ATAGI 2023 booster recommendation | Australian Authorities Division of Well being and Aged Care

ATAGI 2023 booster recommendation | Australian Authorities Division of Well being and Aged Care

Date revealed:

The purpose of the Australian COVID-19 vaccination program stays the prevention of extreme sickness from COVID-19. ATAGI has evaluated this danger within the context of excessive inhabitants ranges of hybrid immunity (i.e., mixed immunity from previous an infection and previous vaccination), the proof concerning COVID-19 vaccine effectiveness, together with for brand spanking new bivalent vaccines, and the altering epidemiology of COVID-19 associated to newly emerged subvariants of Omicron.

These suggestions substitute earlier ATAGI COVID-19 vaccine booster recommendation.


  • ATAGI recommends a 2023 COVID-19 vaccine booster dose for adults within the following teams, if their final COVID-19 vaccine dose or confirmed an infection (whichever is the latest) was 6 months in the past or longer, and whatever the variety of prior doses obtained: 
    • All adults aged 65 years and over
    • Adults aged 18-64 years who’ve medical comorbidities that enhance their danger of extreme COVID-19, or incapacity with important or advanced well being wants.
  • ATAGI advises the next teams ought to take into account a 2023 booster dose if their final COVID-19 vaccine dose or confirmed an infection (whichever is the latest) was 6 months in the past or longer, and whatever the variety of prior doses obtained, based mostly on a person danger profit evaluation with their immunisation supplier. 
    • All Adults aged 18-64 years with out danger elements for extreme COVID-19
    • Kids and adolescents aged 5-17 years who’ve medical comorbidities that enhance their danger of extreme COVID-19, or incapacity with important or advanced well being wants.
  • ATAGI advises {that a} booster dose is not really useful right now for youngsters and adolescents aged underneath the age of 18 who would not have any danger elements for extreme COVID-19.
  • Concerning vaccine alternative, all at the moment out there COVID-19 vaccines are anticipated to offer profit as a booster dose, nonetheless bivalent mRNA booster vaccines are most popular over different vaccines. These embrace: Pfizer Authentic/Omicron BA.4/5, in addition to Pfizer Authentic/Omicron BA.1 or Moderna Authentic/Omicron BA.1. Moderna Authentic/Omicron BA.4/5 is at the moment underneath analysis by the Therapeutic Items Administration.
  • COVID-19 vaccine might be co-administered with influenza and different vaccines.
  • Administration of a 2023 COVID-19 booster dose ought to purpose to happen previous to June 2023  and at a time of 6 months or higher following the latest COVID-19 vaccine dose or confirmed an infection.
  • Ongoing surveillance of COVID-19 an infection charges and medical outcomes, new variants, and vaccine effectiveness will inform future suggestions for extra booster doses.

ATAGI 2023 Booster Recommendation*


In danger**

No danger elements

<5 years

Not really useful

Not really useful

5-17 years


Not really useful

18-64 years



≥ 65 years




Epidemiology of SARS-CoV-2 as of February 2023

A number of new Omicron subvariants have emerged because the BA.4/5 wave in Australia throughout July and August 2022, displaying elevated immune-escape properties (e.g. BQ.1 and XBB)1,2. These have co-circulated with none particular subvariant establishing clear dominance. Quite a few immunological research report diminished neutralisation of recent Omicron subvariants by each vaccine-induced and naturally derived antibodies3,4. COVID-19 vaccines could have a diminished and/or shorter length of safety in opposition to an infection from these subvariants in contrast with older variants, nonetheless vaccines (along with hybrid immunity from pure an infection) proceed to offer sturdy safety in opposition to extreme COVID-19. Of observe, early proof means that the newer Omicron subvariants don’t trigger extra extreme illness in contrast with the unique Omicron subvariant (BA.1)5.

Anticipated advantages of a 2023 COVID-19 vaccine booster dose

A further COVID-19 booster dose is anticipated to deal with waning of safety in opposition to extreme COVID-19 previous to winter. This can present a rise in safety in opposition to extreme sickness and defend the healthcare system throughout a time of excessive demand.

It’s endorsed to defer vaccination for six months following a confirmed SARS-CoV-2 an infection, as this, along with prior vaccine doses obtained, will enhance safety in opposition to COVID-19. ATAGI notes that testing charges have decreased and there are prone to have been many individuals with undetected SARS-CoV-2 an infection inside latest months. There are not any security issues for people receiving a COVID-19 vaccine who could have had undetected SARS-CoV-2 an infection throughout the previous 6 months.

The rise in safety in opposition to extreme sickness from COVID-19 following a booster dose is most useful for individuals at greater danger of extreme sickness, i.e., older adults and people with related medical danger elements6,7. Research performed all through the pandemic, together with throughout Omicron epidemic waves have recognized the next danger of hospitalisation amongst older adults and adults with immunosuppression or different continual medical situations, in contrast with youthful or wholesome adults8,9.

ATAGI considers a booster dose useful for all adults aged 65 years and older. The danger of extreme illness will increase with every decade of age. With related ranges of hybrid immunity to the Australian inhabitants, UK modelling in the course of the Omicron period discovered that 800 individuals aged 70 years and above would should be given a booster to forestall one hospitalisation from COVID-19, in contrast with 8000 individuals aged 50 to 59 years and 92,500 individuals aged 40-49 years10. Nevertheless, a booster dose should be useful for individuals aged 5-64 years based mostly on particular person circumstances comparable to underlying situations that enhance their danger of extreme illness.

For youngsters and adolescents aged 5-17 years with danger elements for extreme sickness, a booster dose could also be useful; decision-making round booster vaccination must be based mostly on a person risk-benefit evaluation with their immunisation supplier. The danger of extreme illness with present excessive inhabitants ranges of hybrid immunity in youngsters and adolescents aged 5-17 years with out danger elements is now thought-about to be decrease than when earlier ATAGI booster recommendation was issued. At current, most at-risk youngsters aged 6 months to <5 years who’ve obtained a main course have executed so inside latest months and a booster dose isn’t really useful at current.

ATAGI continues to advocate a main course of vaccination in opposition to COVID-19, adopted by a booster dose for these eligible, even in people who’ve had previous an infection. Adults who’ve already been contaminated with an Omicron subvariant and vaccinated with 3 doses of COVID-19 vaccine are at decrease danger of reinfection and hospitalisation in comparison with those that have been contaminated however not vaccinated11.

Potential dangers of a COVID-19 booster dose

For individuals aged underneath 65 years, the choice to have a 2023 COVID-19 booster dose within the coming months ought to take into consideration a person’s age, danger elements for extreme COVID-19, quantity and timing of earlier doses or earlier an infection, and danger elements (predominantly age) for myocarditis and pericarditis following vaccination.

Adolescents and youthful adults have a decrease age-related danger of extreme COVID-19, and a relatively greater danger of myocarditis following vaccination. The danger of myocarditis is highest in individuals aged 16-30 years (peak 16-18 years), and is greater in males than females12–14.  The danger of myocarditis seems to be decrease after COVID-19 booster doses as compared with dose 2 of the first course and is decrease following Pfizer COVID-19 vaccine as in contrast with Moderna COVID-19 vaccine in some contexts14,15. See COVID-19 vaccination – Steering on myocarditis and pericarditis after COVID-19 vaccines for extra data.

Vaccine alternative

Any age-appropriate COVID-19 vaccine, together with authentic (ancestral virus-based) vaccines, are anticipated to spice up neutralising antibodies and thereby present extra safety in opposition to any an infection and longer lasting safety in opposition to extreme illness.

Nevertheless, most immunogenicity research have proven a pattern in the direction of BA.4/5-based vaccines inducing greater neutralising exercise in opposition to Omicron subvariants (together with BQ.1 and XBB) than authentic vaccines or BA.1-containing vaccines4,16–18, though a number of research reported related neutralising antibody titres when evaluating the responses to totally different vaccines19. Early revealed and preprint information on whether or not these will increase in neutralisation exercise translate into measurable variations in medical safety recommend a small benefit in vaccine effectiveness with bivalent vaccines over authentic vaccines in stopping hospitalisation and loss of life20,21. Nevertheless, additional confirmatory research are awaited. Early information recommend that the vaccine effectiveness of BA.1-based bivalent booster vaccines is much like ancestral-based booster doses, however doubtlessly with slower waning of safety6,22.

For extra data on which vaccines can be found for every age group discuss with the COVID-19 vaccine doses and administration webpage. Bivalent Authentic/Omicron BA.1 vaccines are solely registered to be used in individuals aged 18 years and over. The Pfizer bivalent Authentic/Omicron BA.4/5 vaccine is registered to be used from 12 years of age.

There are at the moment inadequate information to find out the timing of any extra future COVID-19 booster doses. Nevertheless it’s possible, as with influenza vaccine, that common doses of COVID-19 vaccine shall be wanted to keep up immunity in opposition to SARS-CoV-2 over years to come back, notably for these at highest danger of extreme illness. ATAGI will proceed to observe information on the length of safety from booster doses, in addition to on new circulating virus variants or subvariants, and can present up to date vaccine recommendation as required.


1.            World Well being Group. Monitoring SARS-CoV-2 variants.

2.            New South Wales Ministry of Well being. NSW Respiratory Surveillance Report – week ending 07 January 2023. https://www.well…

3.            Jiang XL, Zhu KL, Wang XJ, et al. Omicron BQ.1 and BQ.1.1 escape neutralisation by omicron subvariant breakthrough an infection. Lancet Infect Dis. 2023;23(1):28-30. doi:10.1016/S1473-3099(22)00805-2

4.            Kurhade C, Zou J, Xia H, et al. Low neutralization of SARS-CoV-2 Omicron BA. 2.75. 2, BQ. 1.1, and XBB. 1 by parental mRNA vaccine or a BA. 5-bivalent booster. Nature Medication. Revealed on-line 2022:1-1.

5.            Karyakarte R, Das R, Dudhate S, et al. Scientific Traits and Outcomes of Laboratory-Confirmed SARS-CoV-2 Circumstances Contaminated with Omicron subvariants and XBB recombinant variant. medRxiv. Revealed on-line 2023:2023-01.

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7.            Arbel R, Peretz A, Sergienko R, et al. Effectiveness of the bivalent mRNA vaccine in stopping extreme COVID-19 outcomes: An observational cohort examine. Accessible at SSRN 4314067. Revealed on-line 2023.

8.            Nafilyan V, Ward IL, Robertson C, Sheikh A, Nationwide Core Research—Immunology Breakthrough Consortium. Analysis of Threat Elements for Postbooster Omicron COVID-19 Deaths in England. JAMA Community Open. 2022;5(9):e2233446. doi:10.1001/jamanetworkopen.2022.33446

9.            Vo AD, La J, Wu JTY, et al. Elements Related With Extreme COVID-19 Amongst Vaccinated Adults Handled in US Veterans Affairs Hospitals. JAMA Community Open. 2022;5(10):e2240037. doi:10.1001/jamanetworkopen.2022.40037

10.          United Kingdom Authorities, Division of Well being and Social Care. JCVI assertion on the COVID-19 vaccination programme for 2023: 8 November 2022. Revealed January 27, 2023.…

11.          Hansen CH, Friis NU, Bager P, et al. Threat of reinfection, vaccine safety, and severity of an infection with the BA. 5 omicron subvariant: a nation-wide population-based examine in Denmark. The Lancet Infectious illnesses. Revealed on-line 2022.

12.          Yasuhara J, Masuda Ok, Aikawa T, et al. Myopericarditis After COVID-19 mRNA Vaccination Amongst Adolescents and Younger Adults: A Systematic Overview and Meta-analysis. JAMA Pediatrics. 2023;177(1):42-52. doi:10.1001/jamapediatrics.2022.4768

13.          Ling RR, Ramanathan Ok, Tan FL, et al. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a scientific evaluate and meta-analysis. Lancet Respir Med. 2022;10(7):679-688. doi:10.1016/S2213-2600(22)00059-5

14.          Pillay J, Gaudet L, Wingert A, et al. Incidence, danger elements, pure historical past, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: dwelling proof syntheses and evaluate. BMJ. 2022;378:e069445. doi:10.1136/bmj-2021-069445

15.          Yechezkel M, Mofaz M, Painsky A, et al. Security of the fourth COVID-19 BNT162b2 mRNA (second booster) vaccine: a potential and retrospective cohort examine. The Lancet Respiratory Medication. Revealed on-line 2022.

16.          Davis-Gardner ME, Lai L, Wali B, et al. Neutralization in opposition to BA. 2.75. 2, BQ. 1.1, and XBB from mRNA Bivalent Booster. New England Journal of Medication. 2023;388(2):183-185.

17.          Zou J, Kurhade C, Patel S, et al. Improved Neutralization of omicron BA. 4/5, BA. 4.6, BA. 2.75. 2, BQ. 1.1, and XBB. 1 with bivalent BA. 4/5 vaccine. BioRxiv. Revealed on-line 2022:2022-11.

18.          Collier A ris Y, Miller J, Hachmann NP, et al. Immunogenicity of BA. 5 Bivalent mRNA Vaccine Boosters. New England Journal of Medication. Revealed on-line 2023.

19.          Wang Q, Bowen A, Valdez R, et al. Antibody Response to Omicron BA. 4–BA. 5 Bivalent Booster. New England Journal of Medication. Revealed on-line 2023.

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21.          Lin DY, Xu Y, Gu Y, et al. Effectiveness of bivalent boosters in opposition to extreme omicron an infection. New England Journal of Medication. Revealed on-line 2023.

22.          UK Well being Safety Company. COVID-19 vaccine surveillance report. Week 48: 1 December 2022.…