COVID vaccine deferral cut to four-month maximum

The Australian Technical Advisory Group on Immunisation (ATAGI) has reduced the length of time people can temporarily defer COVID-19 vaccination in the event of prior infection.
 
The time limit for temporary medical exemptions due to previous infection with SARS-CoV-2 now stands at four months, having previously been six months.
 
Infection needs to be proved with a PCR test.
 
The group cites the heightened transmissibility of Omicron as the reason behind the change, with those infected with the Delta strain now more likely to contract COVID-19 again.
 
‘This is due to the increased risk of re-infection with the Omicron variant, particularly for those who had a Delta variant infection in 2021,’ ATAGI said in an update published on Monday (24 January) following a meeting on 19 January.
 
The group does not recommend deferring vaccination for this amount of time but simply notes that it is possible.

‘ATAGI continues to advise that previous infection is not a contraindication to vaccination and that vaccination can occur following recovery of acute illness from COVID-19,’ the ATAGI statement reads.
 
‘Those with prolonged symptoms of COVID-19 should be vaccinated on a case-by-case basis.’
 
It says vaccinators should also ensure any temporary medical deferral recorded on the Australian Immunisation Register (AIR) not be for longer than four months.
 
Anecdotally, newsGP is aware of a number of general practices being approached for exemptions due to prior infection, including GPs being threatened when exemptions are refused.
 
Some have expressed fears temporary medical exemptions are being used by anti-vaccination patients looking for a loophole to avoid vaccine mandates.
 
One GP has reported patients using health department messages after lodging positive rapid antigen tests (RATs) as proof they have been COVID positive.
 
While some state governments are now accepting RATs for COVID-19 diagnosis, ATAGI’s guidance continues to require a PCR test as proof of infection – a guideline likely to deter attempts to manipulate a positive result for the sake of a temporary exemption.
 
The updated ATAGI advice on vaccine exemptions does not include any further guidance on the recommended wait after COVID-19 for a booster injection.
 
At present the advice is simply that vaccination be deferred 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 [the] next dose until they have recovered from the acute illness,’ the latest clinical guidance reads.
 
Associate Professor Margie Danchin of the Murdoch Children’s Research Institute (MCRI) has previously written that a wait for a booster of ‘at least three months’ post recovery is worth considering ‘based on vaccinology principles’.
 
However, she also said a shorter timeframe should be considered for those at higher medical risk, as well as those in workplaces with higher risk of COVID-19 exposure, and people whose industries have imposed booster vaccine mandates. 
 
ATAGI has also recently clarified its advice surrounding the interval between COVID-19 doses for children at higher risk, including those with underlying conditions.
 
The recommended interval between doses is eight weeks but ATAGI says this can be brought forward in particular situations for specific patients.
 
‘The interval can be shortened in special circumstances to a minimum of three weeks, for higher risk groups [such as those with medical risk factors for severe illness] in the context of ongoing community transmission,’ ATAGI stated.
 
In another update, all age groups of severely immunocompromised patients, now including children aged 5–11 years, are recommended to have three doses as part of a primary vaccination course.
 
The ATAGI primary dose guidance was updated earlier this month to include severely immunocompromised children in the youngest age group eligible for vaccination. The recommended interval for a third primary dose is 2–6 months after a second dose.
 
A fourth booster dose is now also advised for those with weakened immune systems aged 18 and older, in line with the rest of the population.
 
The full ATAGI advice on temporary medical exemptions, which was last updated on 24 January, is available on the Department of Health website.
 
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