14 October update”

The Australian Rheumatology Association has updated the COVID vaccination sheet for consumers here.


As per the latest information from the Australia Technical Advisory Group on Immunisation (ATAGI) version 1.0 released on the 7th of October 2021, the use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised is recommended.

  • ATAGI recommends a 3rd primary dose of COVID-19 vaccine in severely immunocompromised populations to address the risk of suboptimal or non-response to the standard 2 dose schedule. The 3rd dose is intended to maximise the level of immune response to as close as possible to the general population.


  • ATAGI recommends that all individuals aged ≥12 years with certain conditions or on therapies leading to severe immunocompromise receive a 3rd primary dose of a COVID-19 vaccine.
  • An mRNA vaccine (Pfizer or Moderna) is preferred to Vaxzevria (AstraZeneca) for this 3rd dose. AstraZeneca can be used for the 3rd dose for individuals who have received AstraZeneca for their first 2 doses if there are no contraindications or precautions for use, or if a significant adverse reaction has occurred after a previous mRNA vaccine dose which contraindicates further doses of mRNA vaccine (e.g., anaphylaxis, myocarditis).
  • The recommended interval for the 3rd dose is 2 to 6 months after the 2nd dose of vaccine.


The following criteria are used to determine who is eligible to receive the 3rd dose and the process to obtain this is not yet determined. It is likely that each individual patient will require a letter

advising that they meet the criteria.

The following is the current definition of severe immunocompromise:


  • 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


  • At least one of the following conventional synthetic DMARDs:
    • methotrexate (>0.4mg/kg/week)
    • leflunomide
    • mycophenolate
    • azathioprine (>3mg/kg/day)
    • cyclosporine
    • cyclophosphamide
    • tacrolimus


  • At least one of the following biological or targeted synthetic DMARDs:
    • janus kinase (JAK) inhibitor
    • abatacept
    • rituximab