Underlying medical conditions
Children 12 to 15
If your child is aged 12 to 15 and has an underlying medical condition or disability, you should discuss their vaccination with their treating doctor or specialist.
Your doctor or specialist may decide your child requires further review or they may need an appointment at the Paediatric COVID-19 Specialist Immunisation Service at the Women’s and Children’s Hospital.
If this is the case, your doctor will need to complete a referral form and you will be contacted directly by the Women’s and Children’s vaccination clinic for an appointment.
Speak to your child’s treating doctor or specialist if they are on National Disability Insurance Scheme (NDIS) and/or living with disability requiring frequent assistance with activities of daily living, including down syndrome, muscular dystrophy, traumatic brain and spinal cord injury, and severe intellectual disability, or have any of the following medical conditions:
- Children with a complex chronic disease
- Cancers and haematological diseases, currently or in the past
- Haematological diseases or cancers including leukaemia, lymphoma or myeloma resulting in immunocompromise
- Non-haematological cancers, diagnosed within the past 5 years OR on chemotherapy, radiotherapy, immunotherapy or targeted anti-cancer therapy (active treatment or recently completed) OR with advanced disease regardless of treatment
- Adult survivors of childhood cancers
- Transplant recipients
- Solid organ transplant recipients who are on immune suppressive therapy
- Bone marrow transplant recipients
- Chimeric antigen receptor T-cell (CAR-T) therapy recipients
- People with graft versus host disease
- Chronic inflammatory Conditions
- Systemic Lupus Erythematosus
- Rheumatoid Arthritis
- Crohn’s disease
- Ulcerative colitis
- Similar conditions who are being treated with Disease modifying anti-rheumatic drugs (DMARDs) or immune-suppressive or immunomodulatory therapies
- Immunodeficiency conditions
- Primary or acquired immunodeficiency, including congenital causes of immunodeficiency and HIV/AIDS
- Chronic kidney, liver, lung or neurological conditions or diabetes
- Chronic renal (kidney) failure, but not including mild to moderate chronic kidney disease
- Chronic lung disease including Chronic Obstructive Pulmonary Disease, cystic fibrosis, interstitial lung disease, and severe asthma (defined as requiring frequent hospital visits or the use of multiple medications. This doesn’t include mild or moderate asthma
- Chronic liver disease
- Chronic neurological conditions, including stroke, dementia, multiple sclerosis, motor neurone disease, Parkinson’s disease, cerebral palsy, and epilepsy. This does not include migraine or cluster headaches.
- Severe obesity
- Adults: body mass index of 40 or greater
- Children: body mass index greater than 120% of the 95% percentile for age or body mass index of 35 or greater (whichever is lower).
- Heart disease and blood pressure disorders
- Ischaemic heart disease, valvular heart disease, cardiomyopathies and pulmonary hypertension and people with complex congenital heart disease
- Poorly controlled blood pressure (people taking two or more medicines for blood pressure control, regardless of recent readings)
- Severe mental health conditions
- people living with severe mental health conditions, including schizophrenia and bi-polar disorder
- Pregnant people
Third dose of COVID-19 vaccine
Currently, the Australian Technical Advisory Group on Immunisation (ATAGI) recommend that people who are severely immunocompromised aged 12 and over receive a third dose of a COVID-19 vaccine.
This is to increase the level of immunity for severely immunocompromised people to as close as possible to the general population.
A third dose is recommended for people with the following immunocompromising conditions:
- Active haematological malignancy
- Non-haematological malignancy with current active treatment including chemotherapy, radiotherapy, and/or hormonal therapy, but excluding immunotherapy with immune checkpoint inhibitors
- Solid organ transplant with immunosuppressive therapy
- Haematopoietic stem cell transplant (HSCT) recipients or chimeric antigen receptor T-cell (CAR-T) therapy within 2 years of transplantation.
- These patients require revaccination with 3 additional doses of COVID-19 vaccine, irrespective of doses given prior to transplantation, commencing generally ≥3-6 months after their transplant after discussion with their treating specialist.
- Those beyond 2 years from transplant should discuss with their treating specialist about the need for a third dose.
- Immunosuppressive therapies including:
- High dose corticosteroid treatment equivalent to >20mg/day of prednisone for ≥14 days in a month, or pulse corticosteroid therapy.
- Multiple immunosuppressants where the cumulative effect is considered to be severely immunosuppressive.
- Selected conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDS):
- including mycophenolate, methotrexate (>0.4 mg/kg/week), leflunomide, azathioprine (>3mg/kg/day), 6-mercaptopurine (>1.5 mg/kg/day), alkylating agents (e.g. cyclophosphamide, chlorambucil), and systemic calcineurin inhibitors (e.g. cyclosporin, tacrolimus)
- excluding hydroxychloroquine or sulfasalazine when used as monotherapy
- Biologic and targeted therapies anticipated to reduce the immune response to COVID-19 vaccine:
- including B cell depleting agents (e.g. anti-CD20 monoclonal antibodies, BTK inhibitors, fingolimod), anti-CD52 monoclonal antibodies (alemtuzumab), anti-complement antibodies (e.g. eculizumab), anti-thymocyte globulin (ATG) and abatacept
- excluding agents with likely minimal effect on vaccine response such as immune checkpoint inhibitors, anti-integrins, anti-TNF-α, anti-IL1, anti-IL6, anti-IL17, anti-IL4 and anti-IL23 antibodies
- Primary immunodeficiency 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 primary immunodeficiencies.
- Advanced or untreated HIV with CD4 counts <250/μL or those with a higher CD4 count unable to be established on effective anti-retroviral therapy
- a thirdprimary dose is not required for people living with HIV, receiving ART with CD4 counts ≥250/μL
- Long term haemodialysis or peritoneal dialysis
Recommended COVID-19 vaccines
The Pfizer or Moderna COVID-19 vaccines are preferred for a third dose for people who are severley immunocompromised. The AstraZeneca COVID-19 vaccine can be used for the third dose for individuals who received AstraZeneca for their first two doses if there are no contraindications or precautions for use, or if a significant adverse reaction occurred after receiving the Pfizer or Moderna COVID-19 vaccines.
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. People who have received a second dose more than 6 months ago should receive a third dose as soon as possible.
Where to get vaccinated
General Practitioners (GPs) are able to vaccinate eligible patients with a third dose of a COVID-19 vaccine. If eligible patients cannot access this at their GP, they can attend a SA Health vaccination clinic site or pharmacy with evidence of eligibility.
Evidence of eligibility can include:
- A referral letter from GP or other treating clinician
- Proof of an alternative medical record that is dated within the last 5 years:
- a printout of the medical history (from clinical records or MyHealth Record)
- a printout of a chronic disease care plan from treating GP
- a discharge summary from a hospital or other medical facility
- a named script for a medication that has been prescribed to treat one or more of the relevant conditions or procedures outlined in the guideline.
- A condition-specific identifier
- A completed Eligibility Declaration Form (if unable provide any of the above evidence of eligibility).
For more information speak to your GP and read the ATAGI statement.