COVID-19 Guide

About COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.^[1]

The original COVID-19 virus, which is caused by the SARS-CoV-2 virus, was first identified in December 2019. It belongs to the coronavirus family which also includes viruses that cause illnesses like the common cold, MERS (Middle East Respiratory Syndrome), and SARS (Severe Acute Respiratory Syndrome). The virus is characterised by its spike proteins which it uses to enter human cells. 

There have been many identified SARS-CoV-2 virus strains, variants, and sub-variants as the virus mutates and evolves over time. Omicron, a variant of the SARS-CoV-2 virus, was first identified in November 2021 and was officially designated as a variant of concern by the World Health Organization (WHO) shortly thereafter. Omicron is notable for having a large number of mutations in the spike protein of the virus which is the part of the virus that binds to human cells.

Each variant and subvariant is associated with varying levels of transmissibility, immune escape, and disease severity. Each of these is given a name and an abbreviated classification. The epidemiology of each variant varies widely, with some strains dominating more than others as they evolve or phase out.

What’s important is for people to stay vigilant, ensure they are vaccinated against the virus (particularly for at-risk individuals with underlying medical conditions), and continue to apply non-pharmaceutical practices during outbreaks. 

COVID-19 Cause And Transmission

COVID-19 is a disease caused by a new form of coronavirus, first reported in December 2019. Coronaviruses are a large family of viruses that cause respiratory infections ranging from the common cold to more serious diseases.^[2]

The virus can spread from person to person through:

• Close contact with an infectious person (including in the 48 hours before they had symptoms)
• Contact with droplets from an infected person’s cough or sneeze
• Touching objects or surfaces (like doorknobs or tables) that have droplets from an infected person, and then touching your mouth or face.

Current evidence suggests that the most likely spread is from respiratory droplets between people from close contact with each other.^[3][4]

People are believed to be most infectious two days before they start showing symptoms.^[5] However, even if people do not show any symptoms, they can still spread the virus to other people.

COVID-19 Symptoms

Symptoms of COVID-19 can range from mild illness to pneumonia. Some people may get very sick very quickly, and most people will recover easily. People with coronavirus may experience symptoms such as:^[6]

• Fever
• Coughing
• Sore throat
• Shortness of breath

Other symptoms can include runny nose, acute blocked nose (congestion), headache, muscle or joint pains, nausea, diarrhoea, vomiting, loss of sense of smell, altered sense of taste, loss of appetite and lethargy.^[7]

COVID-19 Complications

Most people will recover from COVID-19 within a few weeks, however it can cause serious complications.

Older people and those with underlying medical conditions e.g. heart disease, diabetes, obesity, chronic liver disease, severe asthma and cystic fibrosis may be more likely to develop a more serious illness.^[8] 

What causes COVID-19 complications?

COVID-19 complications may be caused by a cytokine storm. Cytokines are inflammatory proteins that can flood the bloodstream after an infection such as COVID-19 triggers the immune system. The large influx of cytokines can cause damage to many organs of the body like the heart, lungs, liver and kidneys.^[9]

The most common complications affect the lungs and respiratory system:

• Pneumonia: an infection that affects one or both lungs.^[9]
• Acute Respiratory Distress Syndrome: the lungs become so severely damaged that fluid flows into them which inhibits the body getting oxygen into the bloodstream.^[9]

Other complications include:

• Acute liver injury^[10]
• Acute cardiac injury^[11] 
• Secondary infection: the body may develop another infection unrelated to COVID-19^[12]
• Acute kidney injury^[13]
• Septic shock^[14]
• Disseminated intravascular coagulation: abnormal clotting can lead to internal bleeding and organ failure^[15]
• Blood clots including those causing pulmonary embolism^[16]
• Multi-system inflammatory syndrome in children: some organs in the body become severely inflamed. Symptoms include fever, belly pain, vomiting, diarrhoea, headache, rash and confusion^[17]
• Chronic fatigue: Symptoms may include brain fog, severe fatigue, pain, trouble thinking or dizziness^[18]
• Rhabdomyolysis^[19]
• Damage to the brain: even in young people, COVID-19 can cause strokes and Guillain Barre Syndrome.^[20][21]

People with severe symptoms may be hospitalised and treated in the Intensive Care Unit with mechanical devices such as ventilators. Surviving these experiences can make them more likely to suffer from post-traumatic stress disorder, depression and anxiety.^[22][23][24]

Long COVID

WHO defines Long COVID as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection with these symptoms lasting for at least 2 months with no other explanation.^[25]

The symptoms may include fatigue, shortness of breath and cognitive dysfunction.

10–20% of people with over 17 million people across the WHO European Region have experienced Long Covid during the first two years of the pandemic (2020/21).^[25] 

In Australia, an AIHW review found that 5–10% of COVID-19 cases reported symptoms persisting for more than 3 months with the vast majority resolving within 12 months.^[26]

The key risk factors include: severe COVID-19 illness, comorbidities, female, mid-adult age groups^[26]

Two COVID-19 vaccination doses are associated with a 13% to 47% lower risk of symptoms persisting beyond 4 weeks.^[27]

The Immunisation Coalition has supported the development of the CoRiCal Long-COVID Calculator which provides a personalised risk assessment of developing long COVID 6 months after infection.

Who is Most at Risk?

You are at a high risk of becoming very sick from COVID-19 and needing hospital treatment, if you:^[28]

• are aged 65 years or older
• have certain health conditions, including:
  • weakened immune system
  • neurological disease, such as stroke or dementia
  • chronic lung disease, such as severe asthma or chronic obstructive pulmonary disease
  • heart disease
  • obesity
  • diabetes
  • chronic kidney disease
• are pregnant.

High risk settings include:^[28]

• residential aged care facilities
• disability care services
• in-home aged, health and disability care
• hospitals and other healthcare settings

Among patients with vaccine breakthrough COVID-19 hospitalisations, 40-44% had immunosuppression.^[29][30]

COVID-19 Prevention

COVID-19 cannot be controlled by one approach alone: a combination of wearing a mask, education, hygiene (particularly washing hands), social distancing, vaccination and antiviral treatments continue to be recommended.^[30]

Recommendations

Infants, children and adolescents

Healthy infants, children and adolescents aged <18 years are not recommended to receive COVID-19 vaccine

Adults

Adults aged ≥18 years are recommended to receive COVID-19 vaccine, and further doses are recommended based on age and risk-benefit assessment

People with medical conditions that increase their risk of severe illness

People with medical conditions that increase their risk of severe illness from COVID-19 are recommended to receive further doses of COVID-19 vaccine

Women who are pregnant or breastfeeding

Unvaccinated pregnant women are recommended to receive COVID-19 vaccine

Vaccinated pregnant women are not recommended to receive further doses of COVID-19 vaccine during pregnancy

People with a history of SARS-CoV-2 infection

People with a history of SARS-CoV-2 infection can receive further doses of COVID-19 vaccine as recommended

Serological testing for immunity to SARS-CoV-2

Serological testing for immunity to SARS-CoV-2 is not recommended before or after receiving a COVID-19 vaccine

Table 1: Timing of further COVID-19 vaccine doses by age group and risk status^[31]

Age	With Severe Immunocompromise#	Without Severe Immunocompromise#
≥ 75 years	Recommended every 6 months	Recommended every 6 months
65-74 years	Recommended every 12 months and are eligible for a dose every 6 months	Recommended every 12 months and are eligible for a dose every 6 months
18-64 years	Recommended every 12 months and are eligible for a dose every 6 months	Eligible for a dose every 12 months
5-17 years	Eligible for a dose every 12 months	Not recommended
<5 years	Not recommended	Not recommended

# See the Australian Immunisation Handbook for definitions and examples of severe immunocompromise

Vaccines, dosage and administration

The Therapeutic Goods Administration website provides product information for each vaccine- external site, including the recently registered Comirnaty LP.8.1 vaccines.

Paediatric formulations

• Comirnaty JN.1* 5 years to <12 years (light blue cap) formulation
• Comirnaty JN.1* 6 months to <5 years (yellow cap) formulation
• Comirnaty LP.8.1 5 years to <12 years (light blue cap) formulation
• Comirnaty LP.8.1 6 months to <5 years (yellow cap) formulation

* according to the AIH as of 11 August 2026. According to the AusVax Safety website, it appears that the JN.1* vaccine is no longer available in Australia and has been replaced by LP.8.1. The Immunisation Coalition refers to the AIH – as soon as the AIH is updated, this guide will be updated.

Adolescent and adult formulations

• Comirnaty JN.1* ≥12 years and older formulation (pre-filled syringe and multidose vial [grey cap])
• Comirnaty LP.8.1 ≥12 years and older (dark grey, pre-filled glass syringe) formulation

COVID-19 Vaccine Efficacy

Adults

As of 2026, the preferred COVID-19 vaccines available in Australia are Comirnaty JN.1* and Comirnaty LP.8.1, replacing earlier Omicron-specific formulations.^[32]

Current evidence indicates that vaccines matched to circulating Omicron variants provide greater protection than mismatched vaccines. A large observational study of adults aged ≥65 years found that the JN.1* vaccine reduced the risk of COVID-19-associated hospitalisation by approximately 45–46% in immunocompetent adults and 40% in immunocompromised adults, with protection persisting for at least four months after vaccination.^[33]

Although effectiveness data for LP.8.1 vaccines are still emerging, regulatory approval is based on extensive clinical experience with earlier mRNA vaccines and evidence that updated variant-specific formulations produce immune responses against currently circulating strains.^[34]

Children

Comirnaty JN.1* and Comirnaty LP.8.1 vaccines are approved for children according to age-specific formulations.^[35]

Although effectiveness studies for the newest formulations continue to emerge, updated vaccines are expected to provide protection comparable to earlier mRNA vaccines while improving immune responses against circulating variants.^[33]

COVID-19 Vaccine Safety

AusVaxSafety

Pfizer LP.8.1 COVID-19 vaccine safety data (30 June 2026)^[36]:

AusVaxSafety safety data are based on responses from people who received the Pfizer LP.8.1 COVID-19 vaccine (aged ≥12 years formulation) and completed a survey three days after vaccination. These data provide an overview of what to expect in the days following Pfizer LP.8.1 COVID-19 vaccination and are updated monthly to support ongoing vaccine safety monitoring.^[36]

• 49,728 vaccine safety surveys completed, including:
  • 18,839 people who received Pfizer LP.8.1 vaccine alone
  • 30,889 people who received Pfizer LP.8.1 vaccine with another vaccine
• 24% of people who received Pfizer LP.8.1 vaccine alone and 27% of those vaccinated concomitantly with another vaccine reported at least one adverse event following vaccination.
• The most commonly reported adverse event was a local reaction (pain, redness, swelling or itching at the injection site), reported by 20% of people receiving Pfizer LP.8.1 vaccine alone and 22% of those receiving another vaccine at the same visit.
• Fatigue was the second most commonly reported adverse event, affecting 13% of people receiving Pfizer LP.8.1 vaccine alone and 15% of those vaccinated with another vaccine.
• Other commonly reported adverse events included muscle or joint pain (10–12%), headache (8–9%), gastrointestinal symptoms (3%), and fever (3%).
• Only 0.1% of participants who received Pfizer LP.8.1 vaccine alone and 0.2% of those vaccinated with another vaccine reported seeing a doctor or attending an emergency department following vaccination.
• A small proportion of participants reported that vaccination affected routine activities, including missing work, study or usual activities (3% in both groups).
• These findings are consistent with the established safety profile of mRNA COVID-19 vaccines, with most reported adverse events being mild and short-lived.

Historical data: Safety data for the Pfizer JN.1* COVID-19 vaccine remain available through AusVaxSafety as a historical reference following its replacement by the Pfizer LP.8.1 formulation. See above note: “*”

Common adverse events

Current evidence indicates that updated JN.1* and LP.8.1 vaccines have safety profiles similar to earlier COVID-19 vaccine formulations.^[37]

Children aged 6 months to <5 years^[38]

The most frequently reported adverse events include:

• irritability
• drowsiness
• injection site tenderness
• fatigue
• fever (reported in approximately 5–7% of recipients depending on age).

Children aged 5–11 years^[39] 

The most commonly reported adverse events are:

• injection site pain (approximately 70–75%)
• fatigue (approximately 35%)
• headache (approximately 20–30%)

Fever occurred in approximately 3% of children after the first dose and 7% after the second dose. Large population-based studies have confirmed no new significant safety concerns in this age group.^[39] 

People aged ≥12 years^[40] 

The most commonly reported adverse events following updated mRNA COVID-19 vaccines include:

• fatigue (approximately 35–60%)
• headache (approximately 25–45%)
• local injection site reactions.

Most reactions are mild to moderate and resolve within a few days.^[40

Anaphylaxis

Anaphylaxis following COVID-19 vaccination is very rare and occurs at a rate similar to that seen with many other routinely used vaccines, with an estimated incidence of approximately 10 cases per million doses.^[41]

COVID-19 vaccines are contraindicated in people who have experienced^[42]: 

• anaphylaxis following a previous dose of a COVID-19 vaccine from the same class
• anaphylaxis to a component of the vaccine.

Myocarditis and Pericarditis

Myocarditis and pericarditis remain very rare adverse events following COVID-19 vaccination but have been reported after all currently available COVID-19 vaccines.

The highest risk has been observed in adolescent and young adult males following a second dose of an mRNA vaccine, although cases have occurred across all ages, sexes and following any vaccine dose.^[43]

No cases of myocarditis were reported in clinical studies involving children aged 6 months to 11 years.^[43]

People should be advised to seek prompt medical attention if they develop symptoms suggestive of myocarditis or pericarditis after vaccination, including:

• chest pain
• shortness of breath
• palpitations.

People who develop myocarditis or pericarditis following COVID-19 vaccination should defer further doses and discuss future vaccination with their treating doctor.

Co-administration with other vaccines

People aged ≥5 years

COVID-19 vaccines may be safely administered at the same visit as influenza vaccines and other routine vaccines. Studies have demonstrated that co-administration with influenza vaccine is both safe and immunogenic.^[44]

COVID-19 vaccines may also be co-administered with other routine childhood and adolescent vaccines where appropriate.

For people receiving mpox vaccination, consideration may be given to spacing mRNA COVID-19 vaccines and MVA-BN mpox vaccine by four weeks where timing is not urgent, particularly in young males, to assist interpretation of any rare cardiac adverse events.^[44]

Children aged 6 months to <5 years

For younger children, it is preferable to separate COVID-19 vaccination from other vaccines by 7–14 days where practical.^[45] 

However, vaccines may be administered at the same visit if returning for multiple appointments would be difficult.^[45]

Interchangeability of COVID-19 vaccines^[46] 

Where multiple doses are recommended (for example, in severely immunocompromised individuals), the same vaccine brand should preferably be used to complete the primary course.

If necessary, an alternative brand may be used where:

• the previous brand is unavailable
• there is a contraindication or precaution
• the person declines further doses of the original brand.

The recommended interval between mixed-brand doses is 8–12 weeks, and doses do not need to be repeated if a longer interval has occurred.^[46]

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2. Australian Government Department of Health and Aged Care. COVID-19 disease and symptoms Last updated 14 October 2022

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19. Rhabdomyolysis is a life-threatening complication in patients with COVID-19 [Internet]. ijidonline.com. [cited 2024 Aug 27]. Available from: https://www.ijidonline.com/article/S1201-9712(23)00713-0/fulltext#:~:text=Rhabdomyolysis%20is%20a%20life%2Dthreatening,in%20patients%20with%20COVID%2D19

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34. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Vaccine immunogenicity – COVID-19 [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#vaccine-immunogenicity

35. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: COVID-19 vaccines available in Australia [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#covid19-vaccines-available-in-australia

36. AusVaxSafety. Pfizer LP.8.1 COVID-19 vaccine safety data: all participants [Internet]. Sydney: National Centre for Immunisation Research and Surveillance (NCIRS); [cited 2026 Jul 28]. Available from: https://www.ausvaxsafety.org.au/covid-19-vaccines/pfizer-lp81-covid-19-vaccine-safety-data-all-participants

37. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Adverse events – COVID-19 [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#adverse-events

38. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Children aged 6 months to <5 years – Adverse events [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#children-aged-6-months-to-5-years-1

39. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Children aged 5–11 years – Adverse events [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#children-aged-511-years

40. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: People aged ≥12 years – Adverse events [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#people-aged-12-years

41. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Anaphylaxis after COVID-19 vaccines [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#anaphylaxis-after-covid19-vaccines

42. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Contraindications and precautions – COVID-19 [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#contraindications

43. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Myocarditis and pericarditis – COVID-19 [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#myocarditis-and-pericarditis

44. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Co-administration with other vaccines – People aged ≥5 years [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#people-aged-5-years

45. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Co-administration with other vaccines – Children aged 6 months to <5 years [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#children-aged-6-months-to-5-years

46. Australian Government Department of Health, Disability and Ageing. Australian Immunisation Handbook: Interchangeability of COVID-19 vaccines [Internet]. Canberra: Australian Government; [cited 2026 Jul 28]. Available from: https://immunisationhandbook.health.gov.au/covid-19#interchangeability-of-covid19-vaccines