Australia’s trusted independent immunisation experts

COVID-19 vaccination - summary for immunisation providers

For health professionals

 

This page provides an all-in-one-place summary of new and updated information and advice on COVID-19 vaccines and vaccination program to assist immunisation providers. Each section contains links to further detailed information. We will be updating this page as new information becomes available. (Last updated: 3 August 2021)

You can also download a PDF version of this resource here. (You will need an Adobe Acrobat Reader to view this file.)
 

Also see - NCIRS COVID-19 vaccines: Frequently asked questions for answers to most commonly asked questions. The FAQs are updated regularly.

 

Latest advice - as at 2 August 2021

Current ATAGI clinical advice - 30 July 2021

  • What's new
    • The Pfizer vaccine is recommended for children aged 12–15 years with medical conditions that increase their risk of severe illness; all Aboriginal and Torres Strait Islander children aged 12–15 years and all children aged 12–15 years in remote communities as part of outreach vaccination programs.
    • Additional medical conditions relevant to adolescents have been added to the list of ‘Conditions associated with increased risk of severe COVID-19'.
    • Mixed vaccination schedules are recommended in special circumstances, including in some returned travellers and in those who have had a serious vaccine-attributed adverse event following a first dose.
    • Myocarditis and pericarditis have been rarely reported after the Pfizer vaccine. People who develop myocarditis or pericarditis after the Pfizer vaccine should defer further doses of this vaccine and discuss this with their treating doctor.
    • People with a past history of inflammatory cardiac illness, such as myocarditis, pericarditis, endocarditis; acute rheumatic fever; complex or severe congenital heart disease; acute decompensated heart failure or a history of cardiac transplant, can receive the Pfizer vaccine. However, consultation with a cardiologist is recommended as a precaution before vaccination.
    • A history of capillary leak syndrome is a new contraindication to the AstraZeneca vaccine.
    • Immune thrombocytopenia, Guillain–Barré syndrome and capillary leak syndrome have been reported after AstraZeneca vaccine.
    • Precautions are required for people with a history of confirmed mastocytosis with recurrent anaphylaxis. Patients with other mast cell disorders can be vaccinated without special precautions.

    Related resource: ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021

  • Key recommendations
    • COVID-19 vaccination is recommended for all people aged ≥16 years to protect against COVID-19.
    • ATAGI currently recommends that children aged 12–15 years who have specified medical conditions; all Aboriginal and Torres Strait Islander children aged 12–15 years; and all children aged 12–15 years in remote communities be prioritised for vaccination. 
    • The Pfizer vaccine is preferred over the AstraZeneca vaccine in people aged <60 years on the basis of the higher risk and observed severity of thrombosis and thrombocytopenia syndrome (TTS). However, the AstraZeneca vaccine can be used in adults aged <60 years if the person has made an informed decision based on an understanding of the risks and benefits. In outbreak settings, adults aged <60 years should strongly consider taking the AstraZeneca vaccine if they are unable to access the Pfizer vaccine.
    • COVID-19 vaccine is recommended for people who are immunocompromised because of their increased risk of severe illness with COVID-19.
    • Pregnant women should be routinely offered the Pfizer vaccine at any stage of pregnancy. Women who are breastfeeding or who are planning pregnancy are also recommended to receive the Pfizer vaccine.
    • Past infection with SARS-CoV-2 is not a contraindication to vaccination; however, it is recommended that vaccination be deferred for up to 6 months after the acute illness in those who have had PCR-confirmed SARS-CoV-2 infection.
    • The preferred minimum interval between receipt of a COVID-19 vaccine and any other vaccine, including influenza vaccine, is 7 days. A shorter interval (i.e. less than 7 days, including co-administration) is acceptable in some settings.
    • The same COVID-19 vaccine for the two doses of the primary course should be used but there are special circumstances in which an alternate brand may be recommended for the second dose. 

    Related resources:

    ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021

    COVID-19 vaccination – Clinical advice on the use of a different COVID-19 vaccine as the second dose

     

Thrombosis with thrombocytopaenia syndrome (TTS)

  • Risk of TTS

    For every 100,000 AstraZeneca vaccinations (as at 30 June 2021) 

    Age  Potential harm
    18-29 1.9 blood clots (TTS)*
    30-39 1.6 blood clots (TTS)*
    40-49 5.0 blood clots (TTS)*
    50-59 2.7 blood clots (TTS)
    60-69 1.4 blood clots (TTS)
    70-79 1.8 blood clots (TTS)
    80+ 1.9 blood clots (TTS)

    *estimates of risk are uncertain as rates are based on small numbers of vaccinations in people under 50 in Australia.

    Related resource: Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca

    Total confirmed and probable TTS cases by age and CDS classification (as at 29 July 2021)

    Age, years     Total cases
    <30  1
    30–39 1
    40–49 6
    50–59 22
    60–69 21
    70–79 28
    80+ 11
    All ages 90 (42 men, 48 women)

    Related resource: TGA COVID-19 vaccine safety weekly report

  • Investigation protocol in general practice and non-emergency department settings

    The most common time period for onset of TTS symptoms is 4–30 days after vaccination.

    Consider TTS in anyone presenting with possible thrombosis or thrombocytopenia, 4–42 days after having the AstraZeneca vaccine. A full list of symptoms is available here. 

    Refer suspected cases immediately to emergency if:

    • they are acutely unwell (e.g. neurological deficit, severe abdominal pain, severe bleeding, severe headache that has not responded to analgesia or any other concerning symptoms or sign) 
    • have thrombocytopenia (platelets < 150 x 109/L) or D-dimer ≥ 5 x upper limit of normal 
    • blood tests cannot be performed and reviewed within 6 hours. 

    Initial investigations are:

    • Full blood count – looking for thrombocytopenia (platelets < 150x109/L, noting that the platelet count can initially be normal or fall from a higher baseline  
    • D-dimer – usually raised ≥5 X the upper limit of normal (ULN)

    Typical laboratory findings of TTS are thrombocytopenia (platelets < 150 x 109/L) and very high D-dimer (≥ 5 x ULN).

    Repeat these investigations in 24–48 hours in patients whose results are reassuring but who have persistent symptoms. This includes patients who have been discharged from the emergency department with reassuring results.
     

    Resource:

    Primary care approach to thrombosis with thrombocytopenia syndrome after COVID-19 AstraZeneca vaccine

  • Discussing options for AstraZeneca vaccine

    The AstraZeneca vaccine is very effective in preventing severe disease and death due to COVID-19 in adults of all ages. A single dose of AstraZeneca vaccine partially reduces transmission by around half.

    Three scenarios are detailed in a guide which shows the benefits of vaccination with AstraZeneca vaccine in preventing severe COVID-19 outweigh the potential risks in:

    • older adults in the low exposure risk scenario
    • all adults in the medium and high exposure risk scenarios.

    All individuals aged ≥18 years in Greater Sydney, including adults aged <60 years, should strongly consider getting vaccinated with any available vaccine, including the AstraZeneca vaccine. This is because of the increasing risk of COVID-19 and ongoing constraints of the Pfizer vaccine supply.

    In the context of a COVID-19 outbreak where the supply of Pfizer vaccine is constrained, adults aged <60 years who do not have immediate access to the Pfizer vaccine should re-assess the benefits to them and their contacts from being vaccinated with the AstraZeneca vaccine, versus the rare risk of a serious side effect.

    Related resources:

    Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca

    ATAGI Statement, Response to NSW COVID-19 outbreak 24 July 2021

    ATAGI statement on use of COVID-19 vaccines in an outbreak setting (13 July 2021)

Contraindications (Updated 2 August 2021)

  • Absolute contraindications

    The only absolute contraindications to a COVID-19 vaccine are: 

    anaphylaxis after a previous dose of the same vaccine 

    anaphylaxis to any component of the vaccine, including:

    • anaphylaxis to polyethylene glycol (PEG) for the Pfizer vaccine
    • anaphylaxis to polysorbate 80 for the AstraZeneca vaccine
       

    history of capillary leak syndrome

    thrombosis with thrombocytopenia occurring after the first dose of the AstraZeneca vaccine

    other serious adverse events attributed to the first dose of a COVID-19 vaccine.
     

  • Considerations for dose 2 following a medical contraindication
    • If an individual has a medical contraindication following dose one of a COVID-19 vaccine, an alternative brand should be considered for the second dose.
    • The recommended interval for administration of a second COVID-19 vaccine dose is 4–12 weeks after the first dose. A longer interval is acceptable if the second dose cannot be administered during this time window.

    People should be made aware of the risks and benefits of receiving an alternative vaccine brand for dose two. These people should be aware that there are comparatively less data on the safety and efficacy of mixed vaccine schedules.

    Related resources: 

    ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021

    Advice for people with a contraindication to a second dose of COVID-19 vaccine
     

Anaphylaxis after COVID-19 vaccines

  • Rates of anaphylaxis
    • The observed rate of anaphylaxis after the Pfizer vaccine administration in the United States in early 2021 was 4.7 cases per million doses administered.
    • 89% of cases occurred within 30 minutes of vaccination.
    • The Pfizer vaccine contains polyethylene glycol (PEG), and it is possible that this component is implicated in anaphylaxis. However, anaphylaxis following PEG is reported to be extremely rare (37 case reports between 1977 and 2016). 

    Anaphylaxis to polysorbate 80, which is an excipient in the AstraZeneca vaccine and is also included in many other vaccines, is rare. Anaphylaxis to the AstraZeneca vaccine is rare. The rate of reported anaphylaxis after the AstraZeneca vaccine in Australia appears similar to the overall rate for other vaccines.   

    Related resource: ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021

Myocarditis and pericarditis (updated 2 August 2021)

  • Who may be at risk

    People with a history of any of the following conditions can receive the Pfizer vaccine but advice should be sought from a cardiologist about the best timing of vaccination and whether any additional precautions are recommended: 

    • inflammatory cardiac illness such as myocarditis, pericarditis, endocarditis 
    • acute rheumatic fever 
    • people aged 12–29 years with dilated cardiomyopathy 
    • complex or severe congenital heart disease, including single ventricle (Fontan) circulation 
    • decompensated heart failure 
    • cardiac transplant recipients. 

    Vaccination should be deferred in people with ongoing cardiac inflammation, or an alternative vaccine (e.g. the AstraZeneca vaccine) considered in people aged ≥60 years. People who develop myocarditis and/or pericarditis after receiving the Pfizer vaccine should defer further doses and discuss this with their treating doctor. 

    Related resource: Joint Australian Technical Advisory Group on Immunisation (ATAGI) and the Cardiac Society of Australia and New Zealand (CSANZ) statement 
     

Other medical conditions

  • Immune thrombocytopenia (ITP)
    • The first dose of the AstraZeneca vaccine has been found to be associated with a small risk of immune thrombocytopenia (ITP). 
    • People who develop ITP within 42 days of the AstraZeneca vaccine should consult a haematologist regarding whether to proceed with the second dose using the same or an alternate vaccine, and the timing of the second dose.
       

    Related resource: ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021

  • Guillain-Barre Syndrome (GBS)
    • GBS has been rarely reported after the AstraZeneca vaccine to the Therapeutic Goods Administration (TGA) in Australia and in other countries.
    • It is not yet known whether the vaccine caused these cases of GBS (i.e. a causal association has not yet been found). 
    • The TGA and international regulators are investigating these reports. 
    • GBS was not reported in the clinical trials for the AstraZeneca vaccine.
       

    Related resource: TGA's COVID-19 vaccine weekly safety report 
     

COVID-19 vaccine safety surveillance 

  • AusVaxSafety (as at 25 July 2021)

    AusVaxSafety is conducting comprehensive active safety monitoring of all COVID-19 vaccines being used in Australia. The latest safety surveillance data report on adverse events following dose 1 and dose 2 of both Pfizer and AstraZeneca vaccines for all participants, including Aboriginal and Torres Strait Islander participants. 

    More than 1.8 million participants have reported adverse events following COVID-19 vaccination. Most common adverse events included injection site pain, fatigue, headache and other expected events following immunisations.

    Related resource: AusVaxSafety COVID-19 vaccine safety surveillance

  • Therapeutic Goods Administration

    The TGA is closely monitoring suspected adverse events following vaccination with both COVID-19 vaccines in use in Australia. The latest weekly safety report of the TGA provides detailed information about the reported side effects for COVID-19 vaccines, total adverse event reports, reporting rates per 1000 doses by jurisdiction, and most commonly reported vaccine side effects. 

    The most frequently reported suspected side effects continue to be events that were seen in the clinical trials and are commonly experienced with vaccines generally.
     

    Related resource: TGA COVID-19 vaccine safety weekly report

Symptoms of COVID-19

COVID-19 variants of concern

Vaccine information 

  • Comirnaty and AstraZeneca COVID-19 Vaccine
      Comirnaty (generic name BNT162b2)  COVID-19 Vaccine AstraZeneca
    Sponsor Pfizer Australia Pty Ltd  AstraZeneca Pty Ltd 
    Approval age for use        
        
         		 ≥12 years ≥18 years 
    Presentation           Multi-dose vial without preservative, each vial containing 6 doses in 0.45 mL.   Multi-dose vial without preservative, each vial containing 10 doses in 5 mL.
    Volume/Strength      0.3 mL (30 μg) per dose   0.5 mL per dose     
    Schedule       2 doses, at least 21 days apart  2 doses, 12 weeks apart (minimum 4 weeks apart). Shortened interval of 4 to 8 weeks is recommended during local outbreaks.
    Administration route          Intramuscular injection into deltoid muscle Intramuscular injection into deltoid muscle 
    Ingredients
    (List of excipients)
     
    • ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate) (ALC-0315)
    • 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159)
    • Distearoylphosphatidylcholine (DSPC)
    • Cholesterol
    • Potassium chloride
    • Monobasic potassium phosphate
    • Sodium chloride
    • Dibasic sodium phosphate dihydrate
    • Sucrose
    • Water for injections
    • Histidine
    • Histidine hydrochloride monohydrate\
    • Sodium chloride
    • Magnesium chloride hexahydrate
    • Disodium edetate (EDTA)
    • Sucrose
    • Ethanol absolute
    • Polysorbate 80
    • Water for injection

    Resource:
    ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021
     

Vaccine advice for special populations

  • Which special populations can be vaccinated
    Special populations Can they be vaccinated?
    Pregnant, breastfeeding and planning pregnancy? Yes, preferred Pfizer vaccine (for age)
    Clotting issues?

    No, if TTS occurred after the first dose of the AstraZeneca  vaccine

    Yes, with the Pfizer vaccine for people with a past history of cerebral venous sinus thrombosis (CVST), heparin induced thrombocytopenia (HIT), idiopathic splanchnic (mesenteric, portal, splenic) vein thrombosis or antiphospholipid syndrome with thrombosis.

    Yes. People with a history of the following conditions can receive the AstraZeneca vaccine:

    • deep vein thrombosis or DVT (a type of blood clot usually in the leg or arm)
    • pulmonary embolism (a type of blood clot in the lungs)
    • stroke
    • heart attack
    • a family history of blood clots
    • current or past thrombocytopenia (low platelet count)
    • those taking an anticoagulant medication 

    These conditions do not increase the risk of TTS.
    Immunocompromised 

    High risk of severe COVID-19.

    Either vaccine acceptable. Pfizer vaccine preferred for people aged <60 years.
    Past SARS-CoV-2 infection Yes, vaccination be deferred for up to six months after the acute illness in those who have had PCR-confirmed SARS-CoV-2 infection
    Under 60 years had dose 1 of AZ  Current recommendation is continue with AZ as dose 2 2 if no serious adverse events after dose 1

    Resource 
    ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021 (refer to page 10 of the PDF)

    NCIRS COVID-19 vaccines: Frequently asked questions

Eligibility criteria 

  • Who can get the vaccine

    Eligibility for the Pfizer vaccine

    You are eligible for the Pfizer vaccine if you are 40 to 59 years of age.

    You are also eligible for the Pfizer vaccine if you are aged 16–39 years and you are:

    • an Aboriginal and Torres Strait Islander person 
    • an NDIS participant or unpaid or informal carers of NDIS participants of any age
    • pregnant
    • a quarantine or border worker
    • a healthcare worker
    • an aged care or disability care resident or worker
    • a person with an underlying medical condition or significant disability
    • a critical or high-risk worker, including defence, police, fire, emergency services and meat processing
    • a person with an Australian Border Force outwards travel exemption in an eligible category
    • a temporary visa holder who is currently in Australia and has been approved for return travel to Australia through the travel exemption process.
       

    Eligibility for the AstraZeneca vaccine

    You are eligible for the AstraZeneca vaccine if you are aged 60 years or older.

    If you are aged 18–59 years, you can choose to receive the AstraZeneca vaccine:

    • following an appropriate assessment of suitability by a qualified health professional and
    • if you provide verbal or written consent.

    Some states and territories will amend their eligibility based on their COVID-19 situation, vaccine supply and uptake. Please stay up to date with information from your local state or territory department of health.

    Related resources:

    Eligibility for the COVID-19 vaccine

    COVID-19 Vaccine Eligibility Checker

Answering patients' questions and concerns about COVID-19 vaccines

Case numbers and vaccine doses given

Other resources

News & events

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We acknowledge that the National Centre for Immunisation Research and Surveillance (NCIRS) is on the land of the traditional owners the Aboriginal and Torres Strait Islander peoples, the First Australians, and recognise their culture, history, diversity and their deep connection to the land. Together, through research and partnership, we aim to move to a place of equity for all. NCIRS also acknowledges and pays respect to other Aboriginal and Torres Strait Islander nations from which our research, staff and community are drawn.

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NCIRS, Kids Research, Sydney Children’s Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead NSW 2145 Tel (612) 9845 1433  |  Fax (612) 9845 1418  |  ABN 53 188 579 090

Our website meets the criteria for credibility and content as defined by the Global Advisory Committee on Vaccine Safety.

We acknowledge that the National Centre for Immunisation Research and Surveillance (NCIRS) is on the land of the traditional owners the Aboriginal and Torres Strait Islander peoples, the First Australians, and recognise their culture, history, diversity and their deep connection to the land. Together, through research and partnership, we aim to move to a place of equity for all. NCIRS also acknowledges and pays respect to other Aboriginal and Torres Strait Islander nations from which our research, staff and community are drawn.

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