A summary of COVID-19 vaccine clinical resources is available on the Australian Government website.
For public health alerts and advisories relating to COVID-19 and other threats to the health and wellbeing of Canberrans, see the ACT Chief Health Officer alerts.
Medical contraindications or temporary exemptions to COVID-19 vaccination
COVID-19 vaccination has become a mandatory condition of employment for some workforces and situations in the ACT.
In these situations and under public health orders, people will be required to provide evidence of their COVID-19 vaccination status, or of an authorised exemption to vaccination.
There may be occasions or exceptional circumstances whereby an individual is unable to fulfil the requirement to receive a COVID-19 vaccination.
There are very few situations where a vaccine is contraindicated.
As such medical exemptions are expected to be rarely required.
Examples of reasons to complete the ACT medical contraindication or temporary exemption to COVID-19 vaccination form include:
- a person who is unable, due to a medical contraindication, to receive a COVID-19 vaccination
- a person who has recently recovered from an acute COVID-19 infection and is choosing to defer their next COVID-19 vaccination for six months
- a person who has a medical reason that exempts them from COVID-19 vaccination for a temporary period.
All temporary and permanent medical exemptions must be authorised by a medical practitioner and be in accordance with established ATAGI clinical guidance and ATAGI Expanded guidance on temporary medical exemptions for COVID-19 vaccine.
The form should be provided to the individual for them to follow up the relevant exemption process required for their situation.
We recommend that a copy is also saved to the individual’s medical record.
Exemptions cannot be granted on religious, political or personal grounds.
The COVID-19 vaccine medical contraindication or temporary exemption form is available here.
The completed form should be returned to the patient.
Please note: this form is not intended to replace the Australian Immunisation Register (AIR) immunisation medical exemption form.
More information in the ACT COVID-19 vaccination exemption policy.
Anaphylaxis or specific allergies related to the COVID-19 vaccine
A dedicated COVID-19 vaccine allergy clinic at the Canberra Hospital runs monthly to assess suitability of COVID-19 vaccinations.
The COVID-19 vaccine allergy clinic assesses any patient who has had:
- an anaphylactic reaction to a COVID-19 vaccination
- immediate (within 4 hours) and generalised symptoms of a possible allergic reaction to a previous dose of a COVID-19 vaccination
- generalised allergic reactions to polyethylene glycol (PEG) or polysorbate 80 in the past, including medications used for bowel preparation, steroid joint injections
- a prior history of anaphylaxis to vaccines or multiple drugs where polysorbate 80 or PEG may have been the cause.
Referrals should be directed to the Department of Immunology at the Canberra Hospital, by:
- fax (02) 5124 5500
- phone (02) 5124 2415 (option 2 to speak to a nurse), or
- email email@example.com
The referrals should include:
- for allergic and anaphylactic reactions to COVID-19 vaccines
- vaccine type
- date of reaction
- copy of adverse event following immunisation (AEFI) notification, if available
- treatment required
- copy of any discharge letter from treating hospital
- vital signs taken at the time of reaction
- a copy of any blood tests, in particular tryptase levels for suspected anaphylaxis
- for previous allergic reactions to vaccine components PEG or polysorbate 80
- a list of implicated medications
- copy of any letters from previous specialist review
- list of vaccinations given without incident
Following the review of the referral, advice about COVID-19 vaccination will be provided.
People with a history of severe allergy to foods, venom or medications, including latex, that don’t contain the listed excipients should be able to be vaccinated in the community.
Reporting an adverse event following immunisation (AEFI)
An adverse event following immunisation (AEFI) is any untoward medical event that occurs after a vaccination has been given which may be related to the vaccine itself or to its handling or administration.
A conclusion regarding a causal relationship with the vaccine is not necessary to suspect or report an AEFI.
An AEFI is a notifiable condition under the ACT Public Health Act (1997).
All uncommon, unexpected or serious AEFI, or any event considered to be significant following immunisation, must be notified by medical practitioners or other health professionals to:
- the ACT Health Immunisation Unit on (02) 5124 9800 (Monday-Friday, 8.30am-4.30pm)
- online using the Immunisation adverse event reporting form (online form) or
- fax and/or email using the COVID-19 Vaccine Adverse Event Following Immunisation Reporting Form.
Routine notifications can be made during business hours.
For urgent advice after hours, contact the Immunisation Unit on (02) 5124 9800 and follow the prompts.
All notifications of AEFI received by ACT Health will be reported on to the Therapeutic Goods Administration (TGA).
Referring a patient for a different COVID-19 vaccine as the second dose to an ACT Government COVID-19 vaccination clinic
ATAGI recommends to use the same COVID-19 vaccine for the two doses of the primary vaccination course, unless there are specific medical contraindications or precautions, or the same vaccine brand is not available in Australia.
Please refer to this advice which explains:
- the medical contraindications and serious vaccine-attributable adverse events after dose 1 of a COVID-19 vaccine that warrant using an alternative vaccine brand for dose 2
- the medical conditions that mean that an mRNA vaccine (Comirnaty or Spikevax) is recommended over COVID-19 Vaccine AstraZeneca
- the recommendations for completing the primary vaccination course for people who have received dose 1 with a vaccine that is not available in Australia.
GP immunisation providers are encouraged to follow the ATAGI guidance, seeking advice from relevant specialist clinicians when required (for example, cardiologist, haematologist, neurologist), and provide the relevant vaccine accordingly.
If an individual has one of the above specific reasons for an alternate dose and needs a booking at one of the ACT Government COVID-19 vaccination clinics, they can be referred via the following pathway:
- Email: firstname.lastname@example.org or
- Fax: 02 5124 3222
The referral must include:
- the rationale for the request for an alternative vaccine, based on the ATAGI guidelines.
- confirmation an AEFI report has been made, and the content of that report
- medical history
Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines
Guidance has been developed jointly by the Australian Technical Advisory Group on Immunisation (ATAGI) and the Cardiac Society of Australia and New Zealand (CSANZ) COVID-19 vaccination – Guidance on Myocarditis and Pericarditis after mRNA
mRNA vaccines for people over 60
Everyone aged 12 years and over can now book in for an mRNA vaccine now: Comirnaty (Pfizer) or Spikevax (Moderna) vaccine.
In addition, Comirnaty (Pfizer) or Spikevax (Moderna) vaccine is also recommended for people 12 years and above with:
- a past history of cerebral venous sinus thrombosis (CVST)
- a past history of heparin-induced thrombocytopenia (HIT)
- a past history of idiopathic splanchnic (mesenteric, portal and splenic) venous thrombosis
- anti-phospholipid syndrome with thrombosis
- a history of certain reactions to the first dose of the AstraZeneca vaccine, for example:
- anaphylaxis to a previous dose of AstraZeneca vaccine, or to an ingredient of the vaccine
- thrombosis with thrombocytopenia occurring after the first dose of AstraZeneca vaccine
- other serious adverse events attributed to the first dose of the AstraZeneca vaccine
COVID-19 vaccine ingredients are listed in the TGA consumer medicines information (CMI) and product information (PI) for:
If your patient has booked an appointment but haven’t had their first dose of AstraZeneca vaccine yet, they can cancel it and book an appointment for the Pfizer or Moderna instead.
If your patient has had a first dose of a different COVID-19 vaccine it is not recommended to switch COVID-19 vaccines.
Further information can be found at Australian Government website and the National Centre for Immunisation Research and Surveillance (NCIRS).
Timing between doses of the AstraZeneca COVID-19
The AstraZeneca vaccine requires 2 doses.
In non-outbreak settings, it is recommended that AstraZeneca doses should be 12 weeks apart to provide the most effective clinical protection.
In outbreak settings, the recommended interval between the first and second doses of the AstraZeneca COVID-19 vaccine is between 4 and 8 weeks.
The ACT is currently experiencing a COVID-19 outbreak.
People who had their first dose of AstraZeneca COVID-19 more than 4 weeks ago should contact their vaccine provider to arrange their second dose as soon as possible.
Thrombosis with thrombocytopaenia (TTS) and pathways for advice and investigation in the ACT
Thrombosis with thrombocytopenia syndrome (TTS) is a newly described serious condition, with unusual blood clots in the brain (cerebral venous sinus thrombosis) or in other parts of the body, associated with low platelet levels after vaccination with COVID-19 vaccine AstraZeneca.
This condition is also being referred to as ‘vaccine induced immune thrombotic thrombocytopenia’ (VITT) or ‘vaccine induced prothrombotic immune thrombocytopaenia’ (VIPIT).
Clinicians should be alert to any new, severe, persistent headache or other significant symptoms, such as severe abdominal pain with an onset between 4 to 42 days after vaccination with COVID-19 Vaccine AstraZeneca.
For cerebral venous sinus thrombosis ‘red flag’ features include new onset of severe persistent headache that is not settling with analgesia.
Patients may also present with features of raised intracranial pressure (acute severe headache, vomiting, confusion), focal neurological deficits and/or seizures.
In the ACT, discuss urgently with haematology at The Canberra Hospital any patient presenting within 42 days of vaccination with features suggestive of thrombosis in any body system and assess urgently for thrombocytopaenia and elevated D-dimers.
The Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) have an advisory statement, including investigation algorithms, for clinicians that is being updated regularly.
Further information for health professionals outlining a primary care approach for identifying, diagnosing and treating TTS after the COVID-19 AstraZeneca vaccine is available on the Australian Government Department of Health website.
Pregnant people getting the COVID-19 vaccine
On June 9, ATAGI and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) released a joint statement about COVID-19 vaccination for pregnant women.
The Joint statement recommends that pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) or Spikevax (Moderna) at any stage of pregnancy because the risk of severe outcomes from COVID-19 are significantly higher for pregnant women and their unborn baby.
Guidance around administering the COVID-19 Vaccine in pregnancy, including recommendations for women who have already received a dose of COVID-19 vaccine AstraZeneca is available on the following links:
- COVID-19 vaccination – shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy.
- COVID-19 Vaccination in Pregnant and Breastfeeding Women and those planning pregnancy
If you have a patient who is pregnant and has already received AstraZeneca COVID-19 vaccine as a first dose, you may recommend the Pfizer (Comirnaty) or Moderna (Spikevax) COVID-19 vaccine for their second dose.
To do this, ACT clinicians can fax us on 02 5124 3222 or email email@example.com with the following information:
- patient name
- date of birth
- contact phone number
- Medicare number (if applicable)
- Recommendation to change vaccine type for second dose during pregnancy, including preferred timeframe for this
Your patient will be contacted directly on the phone number provided to make a vaccine appointment.
Please note that this may take up to 15 business days.
Pregnant women who have not yet had a COVID-19 vaccine can book a priority appointment for a Pfizer (Comirnaty) COVID-19 vaccine at an ACT Government COVID-19 mass vaccination clinic through the usual booking process.
Access and Sensory Clinic
The Access and Sensory COVID-19 vaccination clinic has been set up to provide greater access for people with disability or mental health conditions, or those who need extra support, to book in for a Pfizer COVID-19 vaccination.