The 3rd COVID-19 vaccine dose for people who are immunocompromised

• October 21, 2021
• Dr Peter Landsberg

Last updated on August 21, 2023

On 8th October this year, the Australian Government recommended that many Australians receive a third dose of the COVID-19 vaccine as part of the primary course of vaccinations. It was particularly recommended that individuals who are immunosuppressed have a third dose.

As a result, we have received many enquiries at ArthritisCARE from our patients checking in to see if their rheumatologist recommends this third dose for them. So I thought it might be helpful to share a few quick thoughts here and point you to further resources for more information about the third COVID vaccine roll-out plan for Australia.

Given that this booster dose is being made available for individuals who are immunosuppressed, this means that most people with rheumatoid arthritis, lupus, psoriatic arthritis, vasculitis, ankylosing spondylitis and other conditions needing immunotherapy medications, will be entitled to access the third dose. This will also apply to cancer patients and others on immunotherapy drugs.

An mRNA vaccine (Pfizer or Moderna) is preferred to AstraZeneca for the third dose. But AstraZeneca can be used if the first two doses received were also AstraZeneca vaccines, or if the person has previously had an adverse reaction to the mRNA vaccine.

The recommended interval for the third dose is 2-6 months after the second dose of the vaccine. While not ideal, a minimum interval of four weeks may also be considered if there is a local outbreak of COVID-19.

Not all people with rheumatological diseases will need a third dose, however, it is recommended for people who might not have had a complete response to the first two doses because they have been taking certain immunosuppressive therapies.

The medications most likely to reduce the effectiveness of the original vaccines include:

• Prednisone
• Methotrexate
• Mycophenolate
• Cyclosporine
• Cyclophosphamide
• Rituximab
• Abatacept
• Leflunomide
• Azathioprine

Other types of immunotherapy medications appear to have much less of an impact on the effectiveness of the first two vaccines. TNF Blockers, Tocilizumab (Actemra), Plaquenil (Hydroxychloroquine), IL-17 and  IL-23 blockers and Sulfasalazine fall into this group. So for people taking these medications, the third COVID vaccine dose is not as strongly recommended.

While I would be happy to recommend a booster for anybody on immunotherapy, advice may vary from one rheumatologist to another. For this reason, my firm suggestion is that you check with your own rheumatologist or GP for advice about how the third COVID vaccination applies to your specific circumstances.

Of course, there is a lot of valuable information now available online.  Clicking on the following links will take you to information from reliable and credible sources to help you to conduct your own research and be well-informed when you do have the chance to speak to your doctor.

COVID Vaccination Information for Patients from the Australian rheumatology Association
Download this Australian rheumatology Association information in a printable PDF format here
Updated 13th October 2021

Recommendations from the Australian Technical Advisory Group on Immunisation (ATAGI) on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised.

Creaky Joints – experiences as shared on the American site – not the Australian site – as our 3rd COVID dose rollout is yet to commence.
What It’s Like Getting the Third COVID-19 Vaccine Dose: Immunocompromised Patients Report Back