The Department of Health has updated the exemption guidelines.What is new:
1. The exemption after an active infection is reduced to 4 months.2. There is no mention of the RAT test as being or not being valid proof of the past infection. Istead, the department uses these words: “The maximum time allowable for this exemption is 4 months following release from isolation after acute infection”. This is 7 days after the diagnosis. There is no mention of how the diagnosis was confirmed.
ATAGI has added a paragraph on Temporary exemptions for COVID-19 vaccine:
“If the vaccinee is a risk to themselves or others during the vaccination process they may warrant a temporary vaccine exemption. This may include a range of individuals with
underlying developmental or mental health disorders, but noting that non-pharmacological interventions can safely facilitate vaccination in many individuals with behavioural disturbances and that specialist services may be available to facilitate the safe administration of vaccines in this population.”
What they are trying to say is that if someone needs an exemption based on a mental health disorder, the assessment of the risk to themselves or others needs to be performed. If such risk exists, a referral to an appropriate mental health service needs to be made to prepare the patient for vaccination. In the meantime, this patient would have an exemption.
The news of GPs no longer providing any exemptions from COVID-19 vaccination were premature. From the 29th of October 2021, GPs will have to submit the exemption form to AIR. Patients will need to download the actual Certificate from their MyGov portal. So, the pressure is still on GPs. Please, see updated guidelines on what conditions are eligible for exemption below.
THE INFORMATION BELOW IS LARGELY OUTDATED AND KEPT FOR REFERENCE ONLY
Lately, GPs became inundated with requests for exemption letters allowing patients not to be vaccinated against COVID-19. More and more categories of people are being mandated to get the vaccine in order to continue with their work. Construction workers, aged care workers, healthcare workers, childcare workers and teachers must be vaccinated in some states (e.g. Victoria). The demand for the exemption letters will only increase.
Who can grant the exemption?
Exemption from the COVID-19 vaccine can be granted only by a vocationally registered GP and specialists. Doctors with General or Limited or Provisional registration cannot issue an exemption.
What kind of exemptions can be given?
There is a permanent exemption and temporary exemption.
A permanent exemption can be granted based on:
- had anaphylaxis after a previous dose of a vaccine e.g. patient had anaphylaxis after the first COVID-19 vaccine.
- had anaphylaxis after a dose of any component of a vaccine e.g. a patient had anaphylaxis in the past to polysorbate that is a component of some flu vaccines. The same component is present in some COVID-19 vaccines.
A temporary exemption can be granted based on:
- acute major medical illness
- significant immunocompromise of short duration (live
attenuated vaccines only)
- the individual is pregnant (live attenuated vaccines and
COVID-19 vaccines only)
* Acute major medical illness is something that requires urgent hospital treatment. Anxiety is not an acute major medical illness.
**Please, note that pregnancy is not a contraindication to COVID-19 vaccination at all. However, since pregnancy is included in the prescribed exemption form it may be a valid reason for exemption. I understand that it is related to the patient’s choice. Please, see the screenshot below.
What is not a valid ground for exemption?
These aren’t valid reasons:
- mild illness without fever—meaning your temperature is below 38.5ºC
- any family history of adverse events following immunisation
- history of convulsions
- treatment with antibiotics
- treatment with locally acting steroids, inhaled or low dose topical
- replacement corticosteroids
- asthma, eczema, atopy, hay fever or sniffles
- previous infection with the same pathogen
- prematurity, vaccination shouldn’t be postponed and can be given if the infant is medically stable
- history of neonatal jaundice
- low weight in an otherwise healthy child
- neurological conditions, including cerebral palsy and Down syndrome
- contact with an infectious disease
- child’s mother is pregnant
- child is being breastfed
- woman is breastfeeding
- recent or planned surgery.
Is past infection with COVID-19 a valid ground for exemption from vaccination?
No, it is not. A vaccination against COVID-19 may be deferred by up to 6 months after a confirmed diagnosis.
Past confirmed diagnosis of COVID-19 is a temporary contraindication for 6 months since the confirmed diagnosis. Most of the exemption forms will require the date of the diagnosis. ” Past confirmed infection with SARS-CoV-2 is not a contraindication to vaccination, however ATAGI recommends deferring COVID-19 vaccination for up to 6 months after the acute illness. Current evidence suggests that the risk of SARS-CoV-2 re-infection is low in the 6 months after initial infection, but may increase with time due to waning immunity. There may be some situations where it is reasonable to be vaccinated earlier than 6 months following infection in consultation with a health practitioner, such as people working in a job with a high risk of exposure to SARS-CoV-2, or patients who are significantly immunocompromised and may not have a strong immune response after being infected with the virus. Similarly, if a person is infected with SARS-CoV-2 and has had their first dose of COVID-19 vaccine, the second dose may be deferred for up to 6 months.”
How an exemption is granted?
A GP must fill in the form IM011 (below) OR enter the exemption directly to AIR (PRODA).
What if a GP is in doubt?
If a GP is in doubt, a referral to a specialised immunology service can be made. This service is called VicSIS.
In the nutshell, referral to a VicSIS allergy clinic is required if a person has a history of:
• Immediate (within 4 hours) and generalised symptoms of a possible allergic reaction (e.g. urticaria/hives) to a previous dose of a COVID-19 vaccine
• Generalised allergic reaction (without anaphylaxis) to any component of the COVID-19 vaccine to be administered (e.g. PEG in the Pfizer/BioNTech vaccine, or polysorbate 80 in the COVID-19 vaccine AstraZeneca)
• A prior history of anaphylaxis to previous vaccines and/or multiple drugs (injectable and/or oral) where ingredients such as PEG or polysorbate 80 may conceivably be the cause
• A known systemic mast cell activation disorder with raised mast cell tryptase that requires treatment
A more detailed VicSIS referral framework is reproduced below:
Please, see the referral form to VicSIS below:
There is a potential controversy about the guidelines. The Australian Immunisation Register immunisation medical exemption (IM011) form provides that a person with prior anaphylaxis to a vaccine component may be exempted. However, the VicSIS framework does not recognise prior anaphylaxis as a contraindication. Similarly, ASCIA, the Australasian Society of Clinical Immunology and Allergy (https://www.allergy.org.au/hp/papers/guide-allergy-and-covid-19-vaccination) recommends vaccinations for people with a history of anaphylaxis to previous vaccines. It is not clear if prior anaphylaxis reaction to any vaccine is, in fact, a contraindication.