Last week, the CDC issued this guidance on strategies to evaluate and managed post-vaccination signs and symptoms for LTC residents. The guidance intended to balance the risks of unnecessary testing and use of Transmission Based Precautions with residents displaying only post-vaccination symptoms with the risk of inadvertently allowing residents with COVID-19 to expose others in the facility.
Current data on the COVID-19 indicated post-vaccination signs and symptoms are mild, occur within the first three days of vaccination, and resolve within 1-2 days of onset. Immediate reactions and local pain/redness at the injection site are not consistent with COVID-19.
Importantly, cough, shortness of breath, runny nose, sore throat, or lost of taste or smell are not consistent with post-vaccination symptoms and may be signs of COVID-19 or another infection. Please refer to the chart in the CDC guidance for additional detail on suggested management approaches.
A person recently exposed to COVID-19 (within 2-14 days) of receiving the vaccine can still become infected with COVID-19. The vaccine itself does not cause a person to become infected.
When evaluating new-onset post-vaccination signs and symptoms, the CDC recommends the following for any HCP who received the COVID-19 vaccine in the prior three days (including the day of vaccination)
- Signs and Symptoms from vaccine unlikely to be from vaccine – presence of any systemic COVID-19 sign or symptom (cough, shortness of breath, runny nose, sore throat, or lost of tase or smell) or other infectious diseases like flu.
- Evaluate resident for COVID-19. Pending evaluation place resident in single room (if available) in TBP. Residents should not be cohorted with other residents confirmed to have COVID-19 unless and until the resident also confirmed to have COVID-19 through testing.
- TBP can be discontinued pending results of the above evaluation and testing.
- Signs and Symptoms from vaccine that may be from either the vaccine, COVID-19, or other infection (fever above 100F, fatigue, headache, chills, muscle or joint pain).
- Evaluate the resident and restrict to current room (except for medically necessary procedures) and closely monitor until:
- Any fever resolves and
- Symptoms improve.
- HCPs caring for these residents should wear all PPE consistent with TBP. If resident’s symptoms resolve within 2 days, TBP can be discontinued. Fever, if present, must have resolved for at least 24 hours before discontinuing TBP.
- COVID-19 testing should be considered for any residents with symptoms that are not improving or persist for longer than 2-days (outbreak testing and exposure testing criteria still apply too).
- Evaluate the resident and restrict to current room (except for medically necessary procedures) and closely monitor until:
- See note in CDC guidance regarding antigen tests being confirmed with a n nucleic acid amplification test.
- Positive viral (nucleic acid or antigen) tests for SARS-CoV-2, if performed, should not be attributed to the COVID-19 vaccine, as vaccination does not influence the results of tests.