Boosters brought forward to three months

7 minute read

Communicable Disease COVID-19 Live blog

By

Bianca Nogrady

And Novavax's covid vaccine is granted provisional approval for use in Australia.

Welcome to The Medical Republic’s Covid Catch-Up.

It’s the latest covid-19 news in one convenient post. Email bianca@biancanogrady.com with tips, comments or suggestions.

20 January

Boosters are now recommended for severely immunocompromised children aged 5-11, given two to six months after their second vaccine dose, according to new advice from the Australian Technical Advisory Group on Immunisation.
ATAGI has flagged that it is now reviewing what the meaning of “up to date” is with respect to covid vaccines, and whether a third dose is to become required as part of that.
Meanwhile, NSW, Victoria, South Australia and the ACT [Friday update: and now Queensland] have all shortened the wait between second dose and boosters to three months.
In December, ATAGI had advised shortening the gap to three months “as soon as is practical”, but only this week has there been enough vaccine supply to enable the change.

A new vaccine player has entered the arena, with the Therapeutic Goods Administration granting provisional approval to new covid vaccine Nuvaxovid, from Novavax.
The two-dose vaccine is the first protein-based vaccine – consisting of nanoparticles coated in the SARS-CoV-2 spike protein – to be approved in Australia. It differs from the three existing vaccines in that its payload is the spike protein itself rather than the gene for the spike protein. The two doses are to be given three weeks apart.
A phase 3 randomised controlled trial in nearly 30,000 adults found the vaccine was 90% protective against symptomatic covid and 100% effective against moderate to severe disease.
The most common adverse events were local tenderness or injection-site pain, which affected 58% of people after the first dose and nearly 79% after the second dose. Around 40% of people also reported headache, fatigue or muscle pain after the second dose, but there were no increased events of Guillain-BarrĂŠ syndrome, myocarditis or pericarditis or thrombosis with thrombocytopenia compared to placebo.
The federal government has a pre-existing order of 51 million doses of Nuvaxovid, and the first doses are expected to arrive over the next month.

And in case you still get covid after being fully-vaccinated, the TGA has also provisionally approved two new antiviral therapies against covid.
Molnupiravir works by interfering with SARS-CoV-2’s replication machinery and causing the introduction of errors into the viral RNA that ultimately stop the virus from replicating and infecting cells.
A phase 3 study found the drug was associated with a seven percentage-point reduction in the risk of hospitalisation or death from covid among unvaccinated individuals with covid who weren’t hospitalised but had at least one risk factor for more severe disease.
The second drug given provisional approval is a combination of nirmatrelvir and ritonavir, for use in adults with mild to moderate disease but risk factors for severe disease. The nirmatrelvir inhibits a key enzyme that SARS-CoV-2 needs to replicate, and the ritonavir boosts its action.
However the drug is contraindicated during pregnancy and breastfeeding, in patients with kidney or liver disease, and has significant risk of interactions with other drugs including some statins, antipsychotics, sedatives and opioids.

Inhaled heparin is attracting interest as a possible treatment for severe covid, after a study saw improvements in oxygenation both in intubated and non-intubated patients.
The 98 patients in the study, published in the British Journal of Pharmacology, were all hospitalised with covid, already on anticoagulant therapy, and were treated with nebulised unfractionated heparin.

When should healthcare workers who are either close or casual contacts go back to work? The federal Department of Health has released detailed interim guidance on the implications of different exposure settings for healthcare workers, and what that means for work permissions and restrictions.
Given the pressure being placed on the healthcare system by the current outbreak, the advice is that asymptomatic high-risk contacts can continue to work under certain conditions – regular testing and increased PPE – as a “contingency strategy”.
The guidance includes a table that summarises the requirements for testing, isolation and return to work across a range of scenarios.

Mandatory vaccination is not incompatible with human rights, and there is even a case to be made that nations have a rights-based duty to consider adopting it, say legal experts writing in The Lancet.
Citing the widespread understanding that “restrictions on liberty can be justified if they prevent harm to others”, the authors of the article point out that the European Convention on Human Rights already recognises that the right to physical integrity can be limited for the protection of the health of others.
Immunisation is a key part of the right to health that all are entitled to, and is a responsibility not just of individuals but also communities and governments, as a way to prevent, treat and control disease epidemics.
“As far as we know, no major constitutional or international court has found that a mandatory vaccination policy violates any general right to liberty,” they wrote. “Nevertheless, the in-principle compatibility of mandatory vaccination and human rights does not mean that governments, employers, or schools should be cavalier about their adoption.”

Vaccination may offer a high degree of protection against long covid, according to a non-peer-reviewed preprint study published on MedRxiv.
Researchers followed up with 951 individuals diagnosed with covid between March 2020 and November 2021 – two-thirds of whom were vaccinated with the Pfizer vaccine – and surveyed them a median of 300 days after their diagnosis.
Overall, 35% of participants reported having not fully recovered at the time of follow-up. After adjusting for follow-up time and symptoms at baseline, the study found those who were double-vaccinated had 54-82% reduction in the most common persistent symptoms – fatigue, headache, weakness or muscle pain – compared to those who were unvaccinated.
Double-vaccinated people had the same risk of these symptoms at the time of follow-up as people who were never infected with covid to begin with.
“Our results therefore suggest that receiving two doses of covid-19 vaccine, at least the BnT162b2 mRNA vaccine used in Israel, brings the incidence of such symptoms back to baseline,” the authors wrote.

The US government is now providing free at-home rapid antigen tests to all its citizens.
Shame there’s no postage to Australia from the US.

New covid infections have increased 20% globally in the past week compared to the previous week, and the number of deaths has also increased, according to the latest WHO update.
But while 57% of the global population has received at least one dose of a covid vaccine, and 47% have received a full course of vaccine, only 9% of people in low-income countries have had even their first dose, compared to 66% of those in high-income countries.
“Individual countries need to balance decisions about their booster dose policy and local public health benefits against the need to support global equity in vaccine access,” the WHO said.

Sixty-five Australians died from covid in the 24 hours to 9pm Wednesday, bringing the total number of deaths to 2841.

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