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

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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