ATAGI advice from 24th July 2021
All individuals aged 18 years and above in greater Sydney, including adults under 60 years of age, should strongly consider getting vaccinated with any available vaccine including COVID-19 Vaccine AstraZeneca. This is on the basis of the increasing risk of COVID-19 and ongoing constraints of Comirnaty (Pfizer) supplies. In addition, people in areas where outbreaks are occurring can receive the second dose of the AstraZeneca vaccine 4 to 8 weeks after the first dose, rather than the usual 12 weeks, to bring forward optimal protection.
ATAGI continues to closely monitor the epidemiology of COVID-19 in New South Wales, Victoria and South Australia. The outbreak in NSW continues to grow and the risk of disease, particularly in the greater Sydney area, is likely to continue to be significant over coming weeks.
ATAGI reaffirms our previous advice that in a large outbreak, the benefits of the COVID-19 Vaccine AstraZeneca are greater than the risk of rare side effects for all age groups.
In the context of the current risk of COVID-19 in NSW and with the ongoing constraints on Comirnaty (Pfizer) vaccine supplies, all adults in greater Sydney should strongly consider the benefits of earlier protection with COVID-19 Vaccine AstraZeneca rather than waiting for alternative vaccines
Maximal protection requires two doses of vaccine, but even a single dose of either vaccine provides substantial protection (by more than 70%) against hospitalisation. A single dose of COVID-19 Vaccine AstraZeneca partially reduces transmission by around half and therefore may also benefit close contacts and the community. It should be noted that there is a delay of 2-3 weeks after receiving a first dose of vaccine and being protected from COVID-19.
A second reason for ATAGI to recommend that individuals strongly consider vaccination at this time is emerging data about severity of disease. The Delta variant may be more severe than the original SARS-CoV-2 strain. The proportion of people less than 60 years requiring hospitalisation appears to be higher than was reported in outbreaks with the original SARS-CoV-2 strain. This reinforces the benefit of protection with any available vaccine.
People considering vaccination should be informed of the benefits and risks and give informed consent. People who receive COVID-19 Vaccine AstraZeneca should be aware of the symptoms of thrombosis with thrombocytopenia syndrome (TTS), and when to seek prompt medical attention. Early detection of TTS means that people can get treatment and this can improve their outcomes.
ATAGI has previously issued advice recommending a shorter interval between the first and second doses of COVID-19 Vaccine AstraZeneca of 4-8 weeks in an outbreak (versus the routine 12 week interval) so that maximal protection against COVID-19 can be achieved earlier.
ATAGI also reinforces that the interval between the first and second doses of Comirnaty (Pfizer) is 3-6 weeks, providing flexibility in managing available supplies of vaccines, whilst also noting two doses are required for optimal protection. Spacing Comirnaty (Pfizer) to a routine interval of 6 weeks would allow limited vaccine supplies to be redirected to obtain first dose protection in outbreak areas of greatest need.
Updated 23rd July
Current eligibility criteria for the AstraZeneca vaccine
All adults aged 18 years and over
The AstraZeneca vaccine is the recommended vaccine for people aged 60 and above. However, under new arrangements, AstraZeneca vaccine is available to any adult aged 18 or over, provided they give informed consent.
The AstraZeneca vaccine is highly effective in protecting people against the serious health effects of COVID-19 – including hospitalisation and death. It is locally produced and readily available in Australia. Currently Australia has adequate supplies of AstraZeneca to vaccinate all eligible people.
This means people aged 18 to 39 who are not yet eligible to receive the Pfizer vaccine can choose to receive the AstraZeneca vaccine now, after an appropriate individual risk-benefit analysis and consent process. The guide to weighing up the potential benefits against risk of harm from COVID-19 vaccine AstraZeneca may assist in discussions.
Health providers should only vaccinate a patient with AstraZeneca when they have no contraindications* and if the patient has given informed consent, noting they may be able to access Pfizer later this year.
*Contraindications to the AstraZeneca vaccine are rare and include:
cerebral venous sinus thrombosis
heparin induced thrombocytopenia
idiopathic splanchnic (mesenteric, portal, splenic) vein thrombosis
antiphospholipid syndrome with thrombosis
New: 6 week interval between AstraZeneca doses in Sydney
NSW Health is recommending changing the routine dose interval window to 6-8 weeks for the AstraZeneca vaccine in the Sydney region. In June the UK made the decision to reduce the length of time between doses to eight weeks because of the rapid spread of the Delta variant. Similar advice is being provided in Canada.
Chief Medical Officer Paul Kelly yesterday also encouraged anyone in Sydney waiting on their second dose of AstraZeneca to bring it forward.
New ATAGI guidelines for administration of AstraZeneca vaccine were announced on 17th June, 2021. The recommendations from these guidelines are;
ATAGI advises that Comirnaty is preferred over COVID-19 Vaccine AstraZeneca from the age of 16 to under 60 years. This is based on recent data regarding TTS cases in Australia and a reassessment of current age-specific risks and benefits of vaccination.
ATAGI considers the benefit of vaccination in preventing COVID-19 with COVID-19 Vaccine AstraZeneca outweighs the risk of TTS in people aged 60 and above. For this age group, the benefits of receiving a COVID-19 vaccine are greater than in younger people. The risks of severe outcomes with COVID-19 increase with age and are particularly high in older unvaccinated individuals.
COVID-19 Vaccine AstraZeneca can be used in adults aged under 60 years for whom Comirnaty is not available, the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.
People of any age without contraindications who have had their first dose of COVID-19 Vaccine AstraZeneca without any serious adverse events should receive the second dose.
ATAGI reinforces the importance of providing clear communications to people who have received or are considering COVID-19 Vaccine AstraZeneca, and notes guidance documents for consumers, for primary care and for hospitals are being continually revised to accommodate this new recommendation.
The covid vaccination clinic is for vaccination only and there will not be time to address vaccination concerns. The online booking form will include a vaccination consent form and so we are encouraging all patients to book online.
Information on clotting and AZ vaccine can be found here.
If you have questions about the covid vaccination please book an appointment with your doctor to discuss your concerns.