The information on this page will assist health professionals delivering the COVID-19 Vaccination Program in South Australia. Information contained in these documents is correct at the time of release. As information is continually evolving some documents will be updated if related information and recommendations change in the future.

Advice from ATAGI

The Australian Technical Advisory Group on Immunisation (ATAGI) advises the Minister of Health on the immunisation programs and provides clinical guidance on the vaccines available in Australia.

Regularly updated ATAGI statements can be found here:

Children aged 6 months to less than 5 years

Children aged 6 months to less than 5 years with the following or similar conditions which increase the risk of severe COVID-19 are eligible to receive paediatric Moderna or Pfizer COVID-19 vaccine:

  • Severe primary or secondary immunodeficiency, including those undergoing treatment for cancer, or on immunosuppressive treatments as listed in the ATAGI advice on 3rd primary doses of COVID-19 vaccine in individuals who are severely immunocompromised;
  • Bone marrow or stem cell transplant, or chimeric antigen T-cell (CAR-T) therapy;
  • Complex congenital cardiac disease;
  • Structural airway anomalies or chronic lung disease;
  • Type 1 diabetes mellitus;
  • Chronic neurological or neuromuscular conditions; or
  • A disability that requires frequent assistance with activities of daily living, such as severe cerebral palsy or Down Syndrome (Trisomy 21).

Eligible children aged 6 months to less than 5 years will be able to access either paediatric Moderna or Pfizer COVID-19 vaccine at participating clinics. Refer to COVID-19 Vaccine Clinic Finder for further information.

Vaccinating eligible children aged 6 months to less than 5 years against COVID-19 decreases the child’s risk of severe illness with COVID-19 infection.

Recommended vaccine, dosage and schedule

  • Paediatric Moderna COVID-19 vaccine for children aged 6 months to 5 years
    • vial: blue top
    • dosage: 25mcg in 0.25ml
    • two primary course doses are required, or three doses for severely immunocompromised children
    • doses are administered 8 weeks apart
  • Paediatric Pfizer COVID-19 vaccine for children aged 6 months to 4 years
    • vial: maroon top
    • dosage: 3mcg in 0.2ml
    • three primary course doses are required for all eligible children, irrespective of immunocompromise
    • doses are administered 8 weeks apart

Completion of the primary course with the same brand of vaccine is recommended.

ATAGI recommend where possible to separate the administration of Paediatric Moderna or Pfizer COVID-19 vaccine and administration of other vaccines by 7-14 days.

SA Health recommend an interval of 14 days to separate administration of the Paediatric Moderna or Pfizer Paediatric COVID-19 vaccine and any NIP vaccines (including influenza) and the state-based Meningococcal B Vaccine Program to ensure program safety.

For more information

Children aged 5 to 11

Vaccines for children aged 5 to 11 years are available at participating clinics. Refer to COVID-19 Vaccine Clinic Finder for further information.

Vaccinating children aged 5 to 11 against COVID-19 decreases spread of the virus to all age groups. It also reduces the child’s risk of rare but serious complications, such as multi-system inflammatory syndrome, and post-COVID-19 condition (Long COVID).

Recommended vaccines, dosage and schedule

It is preferable that the same brand of vaccine is used for each primary course dose administered to a child aged 5 to 11.

  • Paediatric Pfizer COVID-19 vaccine for children aged 5 to 11
    • vial: orange top
    • dosage: 10mcg in 0.2ml
  • Paediatric Moderna COVID-19 vaccine for children aged 5 years
    • vial: blue top
    • dosage: 25 mcg in 0.25ml
  • Moderna COVID-19 vaccine for children aged 6 to 11 years
    • vial: red top
    • dosage: 50 mcg in 0.25ml

Two primary course doses are required, or three doses for severely immunocompromised children. Doses are administered 8 weeks apart.

This interval can be reduced to a minimum of three weeks for Pfizer or four weeks for Moderna in special circumstances.

For more information



Medically at-risk children aged 6 months to 17 years

It is important that children with an underlying medical condition access COVID-19 vaccination as soon as possible to significantly reduce their risk of COVID-19 infection, illness or hospitalisation.

If the child is medically stable, they can receive their vaccine at an SA Health vaccination clinic, or participating GP, respiratory clinic or pharmacy.

If the child has a medical at-risk condition and/or is medically unstable, they should be referred for assessment at the Specialist Immunisation Service at the Women’s and Children’s Hospital. The website includes a list of medical at-risk conditions.

Referrals can also be made if the child has an eligible condition and the parent or legal guardian is hesitant and requires further counselling that cannot be provided by their vaccine provider, GP or specialist.

Referrals are made by faxing a referral letter to 08 8161 9295.

Medically at-risk adults

The South Australian COVID-19 Specialist Immunisation Clinic (SACSIC) provides specialist services for adults identified as at risk for adverse events following immunisation (AEFI) or those who experience AEFIs in the context of a COVID-19 vaccine.

Referral process and criteria

All referrals to the South Australian COVID-19 Specialist Immunisation Clinic must be forwarded via fax or email using the SACSIC Referral Form (PDF 47KB). Criteria for referral are listed on the form.

Further information is available at:

Immunocompromised people

ATAGI recommends a third dose of COVID-19 vaccine as part of the primary course for people aged 6 months and over who are severely immunocompromised. The third dose is intended to maximise the level of immune response to as close as possible to the general population. The third dose is given two months after the second dose.

Antibody testing is not recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination, including in immunocompromised individuals after a second or third dose.

A booster dose is recommended for severely immunocompromised individuals aged 5 years and over, given three months after the third primary dose.

An additional booster dose can be given to eligible individuals aged 16 and over three months after the first booster dose or three months after a confirmed SARS-CoV-2 infection if infection occurred since the first booster dose.

Immunocompromising conditions and therapies

A list of conditions and therapies for which a third primary dose is recommended is available in ATAGI recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised.

An individual with an unlisted condition should only be considered for a third dose where the treating physician has assessed the patient as having a similar level of severe immunocompromise to the eligible conditions.

Preferred vaccine types for third dose

  • Children 6 months to less than 5 years:
    • paediatric Moderna COVID-19 vaccine, blue top vial
    • paediatric Pfizer COVID-19 vaccine, maroon top vial
  • Children aged 5 years
    • paediatric Pfizer COVID-19 vaccine, orange top vial
    • or paediatric Moderna COVID-19 vaccine, blue top vial
  • Children aged 6 to 11
    • Moderna COVID-19 vaccine, red top vial, 0.25mL dose
    • paediatric Pfizer COVID-19 vaccine, orange top vial or a
      half dose of Moderna vaccine
  • People aged 12 and over
    • Moderna COVID-19 vaccine, red top vial, 0.5mL dose
    • Pfizer or ModernaCOVID-19 vaccine, purple top vial

Possible alternative vaccine types for third dose

  • Novavax can be used as a third dose in those aged 18 and over, noting there is very limited data on its efficacy in people with immunocompromise.
  • AstraZeneca can be used as a third dose in those aged 18 and over if AstraZeneca was given for the first two doses AND there are no contraindications or precautions for use, OR if a significant adverse reaction occurred after previous doses of other vaccine types contraindicating their further use, and the benefits of AstraZeneca vaccination outweigh the risks.

Recommended interval

The recommended interval for the third dose is two months after the second dose of vaccine. A minimum interval of four weeks may be considered in exceptional circumstances (e.g. anticipated intensification of immunosuppression or outbreaks). People who had a second dose more than six months ago should receive a third dose as soon as possible.

Scheduled doses for severely immunocompromised people

  • A three-dose primary course for all those aged 6 months and over.
  • The third primary dose is recommended to be given two months after the second primary dose.
  • A booster dose is recommended for those aged 12 years and over, given three months after the third primary dose.
  • An additional booster dose is recommended for those aged 16 years and over, given three months after the first booster dose or three months after a confirmed SARS-CoV-2 infection if infection occurred since the first booster dose.

Proof of eligibility

Patients attending a pharmacy will need to show evidence of their eligibility for a third dose as outlined in the Commonwealth eligibility declaration form.

Evidence can be provided in one of the following ways:

  1. A letter from a GP or other treating specialist confirming the individual is severely immunocompromised (as per guidelines).
  2. Another medical document dated within the last 5 years which shows the individual is severely immunocompromised (as per guidelines), such as a:
    • patient medical summary from clinical records or My Health Record printed by treating GP’s practice
    • chronic disease care plan from treating GP
    • discharge summary from a hospital or other medical facility
    • named prescription for a medication prescribed to treat relevant conditions or procedures outlined in the guideline.
  1. A condition-specific identifier that the patient has been issued.
  2. An Eligibility Declaration Form completed by the patient, legal guardian or substitute decision maker (if unable provide any of the above evidence of eligibility).

Patients are not required to provide any medical or other details about their condition to their vaccination provider.

Third (booster) dose

A booster dose enhances and extends protection from the primary course and helps prevent spread of the virus.

Currently, booster doses are available to everyone 16 years and over who have completed their primary course of COVID-19 vaccinations at least three months ago.

ATAGI also recommends that a booster dose of Pfizer COVID-19 vaccine may be given to the following children and adolescents aged 5-15 years who have completed a primary course of vaccination three or more months ago:

ATAGI does not currently recommend booster doses for people aged under 5 years.

Vaccine type

  • Eligible people aged 5-15 can have the Pfizer vaccine as a booster dose.
  • People aged 16 to 17 can have the Pfizer vaccine as a booster dose.
  • People aged 18 and over can have the Pfizer vaccine, the Pfizer bivalent vaccine, the Moderna bivalent vaccine, or a reduced dose of the Moderna vaccine as a booster dose.

Although not preferred, AstraZeneca or Novavax can be used as a booster dose for people who have a contraindication to mRNA vaccines (including those who have had a serious adverse event following mRNA vaccines, e.g., a history of anaphylaxis or myocarditis attributed to an mRNA vaccine) and people who do not prefer an mRNA vaccine.

For more information see:

Fourth (booster) dose

In addition to the third (booster) dose a fourth (booster) dose of COVID-19 vaccine is recommended to increase vaccine protection for selected population groups at greatest risk of severe illness from COVID-19 who have completed their primary course and received a first booster dose. These groups are:

People aged 30 years and over are eligible to receive a fourth (booster) dose if they choose.

The fourth dose can be given to eligible individuals provided that three months has passed since their third dose and three months has passed since a positive test result, if the individual had confirmed SARS-CoV-2 since their first booster dose.

For more information see:

Vaccination following COVID-19 infection

  • Past infection with SARS-CoV-2 is not a contraindication to vaccination. This includes children with a past history of paediatric inflammatory multisystem syndrome or long COVID. Individuals who have prolonged symptoms from COVID-19 can be vaccinated on a case-by case basis.
  • It is recommended that all people should wait for 3 months after confirmed SARS-CoV-2 COVID-19 infection before they receive their next COVID-19 vaccination, including recommended booster doses.
  • The next scheduled dose should then be given as soon as possible after this time.
  • Serological testing or other testing to detect current or previous infection with SARS-CoV-2 before vaccination is neither necessary nor recommended.

Vaccination exemptions

A person must meet certain eligibility requirements in order to obtain an exemption from COVID-19 vaccination. Criteria are listed in the ATAGI Expanded Guidance on temporary medical exemptions for COVID-19 vaccines.

Applying for an exemption

  1. For healthcare setting workers required to be vaccinated against COVID-19 under the South Australian Public Health Act, 2011, in accordance with the SA Health Addressing vaccine preventable disease: Occupational assessment, screening and vaccination policy (PDF 456KB), whose COVID-19 vaccinations are not up-to-date as defined by ATAGI, the process for applying for a CPHO exemption from vaccination is as follows.
    1. Medical practitioner writes a medical certificate clearly outlining the individual’s reason for medical exemption in line with the Australian Technical Advisory Group on Immunisation (ATAGI) COVID-19 vaccine exemptions guidelines.
    2. Medical practitioner completes SA Health Chief Public Health Officer Immunisation Exemption Application Form (PDF 68KB) on behalf of the individual (who may be a worker, volunteer or visitor, depending on the specific Direction).
    3. The individual emails the medical certificate and immunisation. exemption application form to Health.NJNPExemptions@sa.gov.au
    4. Application for exemption is considered by the South Australian Chief Public Health Officer (CPHO).
    5. If approved, the CPHO provides a signed exemption letter that can be submitted to the individual’s employer, or the manager of the site which a volunteer or visitor seeks to enter.
  1. For individuals required to be vaccinated as a condition of their employment set by their employer, or for any other activity where vaccination is required e.g. a COVID management plan or event
    1. Medical practitioner completes online Australian Immunisation Register (AIR) - immunisation medical exemption form for workers with medical contraindication to COVID-19 vaccination including, possible deferral of up to 4 months from date of testing positive to COVID-19.
    2. Medical practitioner submits completed form to AIR via PRODA account.
    3. Medical practitioner records vaccine exemption due to a medical contraindication online through the AIR site. Vaccine exemptions recorded on the AIR site are processed immediately.
    4. The individual downloads their COVID-19 digital certificate from Medicare online account through myGov to submit to an employer or event manager. The certificate lists the duration of the medical exemption as a ‘valid to’ date. Alternatively, an individual can ask the medical practitioner to print the certificate from the AIR website.
    5. A temporary medical exemption of up to 3 months may be granted from the date of testing positive to COVID-19.

Vaccine information

Medical practitioners can refer individuals who are at risk or have experience of adverse events following immunisation (AEFI), in the context of a COVID-19 vaccine, to the South Australian COVID-19 Specialist Immunisation Clinic (SACSIC). Please see the information under section, “Medically at-risk adults”. South Australia COVID-19 Specialist Immunisation Clinic (SACSIC) - Referral form

Medical practitioners are encouraged to use tools and resources, for conversation with patients who are hesitant about COVID-19 vaccination, such as the National Centre for Immunisation Research and Surveillance (NCIRS) COVID-19 vaccine decision aids and "It's worth the shot" resources developed by Consumers Health Forum of Australia.

Reporting vaccination administration errors

Vaccine Administration (program) errors are a type of medication incident and include errors relating to:

  • the type or formulation of vaccine used, including where a contraindication exists or the vaccine is not approved for the age group of the recipient
  • incorrect vaccine preparation, dosage, dosage interval or administration route/site
  • use of vaccines which have expired or were incorrectly stored e.g. cold chain breach.

Some error types may occur secondary to inaccurate patient information (e.g. age, date of birth or previous vaccinations) being provided in the absence of access the Australian Immunisation Register, such as when internet access is temporarily unavailable.

View ATAGI clinical guidance on COVID-19 vaccine administration errors for advice about clinical management following vaccine administration errors.

All COVID-19 immunisation program errors must be reported:

AND

Vaccination Administration Error mitigation resources

Mandatory reporting of adverse reactions

As of 13 April 2021, an adverse event following immunisation (AEFI) is a notifiable condition in South Australia pursuant to section 63(2) of the South Australian Public Health Act 2011.

Medical practitioners, pathology services and authorised health practitioners under the Vaccine Administration Code are legally required to notify SA Health if a serious or unexpected AEFI occurs.
The South Australian Vaccine Safety Surveillance System (SAVSS) monitors AEFI for South Australia.

Information from AEFI reports received by SA Health are sent to the Therapeutic Goods Administration (TGA).

Health professionals are required to be alert for any persistent, unexpected or severe AEFI, related to any vaccine.

How to notify

Notify serious or unexpected AEFI, or any AEFI which results in healthcare attendance to SA Health:

  • Complete an online Vaccine Reaction Report Form and a lodgement number will be issued following submission. An option to receive confirmation and lodgement number via email is available. You can also print a copy of your report.

OR

  • Call the SA Health COVID-19 Clinical Advisory Service between 8.30 am – 5.00 pm, Monday to Friday on 1300 232 272. Serious AEFI related to COVID vaccines can also be reported on this number outside of business hours.

For more information, visit the Vaccine safety page.

Cold chain management

COVID-19 vaccines have specific storage requirements. Further information is available at:

In the event of a cold chain breach affecting COVID-19 vaccines:

AND

Contact the SA Health COVID-19 Clinical Advisory Service on 1300 232 272 for further information.

Health workforce training

To ensure the health workforce is competent in the safe management and administration of COVID-19 vaccines, health practitioners must undertake specific mandatory training prior to ordering or administering any COVID-19 vaccinations.

For further information visit the Immunisation provider training and education page.

Additional resources for COVID-19 vaccine providers