 9, 2022

Targeted audience:

General public


Recommendations

  • ATAGI recommends that a first booster dose of the Comirnaty (Pfizer) COVID-19 vaccine can be given to the following adolescents aged 12 to 15 who completed a primary vaccination 3 months or more ago:
    • those who are severely immunocompromised
    • those who have a disability with significant or complex health needs
    • those with complex and/or multiple health conditions that increase the risk of severe COVID-19
  • Currently, Spikevax (Moderna) and Nuvaxovid (Novavax) are not approved for use as the first booster dose in this age group.
  • ATAGI continues to recommend a 3-month gap between recent confirmed SARS CoV-2 infection and a scheduled dose of COVID-19 vaccine.
  • ATAGI does not recommend that a first booster dose of the COVID-19 vaccine be given to all adolescents aged 12 to 15. There is insufficient evidence of severe disease in otherwise healthy adolescents in this age group who have already received two primary doses of a COVID-19 vaccine. ATAGI continues to recommend that all adolescents aged 12 to 15 receive a primary vaccination of 2 doses of COVID-19 vaccine, 8 weeks apart. A third primary dose from 2 months after dose 2 is recommended for severely immunocompromised people.
  • ATAGI also recommends that all Australians, including adolescents aged 12 to 15, receive a dose of flu vaccine as soon as possible. All COVID-19 vaccines can be
    co-administered (given on the same day) with an influenza vaccine.

Reasoning

The current primary goal of Australia’s COVID-19 vaccination program is to prevent serious illness, including hospitalization and death. Early Australian and international data suggest that adolescents aged 12 to 15 have a very low risk of serious illness or death from the Omicron variant of SARS-CoV-2, especially if they have completed a primary series of vaccination .1-3 There is currently insufficient evidence that a first booster dose provides additional protection against serious disease for most children and adolescents in this age group.

Teenagers aged 12-15 who are at increased risk of severe disease can receive a first booster dose

From first principles, ATAGI has identified three groups of adolescents aged 12-15 who may be at higher risk of serious illness from COVID-19 compared to their peers:

  • those who are severely immunocompromised
  • those who have a disability with significant or complex health needs
  • those with complex and/or multiple health conditions

A first booster dose of the COVID-19 vaccine may provide additional protection against severe illness, noting that the overall risk of intensive care unit admission and death in this age group remains very low.1-3 There were no confirmed deaths from COVID-19 in Australian adolescents aged 12-15 during Omicron’s prevalence period.1.2 Most European and North American countries have also recorded no deaths, except for England (1), Denmark (5) and the United States (17).3 These data reflect deaths of adolescents aged 12-15 with concurrent SARS-CoV-2 since February 1, 2022 and do not necessarily attribute cause of death to COVID-19.

Myocarditis after vaccination remains rare. Data from the United States and Israel suggest that the risk of myocarditis after a third dose of the Pfizer COVID-19 vaccine in adolescent males ages 12 to 15 ranges from 1 in 11,000 to 58,000 doses. This is probably lower than the rate after dose 2 and higher than the rate after dose 1.4-5 There are currently no cases of myocarditis following a first booster dose in adolescent girls aged 12-15 years. Although adolescent girls ages 12 to 15 appear to have a lower risk of developing vaccine-associated myocarditis after any dose of the Pfizer COVID-19 vaccine compared to men, cases have been reported after doses 1 and 2. 4 See ATAGI’s clinical advice on myocarditis and pericarditis for more details.

A third primary dose starting 2 months after dose 2 is recommended for severely immunocompromised adolescents 12 to 15 years of age. The first booster dose for this cohort will be their 4e dose of a COVID-19 vaccine. The efficiency and safety of a 4e the dose in this age group is unknown, but the benefits are likely to outweigh the risks. There have been no safety concerns in severely immunocompromised people in older age groups.

A first booster dose is not recommended for all adolescents aged 12 to 15

At present, there is insufficient evidence that a first booster dose of a COVID-19 vaccine provides additional protection against severe disease for the majority of adolescents aged 12-15 years.

Adolescents 12-15 years old who are not severely immunocompromised should receive 2 doses of an approved COVID-19 vaccine, 8 weeks apart, as the primary series.

Early evidence suggests that two doses protect against serious illness, including admission to an intensive care unit and the development of multisystem inflammatory syndrome in children, and this protection persists for at least several months after a primary vaccination in children. teenagers aged 12 to 18.6-8 This is supported by Australian data which shows that unvaccinated adolescents aged 12 to 15 are more likely to be admitted to an intensive care unit than those who have received a primary round of vaccination against COVID-19.1-2

Advice may change as evidence emerges

This advice may change as new evidence or new vaccines emerge or as vaccination program goals respond to local epidemiology (for example, a new variant of SARS-CoV-2 becomes predominant). ATAGI will continue to regularly review the role of first booster doses in all adolescents aged 12-15 years.

References

  1. Active Enhanced Pediatric Disease Surveillance (PAEDS). Interim analysis of PAEDS surveillance data. Westmead: National Center for Immunization Research and Vaccine Preventable Disease Surveillance, PAEDS; 2022. Available from: https://www.ncirs.org.au/our-work/paediatric-active-enhanced-disease-surveillance-paeds
  2. Australian and New Zealand Critical Care Research Center (ANZIC-RC). SPRINT-SARI: Study on the short-term incidence of severe acute respiratory infections. Melbourne: Monash University, ANZIC-RC; 2022. Available from: https://www.monash.edu/medicine/sphpm/anzicrc/research/sprint-sari
  3. Murdoch Children’s Research Institute. COVID-19 and Child Surveillance Report #18. May 9, 2022. Available from: https://www.mcri.edu.au/sites/default/files/media/documents/covid-19_and_childrens_surveillance_report_18_090522.pdf
  4. Klein N, Shimabukuro T. ACIP meeting slides. April 20, 2022. COVID-19 Booster Dose Safety Updates. 2022. Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-04-20/03-COVID-Klein-Shimabukuro-508.pdf (Consulted on 25/5/2022)
  5. Israeli Ministry of Health. Protection by 4th dose of BNT162b2 against Omicron in Israel. meeting of the FDA Advisory Committee on Vaccines and Related Biologicals; 2022. Available from: https://www.fda.gov/media/157492/download (Accessed 05/19/2022).
  6. Olson SM, Newhams MM, Halasa NB, et al. Efficacy of the BNT162b2 vaccine against critical Covid-19 in adolescents. N Engl J Med. 2022 Feb 24;386(8):713-723. doi: 10.1056/NEJMoa2117995. Epub 2022 Jan 12. PMID: 35021004; PMCID: PMC8781318. Available at: https://www.nejm.org/doi/10.1056/NEJMoa2117995
  7. Zambrano LD, Newhams MM, Olson SM et al. Efficacy of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children 12-18 Years Old – United States, July-December 2021. MMWR Morb Mortal Wkly Rep. 2022 Jan 14;71(2):52-58 . doi: 10.15585/mmwr.mm7102e1. PMID: 35025852; PMCID: PMC8757620. Available at: https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e1.htm?s_cid=mm7102e1_w
  8. Price AM, Olson SM, Newhams MM et al. BNT162b2 Protection against Omicron variant in children and adolescents. N Engl J Med. 2022 May 19;386(20):1899-1909. doi: 10.1056/NEJMoa2202826. Published online March 30, 2022. PMID: 35353976; PMCID: PMC9006785. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa2202826

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