https://www.nejm.org/covid-vaccine/faq
Should patients who have recovered from Covid-19 receive the vaccine?
Yes, they should receive the vaccine. Some of the people who participated in the clinical trials had evidence of prior SARS-CoV-2 infection (based on a positive antibody test), and the vaccines were safe and effective in this group.
Since re-infection after recovery from Covid-19 is rare in the first 90 days, some people may wish to defer immunization for this long — however, if they wish to be immunized sooner, there is no contraindication. Patients who were treated with monoclonal antibodies or convalescent plasma should wait this long, however. These treatments might inactivate the vaccines, making them less effective. Deferral of immunization for 90 days after treatment with monoclonal antibodies or convalescent plasma is recommended. (Last reviewed/updated on 11 Jan 2021)
Should a patient who was exposed to Covid-19 receive the vaccine in order to prevent the disease?
Currently there are no data to support use of the Covid-19 vaccines acutely to prevent disease after a known exposure to an active case. Since the incubation period for Covid-19 averages around 5 days, it is unlikely that the vaccine would elicit an immune response quickly enough to block infection. As a result, people who have been exposed to Covid-19 should finish their 10- to 14-day quarantine before undergoing immunization. Since some vaccines for other diseases (notably varicella) are effective in preventing infection after exposure, it is possible that this will be a future recommendation for Covid-19 vaccination, but currently it is not. (Last reviewed/updated on 11 Jan 2021)
Should a patient who is diagnosed with Covid-19 shortly after the first dose still receive the second scheduled dose?
The vaccine begins to generate protective immunity 10 to 14 days after the first shot. As a result, it is not surprising that some people have experienced Covid-19 shortly after their first immunization, and they naturally wonder whether they should proceed with the second shot as originally scheduled.
The current recommendation is that people with current infection should wait until they have recovered from the acute illness and are
eligible to discontinue isolation. opens in new tab. These recommendations apply both to those who developed Covid-19 before their first injection and to those who developed it after starting the vaccine series. On the basis of this guidance, some people in the latter group may be able to proceed with their scheduled second shot and others will need to wait. Treatment of Covid-19 with either monoclonal antibodies or convalescent plasma should delay receipt of the vaccine by 90 days, since these treatments could theoretically make the vaccine less effective. (Last reviewed/updated on 11 Jan 2021)
Should vaccination be delayed if a patient has any symptoms or is actively ill?
Vaccination should be deferred in people with acute illness, preferably until after they recover. However, people with chronic diseases and stable symptoms are eligible to receive the vaccine; examples would be people with COPD and dyspnea on exertion or those with inflammatory bowel disease and gastrointestinal symptoms. Many of the participants in the phase 3 clinical trials had underlying medical problems, and although they were not acutely ill, some presumably had symptoms from their diseases — that’s the nature of chronic medical conditions. (Last reviewed/updated on 11 Jan 2021)
