75 years and older

• Recommended every 6 months.

65-74 years

• Recommended at least every 12 months, but can receive every six months.

18-64 years

• With severe immunocompromise: Recommended at least every 12 months, but can receive every six months.

• Without severe immunocompromise: Can receive every 12 months.

5-17 years

• With severe immunocompromise: Can receive every 12 months.

• Without severe immunocompromise: Not recommended.

Under 5 years

• Not recommended.

Adults

• 18 to 64 years

  • Single primary dose

  • Immunocompromised = 2 or 3 primary doses

  • Can do further doses every 6 or 12 months if conditions that increase risk

• 75 years +

  • Booster every 6 months

• 65 to 74 years

  • Booster every 12 months

  • Can do every 6 months if higher risk

Kids

• 6mo to 18 years

  • Single primary dose if medical condition that increases risk

• 5 years to 18 years

  • Further doses every 12 months can be considered if higher risk

Conditions that increase risk

• Immunocompromise

  • No spleen or dodgy spleen, HIV, Cancer, Organ transplant

• Heart

  • Congenital heart disease, HF, IHD

• Lung

  • Severe asthma, CF, bronchiectasis, COPD, Emphysema

• Brain

  • Degenerative CNS disorder, Seizures, Spinal cord injury, NMJ disorders

• Metabolism

  • Diabetes, AA disorders, Carbohydrate disorders, Porrphyrria, Mitochondrial diorders

• Kidney

  • CKD 4 or 5

• Liver

  • Cirrhosis, AIH, Alcoholic liver disease, MAFLD

• Genetic

  • Trisomy 21

• Other

  • BMI > 30

Pregnant Women

• Unvaccinated pregnant women are at increased risk of severe disease from COVID-19

  • Suggested primary course

• Vaccinated pregnant women

  • Does not require further vaccine

  • Could consider a booster if has a condition that increases risk

• Breastfeeding women

  • Can receive vaccine if required

Contraindications

• Documented anaphylaxis to previous COVID-19 vaccine or ingredient

• Serious adverse events attributable to previous COVID-19 vaccine

Precautions

• Immediate (within 4 hours) and generalised symptoms of a possible allergic reaction (e.g. hives) without anaphylaxis to previous COVID-19 vaccine or ingredient

• Confirmed mastocytosis with recurrent anaphylaxis

Cardiac precautions

• Recent (3 months) myocarditis or pericarditis

• Acute rheumatic fevers

• Acute decompensation heart failure

Adverse events

• Kids 6 mo to 5 years

  • Irritability = 40-50%

  • Drowsiness = 25%

  • Injection site tenderness = 15%

  • Fever = 7%

• Kids 5 to 11 years

  • Injection site tenderness = 75%

  • Fatigue = 35%

  • Headache = 25%

  • Fever = 3%

Adverse events to Comirnaty Bivalent / Omicron BA4.5 > XBB.1.5

• Injection site pain = 75%

• Fatigue = 55%

• Headache = 40%

• Muscle pain = 25%

Anaphylaxis risk

• Similar to common vaccines

• 1 in 100,000

Myocarditis / Pericarditis

• Males 12 to 17 for Pfizer vaccines

  • Dose 1 = Risk of < 1 in 18,000

  • Dose 2 = Risk of < 1 in 2500

  • Dose 3 = Risk of < 1 in 5000

• Females 12 to 17

  • Dose 1 = Risk of < 1 in 500,000

  • Dose 2 = Risk of < 1 in 20,000

  • Dose 3 = Risk of < 1 in 27,000

• Males ages 18 to 29 for Pfizer vaccines

  • Dose 1 = Risk of < 1 in 40,000

  • Dose 2 = Risk of < 1 in 6,000

  • Dose 13 = Risk of < 1 in 15,000

Risk factors

• 30 x risk of dying at age 80 compared to age 50

• Infection fatality rate during Omicron in a Danish study was 6.2 per 100,000 infections = 1 in 16,000 risk

• Post-COVID-19 symptoms

  • 45% of COVID-19 survivors experience unresolved symptoms at 4 months

  • Risk factors for this are

    • Female sex

    • Odler age

    • Higher BMI

    • Smoking

    • Comorbidities

    • Previous hospitalisation with COVID-19

  • Vaccinated people have a lower risk of post-COVID-19 issues

    • OR = 57% i.e. almost half the chance of getting long-COVID

Vaccine effectiveness

• Studies of patients > 60 years old with XBB.1.5

  • Protect against hospitalisation and ICU admission about 75% effective