ACT clinicians

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.

COVID-19 vaccination for children 5 to 11 years

ATAGI recommends vaccination with the paediatric Pfizer COVID-19 vaccine for all children aged 5-11 years.

Children aged 5-11 years with medical risk factors for severe illness, Aboriginal and Torres Strait Islander children, and children living in crowded conditions or outbreak areas are most likely to benefit from COVID-19 vaccination given their increased risk of severe outcomes and/or exposure.

Children aged 5-11 years who have previously had SARS-CoV-2 infection can receive the paediatric Pfizer COVID-19 vaccine. This is recommended following recovery from their illness or vaccination can be deferred for up to 6 months. This includes children with a past history of PIMS-TS or post COVID-19 condition (‘long COVID’).

Schedule

ATAGI recommends a 2 dose schedule for the 5-11 year old cohort of Comirnaty (Pfizer), 8 weeks apart. The interval can be shortened in special circumstances to a minimum of 3 weeks, for higher risk groups (such as those with medical risk factors for severe illness) in the context of ongoing community transmission.

Children who turn 12 after their first dose may receive the adolescent/adult formation of the Pfizer COVID-19 vaccine to complete their primary vaccine course.

ATAGI recommends against use of the adolescent/adult Pfizer COVID-19 vaccine formulation in children aged 5-11 years.

Severely immunocompromised children aged 5-11 years

Severely immunocompromised children aged 5-11 years, are now recommended to have three doses as part of the primary vaccine course.

The third primary dose guidance has been updated to include children aged 5 years and older.

The recommended interval for the 3rd primary dose is 2 to 6 months after the 2nd dose of vaccine.

See the following resources for more information:

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 emergency directions, people will be required to provide evidence of their COVID-19 vaccination status, or of an authorised exemption to vaccination.

All medical contraindications and temporary 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 the COVID-19 vaccine.

Medical exemptions may be considered for:

  • 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 up to six months
  • a person who has a medical reason that exempts them from COVID-19 vaccination for a temporary period.

Exemptions cannot be granted on religious, political or personal grounds.

The ACT medical contraindication or temporary exemption to COVID-19 vaccination form can be completed for individuals who require a medical exemption in order to comply with a public health emergency direction.

Please note: this form is not intended to replace the Australian Immunisation Register (AIR) immunisation medical exemption form.

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.

The COVID-19 vaccine medical contraindication or temporary exemption form is available here.

More information is available in the ACT COVID-19 vaccination exemption policy.

Patients with severe needle phobia or other barriers to vaccination

People with severe needle phobia or other barriers to receiving a COVID-19 vaccination can be referred to the specialist COVID-19 vaccination service.

Referrals will be reviewed and the individual will be contacted to discuss a range of options to determine the best approach to vaccination.

This may be through the special vaccination clinic or other options within our services.

Referrals can be sent to:

The referral must include:

  • the rationale for the request
  • medical history

Anaphylaxis or specific allergies related to the COVID-19 vaccine

A dedicated COVID-19 vaccine allergy clinic at the Canberra Hospital runs monthly for individuals with anaphylaxis or severe allergies.

This 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:

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, including consideration for vaccination at the specialist COVID-19 vaccination service at the AIS COVID-19 mass vaccination clinic.

Patients 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.

Refer to the COVID-19 vaccination – ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021 for further information on specific allergies.

Use of a different COVID-19 vaccine as the second dose

ATAGI recommends using the same COVID-19 vaccine for the two doses of the primary vaccination course, if available.

While the same brand for the two doses of the primary vaccination course is preferred and supported by a strong evidence base, an alternative vaccine brand can be given in select circumstances, including if a patient is unable to access or not accepting of a second dose of the same brand.

Emerging data supports the safety, immunogenicity and effectiveness of mixed brand schedules.

See the following resources for more information:

Booster doses of COVID-19 vaccine

Booster doses are available to everyone 18 years and over, including pregnant women, who have had both doses of their primary course of a COVID-19 vaccine.

In addition, severely immunocompromised individuals aged 18 years and over who have received 3 doses are recommended a booster dose (fourth dose) 3 months after their third dose.

ATAGI is not currently recommending booster doses for people less than 18 years of age.

Comirnaty (Pfizer) and Spikevax (Moderna) is recommended as a single booster dose, irrespective of the primary COVID-19 vaccine used.

Although not preferred, Vaxzevria (AstraZeneca) can also be used as a booster dose in the following situations:

  • for individuals who have received Vaxzevria (AstraZeneca) for their first two doses, if there are no contraindications or precautions for use.
  • if a significant adverse reaction has occurred after a previous mRNA vaccine dose which contraindicates further doses of mRNA vaccine (for example, anaphylaxis, myocarditis).

Third primary dose of COVID-19 vaccine for individuals who are severely immunocompromised

ATAGI recommends that all individuals aged ≥5 years with certain conditions or on therapies leading to severe immunocompromise, receive a third primary dose of a COVID-19 vaccine.

The recommended interval for the third dose is 2 to 6 months after the second dose of vaccine.

A minimum interval of 4 weeks may be considered in exceptional circumstances (for example, anticipated intensification of immunosuppression or outbreaks).

If an immunocompromised person has received their second dose more than 4 months ago, they should receive a third dose as soon as feasible.

A third primary dose of COVID-19 vaccine in severely immunocompromised populations is recommended to address the risk of suboptimal or non-response to the standard 2 dose schedule.

Conditions for which a third primary dose is recommended are defined in the ATAGI recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised.

In addition, severely immunocompromised individuals aged 18 years and over who have received 3 doses are recommended a booster dose (fourth dose) 3 months after their third dose. Booster doses are not currently recommended for individuals under 18 years of age.

ATAGI have produced guides to help providers:

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:

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).

Further information on reporting adverse events following immunisation is available on the ACT Health website.

Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines

COVID-19 vaccination – Guidance on Myocarditis and Pericarditis after mRNA has been developed jointly by the Australian Technical Advisory Group on Immunisation (ATAGI) and the Cardiac Society of Australia and New Zealand (CSANZ).

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.

Timing between doses of the AstraZeneca COVID-19 vaccine

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.

Read the COVID-19 vaccine doses and administration.

Pregnancy and getting the COVID-19 vaccine

The risk of severe outcomes from COVID-19 infection are significantly higher for pregnant women and their unborn baby.

Therefore pregnant women should be routinely offered Pfizer mRNA vaccine (Comirnaty) or Spikevax (Moderna) at any stage of pregnancy.

Guidance around administering the COVID-19 vaccine in pregnancy, including recommendations for women who have already received a dose of AstraZeneca COVID-19 vaccine is available on the following links:

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.

Pregnant women with severe immunocompromise are recommended to receive a third primary dose of a COVID-19 vaccine.

Pregnant women aged 18 years or older who completed a 2 dose primary schedule are recommended to receive a booster dose 3 months after their second dose.

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.

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Acknowledgement of Country

We acknowledge the Traditional Custodians of the ACT, the Ngunnawal people. We acknowledge and respect their continuing culture and the contribution they make to the life of this city and this region.

Last Updated: January 20 2022