We refer our readers to CDC’s updated set of contraindications and precautions to vaccination with COVID-19 vaccines, located in table 3 of its interim clinical considerations for the use of COVID-19 vaccines in the United States: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications.
Ask the Experts: COVID-19: Contraindications & Precautions
We refer our readers to CDC’s updated set of contraindications and precautions to COVID-19 vaccination, located in table 3 of its interim clinical considerations for the use of COVID-19 vaccines: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications.
Yes, they may be vaccinated with any FDA-licensed or FDA-authorized updated (2023–2024 Formula) COVID-19 vaccine (Moderna, Pfizer, or Novavax) as long as they do not have a contraindication to vaccination. Antibody testing is not recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination.
Recipients should be counseled about the unknown and variable effectiveness of COVID-19 vaccination in immunocompromised populations and the potential for reduced immune responses. They should maintain other practices, such as wearing a mask in public and avoiding crowds, to reduce their risk of exposure to SARS-CoV-2.
The current immunization schedules for each available vaccine product for people age 6 months or older with moderate or severe immunocompromise are shown on CDC’s Interim COVID-19 Immunization Schedule for Persons 6 Months of Age and Older: www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages-6months-older.pdf.
CDC has also developed an infographic for use with patients who have moderate to severe immunocompromise when determining what updated (2023–2024 Formula) COVID-19 vaccine is due based on the individual’s age and past COVID-19 vaccination history: www.cdc.gov/vaccines/covid-19/downloads/COVID19-vaccination-recommendations-immunocompromised.pdf.
CDC provides detailed considerations for vaccination of people with moderate or severe immunocompromise here: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised.
History of an anaphylactic reaction to a dose of mRNA COVID-19 vaccine is a contraindication to receipt of further doses of mRNA-type COVID-19 vaccines. However, a person with a contraindication to one type of COVID-19 vaccine (mRNA) may receive the alternative COVID-19 vaccine type (in this case, the adjuvanted protein subunit vaccine by Novavax) in the usual vaccination setting. CDC encourages consultation with an allergist-immunologist to provide expert evaluation of the original allergic reaction, and depending on the outcome of that evaluation, reassess whether administration of additional doses of the original vaccine type may be possible.
This condition is not rare and is sometimes referred to as “COVID arm”. Future doses should be given as recommended. Individuals with only a delayed-onset local reaction (e.g., redness, induration, itching) around the injection site area after an mRNA vaccine dose do not have a contraindication or precaution to subsequent doses. Consider administering the next dose in the opposite arm, if possible.
These delayed-onset local reactions are sometimes quite large but are self-limited. It is not known whether individuals who experienced a delayed-onset injection site reaction after one dose will experience a similar reaction after future doses. These reactions are not believed to represent an increased risk for anaphylaxis after future doses.
Patients who experience “COVID arm” may take an antihistamine if it is itchy or a pain medication, such as acetaminophen or a non-steroidal anti-inflammatory (NSAID), if it is painful.
Medications to reduce fever and pain (e.g., acetaminophen, non-steroidal anti-inflammatory drugs) may be taken to treat post-vaccination local or systemic symptoms, if medically appropriate. However, routine administration of such medications before vaccination is not recommended because information on the potential impact of such use on COVID-19 vaccine-induced antibody responses is not available at this time.
Administration of antihistamines before COVID-19 vaccination to prevent allergic reactions is not recommended. Antihistamines do not prevent anaphylaxis, and their use might mask cutaneous symptoms, which could delay diagnosis and management of anaphylaxis.
The COVID-19 vaccines currently available in the United States (mRNA vaccines and the Novavax protein subunit vaccine) are not contraindicated in patients with a history of TTS. The Janssen COVID-19 vaccine associated with immune-mediated TTS in the United States is no longer available.
According to CDC, MIS-C and MIS-A both include a dysregulated immune response to SARS-CoV-2 infection. Experts consider the benefits of vaccination to outweigh the theoretical risk of an MIS-like illness or the risk of myocarditis following COVID-19 vaccination in a person with a history of MIS-C or MIS-A if the person meets the following criteria: (1) they have clinically recovered, including return to baseline cardiac function; and (2) it has been at least 90 days since the diagnosis of MIS-C or MIS-A.
There are additional considerations for vaccination of those who do not meet these criteria. Refer to CDC’s detailed guidance for the most current clinical considerations for vaccination of children and adults who have experienced this syndrome following SARS-CoV-2 infection or who have experienced MIS-like illness following COVID-19 vaccination: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid19-vaccination-misc-misa.
CDC guidance is that people who have a history of completely resolved myocarditis or pericarditis unrelated to COVID-19 vaccination (e.g., due to SARS-CoV-2 or other viruses) may receive any age-appropriate COVID-19 vaccine that is FDA-approved or FDA-authorized. “Complete resolution” includes resolution of symptoms attributed to myocarditis or pericarditis, as well as no evidence of ongoing heart inflammation or sequelae as determined by the person’s clinical team.
For people who have a history of myocarditis associated with MIS-C or MIS-A following SARS-CoV-2 infection, see CDC’s interim clinical considerations concerning COVID-19 vaccination and MIS-C and MIS-A: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid19-vaccination-misc-misa.
Complete and current clinical considerations for COVID-19 vaccination of patients with a history of myocarditis are available from CDC here: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#myocarditis-pericarditis.
For additional information about myocarditis and mRNA COVID-19 vaccines, visit www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html.
Development of myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine is a precaution to a subsequent dose of any COVID-19 vaccine, and subsequent doses should generally be avoided. Under certain conditions, the clinical team may determine that benefits of vaccination outweigh risks. See CDC’s detailed guidance for additional information about these clinical considerations: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#myocarditis-pericarditis.
People with a history of GBS can receive any currently recommended COVID-19 vaccine.