Statement – Australian Technical Advisory Group on Immunisation (ATAGI), 7 July 2022

ATAGI updated recommendations for a winter dose of COVID-19 vaccine

ATAGI has updated its recommendations for a winter dose of COVID-19 vaccine to help reduce severe disease from the emerging surge of Omicron BA.4 and BA.5 subvariant infections, and to reduce the burden on Australian hospitals and the healthcare system in coming months.

The updated recommendations are:

  • Adults aged 50 to 64 years are now recommended to receive a winter booster dose of a COVID-19 vaccine.
  • Adults aged 30 to 49 years can receive a winter booster dose of a COVID-19 vaccine, however the benefit for people in this age group is less certain.
  • The interval recommended between a recent SARS-CoV-2 infection or the first booster dose and a winter booster dose is now 3 months.

ATAGI emphasises that people previously eligible for a winter booster dose remain at higher risk of severe disease and death from COVID-19 and should receive a winter booster dose as soon as possible. They include:

  • all adults aged 65 years or older
  • residents of aged care or disability care facilities
  • Aboriginal and Torres Strait Islander people aged 50 years or older
  • people who are severely immunocompromised (this will be their fifth dose)
  • people aged 16 years or older with a medical condition that increases the risk of severe COVID-19 illness
  • people aged 16 years or older with disability, significant or complex health needs, or multiple comorbidities which increase the risk of a poor outcome.

ATAGI emphasises that individuals who have previously been infected with SARS-CoV-2, irrespective of which variant it may have been, should continue to receive recommended vaccine doses, after an interval of 3 months, as prior infection alone will not provide sufficient protection against severe disease.

Rationale

The number of people ill from respiratory virus infections, including from COVID-19, has increased over the past few months, placing an increased strain on the Australian healthcare system, particularly hospitals. A surge in cases of COVID-19 from the SARS-CoV-2 Omicron BA.4 and BA.5 subvariants is a contributing factor and is expected to worsen in the coming months. Increasing the uptake of winter booster doses of COVID-19 vaccine in populations most at risk during this time is anticipated to play a limited, but important role in reducing the risk from COVID-19 to individuals  and pressure on the healthcare system.

ATAGI notes with concern that coverage with first booster and winter booster doses of COVID-19 vaccine at this time are suboptimal , 70.6% and 59.5% of the respective eligible populations who have completed prior doses.1 ATAGI emphasises the importance of vaccination in preventing severe disease and death during this time, particularly in older adults and people aged 16 years and older with a medical condition or disability.

Protection against Omicron BA.4 and BA.5

The Omicron BA.4 and BA.5 subvariants can partly escape the immune response generated by both prior vaccination and infection. 2,3 A first booster dose of COVID-19 vaccine has been shown to increase the immune response to these new subvariants, but wanes over several weeks. 2 A winter dose (the second booster dose) is anticipated to boost this immune response.

Reducing the interval between a first booster dose and a winter dose from 4 months to 3 months will also help provide earlier protection as infection rates rise. ATAGI re-emphasises that those individuals who have previously been infected with SARS-CoV-2, irrespective of which variant it may have been, should complete their vaccination course. Vaccination in addition to infection, as compared with prior infection alone, offers the best available protection against reinfection.

Based on first principles and currently available evidence, reaching a higher level of coverage of the COVID-19 winter booster dose in older adults, including those aged 50 to 64 years, is likely to reduce the number of COVID-19 related hospitalisations over the coming months.  However, the impact of this expanded vaccine booster recommendation alone is expected to be limited. ATAGI advises that other public health and social measures, in addition to vaccination, will have the greatest impact against the Omicron BA.4 and BA.5 surge in infections. This includes increased use of masks and increasing the use of antiviral treatment in people diagnosed with COVID-19, including in people aged 50 years and above.

Rates of hospitalisation, severe disease, and death from COVID-19 are lower in adults aged 50-64 years when compared with older adults, especially in people that have received a first booster dose.

ATAGI recognises that some people aged 30 to 49 years would also like to reduce their risk of infection from COVID-19 and therefore may consider a winter booster dose.  While rates of hospitalisation, severe disease, and death from COVID-19 are low in this age group, other factors such as time off work and the risk of long COVID may influence an individual’s personal decision to have a winter booster dose. The impact of vaccination on transmission and maintenance of healthcare capacity in this age group is uncertain but likely to be limited.

At this moment, ATAGI does not support making the winter booster dose available to healthy adults aged less than 30 years as it is unclear whether the benefits outweigh the risks in this population. However, a winter booster dose remains recommended for individuals aged 16 years or more who have a higher risk of severe outcomes from COVID-19 (i.e. they are immunocompromised or have a complex medical condition or disability) as they are most likely to benefit. Although very rare, myocarditis associated with the mRNA vaccines can occur, particularly in adolescent and young adult males. For more information see the ATAGI clinical guidance on myocarditis and pericarditis.

This Advice May Change

This advice may change if and as new COVID-19 vaccines or SARS-CoV-2 variants emerge or disease epidemiology changes. ATAGI will continue to regularly review the role of winter and all doses in the COVID-19 vaccination program.

References
  1. Australian Government, Department of Health and Ageing. COVID-19 Vaccine Roll-out, 6 July, 2022. COVID-19 vaccine rollout update 6 July 2022 (Accessed 06/07/2022)
  2. Hachmann N, Miller J, Collier A, et al. Neutralization Escape by SARS-CoV-2 Omicron Subvariants BA.2.12.1, BA.4, and BA.5. N Engl J Med. 2022 Jun 22. doi: 10.1056/NEJMc2206576. Epub ahead of print. PMID: 35731894. Available from: The New England Journal of Medicine
  3. Arora P, Kempf A, Nehlmeier I, et al. Augmented neutralisation resistance of emerging omicron subvariants BA.2.12.1, BA.4, and BA.5. Lancet Infect Dis. 2022 Jun 28:S1473-3099(22)00422-4. doi: 10.1016/S1473-3099(22)00422-4. Epub ahead of print. Available from: The Lancet

Statement – Australian Health Protection Principal Committee (AHPPC), 8 July 2022

AHPPC statement on COVID-19 winter update and ongoing health protection measures to support our community

This winter, we are experiencing significant community transmission of both COVID-19 and influenza, which is placing real stress on our community and health system.

We are now beginning to see a new wave of COVID-19 infections, driven by the BA.4 and BA.5 Omicron subvariants.  We expect that this wave will lead to a substantial increase in infections, hospitalisations and sadly, deaths, at a time when our communities and health systems are already under strain. Without increased community and public health actions, this impact may be similar to that experienced during the BA.1 wave in January this year.

BA.4 and BA.5 are associated with increased immune escape and we are likely to see rates of reinfection rise among those who have previously been infected with an earlier COVID-19 variant and those who are up to date with their vaccinations.  Vaccination continues to be the most important protection against severe illness.

Given reinfections may occur as early as 28 days after recovery from a previous COVID-19 infection, the AHPPC advises that the reinfection period be reduced from 12 weeks to 28 days.  People who test positive to COVID-19 more than 28 days after ending isolation due to previous infection should be reported and managed as new cases.

The AHPPC reiterates the shared responsibility of individuals, employers and governments in minimising the impact of COVID-19. There are a range of health behaviours all Australians can undertake to reduce the transmission of COVID-19, protect the community, in particular those most at risk, and protect our health system and essential services, such as:

  • Staying up to date with your vaccinations
  • Wearing a mask outside your home when in crowded, indoor environments including on public transport.  This is important to protect yourself and others.
  • Ensuring indoor spaces are well ventilated
  • Staying home if you have any COVID-19 symptoms, no matter how mild, and get tested
    • If you have any symptoms, are at higher risk of severe illness and have a negative Rapid Antigen Test (RAT) result, seek a PCR test to confirm whether or not you have COVID-19 so you can access oral treatments for COVID-19 if eligible.
  • Not attending high-risk settings such as health care (unless seeking treatment), aged care and disability settings or correctional facilities if you have any symptoms of COVID-19, no matter how mild
  • Employers should review their occupational health and safety risks and mitigations, and their business continuity plans.  They should consider the feasibility of some employees working from home and support employees to take leave when sick.
  • Practising good respiratory and hand hygiene
  • Staying up to date with jurisdictional public health requirements and information

Treatment is now available for eligible people with COVID-19. Information can be found at Oral treatments for COVID-19 or speak to your GP now to see if you are eligible for oral treatments should you become infected. Oral treatments can assist in preventing severe disease in people at higher risk.

All of these actions become important during significant waves of COVID-19.  If all Australians continue to work together, through early and collective actions, the impact of the BA.4/BA.5 wave can be reduced.  Now is the time for all of us to act to protect ourselves, our loved ones, the health system, those who are more at risk and the broader community.

Media release – Dr Rosalie Woodruff MP, Greens Health spokesperson, 9 July 2022

Rockliff Must Follow ATAGI and AHPPC Advice, as Tasmania Hits 200,000 Covid Cases

Tasmania’s Covid case numbers topped 200,000 yesterday, another grave milestone in the ongoing pandemic. Combined with yesterday’s AHPPC revised health advice about the timing of Covid reinfection, it is continuing evidence the pandemic is not over, despite a conga line of politicians wishing it to be so.

The latest AHPPC advice – to state governments, healthcare workers and the community – is that a person can be reinfected with Covid after just 4 weeks, instead of 12. This is welcome, overdue, advice that substantially lags research and the evidence from other countries.

AHPPC recommends people wear a mask outside the home in crowded indoor environments.

The federal vaccine advisory group, ATAGI, also advises other public health measures, in addition to vaccination, will have the greatest impact against the Omicron BA.4 and BA.5 surge in infections. They too recommend the increased use of the masks.

The Morrison Liberals roundly silenced public health voices during the federal election campaign, and the results for Australians have been devastating. Covid is now a leading cause of death in the country, and two in five Tasmanians have been infected with the virus.

The current wave of Covid subvariants, BA.4 and BA.5, are highly infectious and able to escape vaccine and immunity defences. In Tasmania daily case numbers are trending over 1500, and the NW Regional Hospital and LGH are at level 3 of their COVID-19 Management Escalation Plans, with elective surgeries expected to be delayed.

The Liberals opened Tasmania’s borders in December and it took 4 months for 100,000 Tasmanians to become infected with a virus that increases the risk for serious long-term health effects. The second 100,000 infections have taken just 3 months.

Throughout this time, the Tasmanian Liberals have refused to implement the most effective measure to protect Tasmanians from mass infection with a potentially deadly and disabling virus – universal indoor mask wearing.

The Tasmanian Department of Health has changed online advice to reflect the AHPPC statement that Covid reinfection can occur at 28 days.

The Premier and Minister for Health, Jeremy Rockliff, must also reflect the full ATAGI and AHPPC advice, and announce that masks are required in all crowded indoor settings, and in medical settings and services accessed by vulnerable people.