The Australian Technical Advisory Group on Immunisation (ATAGI) has released a statement, prepared in consultation with ASCIA, which recommends a third primary dose of COVID-19 vaccine for people who are severely immunocompromised. This includes people with primary immunodeficiencies (PID) disorders, also known as inborn errors of immunity (IEI).

.The ATAGI statement is available at:

https://www.health.gov.au/news/atagi-statement-on-the-use-of-a-3rd-primary-dose-of-covid-19-vaccine-in-individuals-who-are-severely-immunocompromised

The following ASCIA documents have been updated to include the ATAGI recommendations:

• Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination FAQ for patients, consumers and carers Updated October 2021
• COVID-19 and Immunodeficiency FAQ for patients, consumers and carers Updated October 2021

The recommended interval for the third dose is two to six months after the second dose of vaccine. People with PID/IEI who had a second dose more than six months ago should receive a third dose whenever this is feasible.

In summary the ATAGI recommendations state that a third primary dose of the COVID-19 vaccine is recommended for people with the following immunocompromising conditions and/or therapies:

• Primary immunodeficiency (PID) disorders, also known as inborn errors of immunity (IEI),
  including combined immunodeficiency and syndromes, major antibody deficiency (e.g. common variable immune deficiency (CVID) or agammaglobulinemia), defects of innate immunity (including phagocytic cells), defects of immune regulation, complement deficiencies and phenocopies of PID/IEI.
• Some immunosuppressive therapies.
• Haematopoietic stem cell transplant (HSCT) or chimeric antigen receptor T-cell (CAR-T) therapy recipients within 2 years of transplantation.
• Solid organ transplant with immunosuppressive therapy.
• Active haematological malignancy.
• Non-haematological malignancy with current active treatment excluding immunotherapy with immune checkpoint inhibitors.
• Advanced or untreated HIV with CD4 counts <250/μL or those with a higher CD4 count unable to be established on effective antiretroviral therapy.
• Long term haemodialysis or peritoneal dialysis.

ASCIA will continue to provide advice to ATAGI on the use of COVID-19 vaccines in people who are severely immunocompromised. 

ASCIA will also continue to update ASCIA COVID-19 information as recommendations and restrictions evolve.

In anticipation of lockdowns easing the following updated pictorial checklist has been developed, which is included in the COVID-19 and Immunodeficiency FAQ:

• Checklist - Actions to Reduce the Spread of COVID-19 Updated October 2021

The following ASCIA COVID-19 information has also been recently updated, to include the Moderna Spikevax vaccine:

• COVID-19 Vaccination Guidelines for Clinical Immunology/Allergy Specialists Updated September 2021
• Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination - Position Statement for health professionals Updated September 2021
• Allergy and COVID-19 Vaccination - Guide for health professionals Updated September 2021
• Immunodeficiency, Autoimmunity and COVID-19 Vaccination - Guide for health professionals Updated September 2021