The primary aim of COVID-19 vaccination continues to be to reduce the risk of serious illness and death. This is particularly important for older adults and those with risk factors for severe disease. ATAGI last issued recommendations regarding a 2023 dose of COVID-19 vaccine in February 2023.
 

This advice provides guidance on who should consider receiving an additional dose of a COVID-19 vaccine in 2023, recognising that older age remains the strongest risk factor for severe COVID-19 disease.
 

This updated advice also reflects that much of the population, particularly younger individuals with no other medical conditions, are currently well-protected against severe disease from COVID-19 from a combination of their previous vaccinations (including those who have already received a 2023 dose) and additional immunity gained from a previous infection. 
 

Recommendations

ATAGI recommends that all adults aged ≥ 75 years should receive an additional 2023 COVID-19 vaccine dose if 6 months have passed since their last dose.
 

ATAGI advises the following groups should consider an additional 2023 COVID-19 vaccine dose if 6 months have passed since their last dose, after discussion with their healthcare provider:

• All adults aged 65 to 74 years, and/or

• Adults aged 18 to 64 years with severe immunocompromise.

• Within the above groups, an additional 2023 COVID-19 vaccine is likely to be of most benefit for people who:

  • Have no known history of SARS-CoV-2 infection (and therefore are unlikely to have protection from hybrid immunity),

  • Have medical comorbidities that increase their risk of severe COVID-19, or disability with significant or complex health needs, or

  • Reside in a residential aged care facility.
     

ATAGI continues to encourage all adults who were recommended to have a COVID-19 vaccine dose in February 2023, and who have not yet had one, to receive a vaccine dose as soon as possible (refer to Table below).
 

For younger people or older adults without severe immunocompromise who have already had a dose in 2023, no further doses are currently recommended. Their baseline risk of severe illness is low if they have already been vaccinated, and particularly if they have also had prior infection.1 Therefore a further 2023 dose will offer little additional benefit even if it has been more than 6 months since their last dose.
 

ATAGI continues to note that while there is minimal benefit from having a COVID-19 vaccine dose too soon after infection, current SARS-CoV-2 testing rates have dropped significantly, so from a practical perspective it is challenging for many individuals to know if or when they last had an infection.  Where previous infection details are unknown, it is appropriate to proceed with a first 2023 dose, and an additional dose for eligible people outlined in this update.
 

A person may be vaccinated earlier than the recommended 6-month interval where considered appropriate, such as before starting an immunosuppressant, before overseas travel or if someone cannot reschedule vaccination easily (such as in an outreach or inreach vaccination program).
 

There are no additional safety concerns relating to the use of additional doses in older adults and people at high risk of severe SARS CoV-2.