What ‘up-to-date’ vaccination status means for GPs

The Australian Technical Advisory Group on Immunisation (ATAGI) has published new guidance, designed to bring COVID-19 vaccination more into line with other inoculation programs.
 
The group flagged a move away from the phrase ‘fully vaccinated’ towards defining vaccination status as either ‘up to date’ or ‘overdue’.
 
The significant change means all those aged 16 and older will be deemed ‘overdue’ if they do not receive their booster shot within six months of a second dose of their primary vaccination course.
 
The new recommendations, which were approved by National Cabinet on Thursday (10 February), will be used by the Australian Immunisation Register (AIR).
 
The Chair of ATAGI, Associate Professor Nigel Crawford, told the Federal Parliament’s Select Committee on COVID-19 earlier this month the change would make the vaccination program more consistent.
 
‘We think the best terminology is actually “up to date with vaccination status”, rather than “fully vaccinated”,’ he said.
 
‘That’s a term that we’ve used in the childhood program.
 
‘Essentially, as you have your children get vaccinated, we say, “Are you up to date with your immunisations?” at a certain age or a point in time.
 
‘As those vaccines become due, you will then get a report to say: “You’re up to date with your vaccines. Please come forward in 18 months to get those doses that are recommended.”’
 
AIR limitations
Associate Professor Crawford also flagged complications over the status for immunocompromised residents.
 
ATAGI currently recommends severely immunocompromised people aged five and above have three COVID-19 vaccine doses for their primary course. No booster recommendations are yet in place for children aged 5–15, both immunocompromised and otherwise.
 
Those with weakened immune systems older than 16 need three primary doses and a booster to be considered up-to-date clinically.
 
This nuance will be unclear on the AIR, ATAGI has stated.
 
‘However, because the AIR does not contain any record of medical conditions, such individuals will only be assessed under the AIR as up-to-date based on receipt and timing of three vaccine doses [or two if (they) received Janssen initially] as for people who are not immunocompromised,’ the guidance reads.
 
The statement does, however, flag that future changes are expected. 
 
‘COVID-19 vaccine up-to-date status will likely need to be modified over time, with the ATAGI recommendations based on future changes in disease epidemiology and as new evidence becomes available regarding booster doses, including those that may be specifically targeting variants of concern,’ it reads.
 
Under existing guidelines, boosters can be administered following a three-month gap after a final COVID-19 vaccine primary course dose, with a two-month timeframe possible in certain circumstances.
 
The group also states that boosters can be ‘safely and effectively’ administered at any point after six months if undelivered previously to allow individuals to become up to date.
 
In its rationale for the decision, ATAGI said boosters ‘will increase protection against symptomatic infection and this should lead to a parallel increase in protection against transmission, therefore providing some indirect protection to the wider population’.
 
Individuals who have had COVID-19 are still advised to complete their vaccination schedule, ATAGI states.
 
The advisory group also notes the concept of being ‘up to date’ could be different to the term ‘fully vaccinated’ in use for public health orders or border control, quarantine and workplace settings.
 
‘These applications may involve legal and policy implications and are not within the remit of ATAGI but should be considered in the implementation of this advice,’ their statement reads.
 
Push for vaccination among high-risk population
ATAGI in particular emphasises the importance of people who are at risk of severe disease being up to date with their immunisations.
 
The advice mentions older people, those with underlying medical conditions, as well as employees within healthcare and aged care environments where limiting transmission is particularly critical.
 
Currently three vaccines have been provisionally approved for boosters, with Pfizer and Moderna stated as the preferred vaccines.
 
This week AstraZeneca was also approved for those who had no contraindications after their primary course, or those who had serious adverse effects after an mRNA dose.
 
According to the latest government statistics, there have been 9,727,513 booster vaccine doses delivered so far in Australia.
 
As of 31 January, Federal Health Minister Greg Hunt stated there were 16 million people eligible for boosters in Australia. With more people having become eligible since, it is likely around seven million eligible Australians are yet to receive one.
 
ATAGI has recommended its new guidance be implemented from the end of March.
 
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