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How long should patients wait for a booster after COVID infection?


Jolyon Attwooll


19/01/2022 4:44:43 PM

The question is likely to be asked more frequently as infections spread and millions more become eligible for booster vaccinations.

Nurse administering Pfizer vaccine
Millions of adult Australians are now eligible for a COVID-19 vaccine booster dose. Picture: AAP Photos.

Most people over the age of 18 in Australia are now eligible for a booster dose.
 
According to the Department of Health (DoH), there would have been more than 16 million adults eligible for a booster under the original plans to shift the minimum interval from four months to three months on January 31.
 
On Wednesday (19 January), however, authorities in NSW, Victoria and South Australia announced they are fast-tracking a third dose for those with a three-month gap. It takes place with immediate effect in Victoria and South Australia and from Friday (21 January) in NSW. 
 
The shortened interval is in line with advice from the Australian Technical Advisory Group on Immunisation (ATAGI), which recommends that boosters be provided to all eligible adults from a minimum of three months following the primary course ‘as soon as practicalities allow’.
 
The DoH has confirmed to newsGP that ‘all primary care vaccination sites may also provide boosters at three months if there are appointments available.’
 
However, as infections spread rapidly in most states, the number of cancelled boosters and re-bookings is also likely to rise substantially.
 
General practices are already fielding queries about when a booster shot should be rescheduled following infection. GPs are also highly likely to be asked whether a booster shot is necessary at all if a patient has been double-vaccinated and subsequently infected with COVID-19.
 
ATAGI is understood to be reviewing guidelines on when vaccination should take place after COVID-19 infection, with an update expected soon.
 
What is the current official advice?
A booster vaccination is still recommended even if a patient has had COVID-19 and a two-dose primary vaccine course.
 
Currently, ATAGI does not state a specific waiting time, simply recommending a wait until acute infection is over.
 
‘If a patient tests positive for COVID-19 between their first and second doses, or between their second and booster dose, the patient should delay next dose until they have recovered from the acute illness,’ the guidelines state.
 
In guidance released for the ‘booster blitz’, the Victorian Department of Health also advises people who have had COVID-19 to have their booster ‘as soon as symptoms subside’.
 
However, in The Conversation this month, Associate Professor Margie Danchin of the Murdoch Children’s Research Institute (MCRI) wrote that it would be worth considering a wait of ‘at least three months’ following recovery ‘based on vaccinology principles’.
 
She also highlighted a lack of current information on how much protection previous infection with the Omicron variant is likely to provide.
 
‘Vaccination can also be deferred for up to six months if preferred, as past infection does reduce the chance of reinfection for at least this amount of time, but there is still much we don’t know about the Omicron variant,’ she wrote.
 
‘With Omicron, the duration of protection from natural immunity is unclear.’
 
Associate Professor Danchin suggested a gap of 3–6 months post recovery from COVID-19 as appropriate for many people who have had a primary vaccination course.
 
However, she also advised a shorter timeframe of a few weeks after recovery could be considered for patients in the following categories:
 

  • Those with underlying health conditions who are at higher medical risk
  • Those whose workplaces mean they are higher risk of exposure to COVID-19
  • Those whose work industries have booster mandates in place

Editor's note: this article was amended on 20 January to reflect the correct age for booster eligibility. 


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Dr Vikram Anand   20/01/2022 8:21:56 AM

Lot of antivaxer with recent COVID inf are coming for 6 mth vaccine exemption.
Exemption period should be reduced to 2 to 3 months max.


Dr Alan Graham MacKenzie   20/01/2022 9:52:34 AM

There are 2 issues .1 Medical the other Political.
If we have 80000 people infected per day who are advised to defer their booster that is 2.5 million a month .
This will affect the % vaccinated immensely and politically be unacceptable
Therefore the Politicians and Quasi Government “Advisory Boards “ will urge us to vaccinate as soon as possible after infection ,whether it is medically best practice or not.


Dr Anthony Cletus McCarthy   22/01/2022 8:14:47 AM

Another increasingly asked question is when I should have my fourth booster, as these are coming up frequently for many people if the interval is 3 months.

If infection is not going to provide any subsequent immunity, even after vaccination, which seems the premise of present policy, we seem to be dealing with a very novel situation, and urgent direction about further boosters is necessary.


Dr Rama Krishnan   12/02/2022 12:46:14 PM

Is there any hard medical evidence to show that double vaccinated and corona infected patients need the third booster dose? If I remember it correctly from recent California studies, primary double vaccination plus Corona infection gives the best immunity . People in this group are least likely to be admitted to hospitals and ICU. When do the booster vaccinations stop? Or it doesn’t stop at all? Israel is going for the fourth booster. Will 5th, 6th dose will follow??? Is there light at the end of the tunnel or are we only groping in the dark? Just wondering!


Dr Shannon Dean Marsh   26/02/2022 8:14:59 AM

A recent study published in the lancet offers a median of 16 months that natural immunity provides. The range is from 3 months to over a few years. Some non-peer reviewed studies have come up with evidence that Ab response to at least two non- spike Covid proteins still there in adequate levels to confer immunity after 18 months as well. I think it’s hard to find the truth when the answer we want has so many political consequences, i can see that science is being forsaken for political gain on both sides of the freedom vs safety debate. I think the answer lies in past practice with things we know to be true like the inextricable link smoking has with lung/ throat/ bowel cancer, using the same ethics for mandates we should have outlawed smoking for individuals by now, and should be rationing EtOH to everyone who has that proclivity as well. We could consider conditions of their employment that they demonstrate they are totally free from smoking, drinking and sedentary lifestyles.