3rd dose COVID-19 vaccine for immunocompromised individuals.
The Australian Technical Advisory Group on Immunisation (ATAGI) recommends a third primary dose of COVID-19 vaccine in severely immunocompromised individuals.
The standard two-dose schedule for those who are severely immunocompromised may provide a less than optimal immune response. The third dose aims to maximise the level of the immune response as close as possible to the general population.
Not everyone with immunocompromise is included. Some types of immunocompromise do not impact your immune response to vaccination.
These 3rd doses are not considered booster doses. ATAGI will provide further advice on boosters for the general population shortly.
As per the criteria below, please book in for a third dose online if you are eligible. If you are uncertain whether you qualify for a third dose, please ask your GP or specialist.
Please read the eligibility below carefully.
Timing of the third dose.
The third dose is recommended 2 to 6 months after your second dose of vaccine, regardless of whether this was Pfizer, Moderna or AstraZeneca. A minimum interval of 4 weeks may be considered in exceptional circumstances, e.g. your level of immunosuppression will be increased.
Choice of the third dose.
An mRNA vaccine such as Pfizer or Moderna is the preferred agent for a third dose. AstraZeneca may be used if there has been a significant adverse reaction to an mRNA vaccine or if it is your preference following an initial two doses of AstraZeneca.
How to book.
Book online, go to Crace or Denman and select ‘Pfizer dose 3 for immunocompromise’.
Eligible conditions leading to severe immunocompromise.
• Active haematological malignancy, e.g. leukaemia, lymphoma.
• Cancer with current treatment including chemotherapy, radiotherapy, and/or hormonal therapy
• Solid organ transplant with immunosuppressive therapy
• Certain immunosuppressive therapies as outlined below
• Primary immunodeficiency including:
o combined immunodeficiency and syndromes,
o major antibody deficiency (e.g., common variable immune deficiency (CVID) or agammaglobulinemia),
o defects of innate immunity (including phagocytic cells),
o defects of immune regulation,
o complement deficiencies and phenocopies of primary immunodeficiencies.
• Advanced or untreated HIV
• Haematopoietic stem cell transplant (HSCT) recipients or chimeric antigen receptor T-cell (CAR-T) therapy within two years of transplantation
• Long term haemodialysis or peritoneal dialysis
Specific immunosuppressive therapies which qualify for 3rd primary dose:
• 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 severely immunosuppressive
• Leflunomide (Arabloc, Arava, Lunava, Ataris)
• Azathioprine (Azamun, Azapin, Imuran, Thioprine, Imazan) – >3mg/kg/day
• Mycophenolate (CellCept, Imulate, Ceptolate, Mycocept, Myfortic)
• Methotrexate >0.4 mg/kg/week
• 6-mercaptopurine (Purinethol/Allmercap) if >1.5 mg/kg/day
• Cyclophosphamide Cyclonex, Endoxan)
• Chlorambucil (Leukeran)
• Cyclosporin (Cicloral, Neoral, Sandimmun )
• Tacrolimus (Pacrolim, Prograf, Tacrograf, Advagraf)
• B cell depleting agents eg anti-CD20 monoclonal antibodies, BTK inhibitors, Fingolimod (Gilenya), Belimumab (Benlysta)
• Rituximab – likely, please speak to your specialist for advice on timing.
• Anti-CD52 monoclonal antibodies e.g. Alemtuzumab (Lemtrada)
• Anti-complement antibodies e.g. Eculizumab (Soliris)
• Antithymocyte globulin (ATG)
• Abatacept (Orencia)
• Jaki – Tofacitinib (Xeljanz), Upadacitinub (Rinvoq), Barcitinib (Olumiant)
These immunosuppressive therapies do not qualify for a third primary dose as they lead to a minimal effect on vaccine response:
• Hydroxychloroquine (Plaquenil) alone – when used alone for
immunosuppression.
• Sulfasalazine (Pyralin, Salazopyrin) – when used alone for
immunosuppression.
• Immune checkpoint inhibitors.
• Anti-integrins.
• Anti-TNF-α Adalimumab (Humira, Amgevito, Hadlima, Hyrimoz,
Idacio), Certolimab (Cimzia), Galimumab (Simponi), Infliximab (Inflectra,
Remicade, Renflexis), Etanercept (Enbrel, Brenzys).
• Anti-IL1s Anakinra (Kineret).
• Anti-IL6 Tocilizumab (Actemra), Sarilumab.
• Anti-IL17 Secukinumab (Cosentyx), Ixekizumab (Taltz).
• Anti-IL4.
• Anti-IL23 antibodies Ustekinumab (Stelara), Rizankizumab
(Skyrizi) Guselkumab (Tremlya).
Dr Mel Deery