Vaccinating individuals with COVID-19 or with a history of COVID-19

Sue Dickinson, Director of Pharmacy, Regional Drug & Therapeutics Centre (Newcastle)Published Last updated See all updates

Guidance on when to vaccinate individuals who are currently unwell with COVID-19, have prolonged symptoms of COVID-19 or have recovered from past infection

Information resources

UK Health Security Agency (UKHSA – formerly known as PHE) COVID-19 Vaccination Programme Information for Healthcare Professionals and  COVID-19: the green book, chapter 14a provides advice on groups as summarised below.

Adults currently unwell with COVID-19

Vaccination should be deferred until clinical recovery to around four weeks after onset of symptoms, or four weeks from the first confirmed positive specimen according to the Green Book.

This is to avoid wrongly attributing any new symptom or the progression of symptoms to the vaccine.

There is no need to defer immunisation in individuals after recovery from a recent episode with compatible symptoms who were not tested unless there are strong clinical and epidemiological features to suggest the episode was COVID-19 infection.

The four week interval may be reduced to ensure operational flexibility when rapid protection is required, for example high incidence or circulation of a new variant in a vulnerable population.

Adults asymptomatic with COVID-19

Vaccination should be deferred until at least four weeks from the first PCR positive specimen.

Care home residents and the housebound with COVID-19

The Green Book notes that JCVI consider that, in care home residents and the housebound, there may be an advantage in offering vaccination to some individuals with recent confirmed COVID-19, without a four-week deferral, where individuals are clinically stable and when infection control procedures can be maintained. These populations are likely to be highly vulnerable and will facilitate vaccination without the need for multiple visits.

Under 18 year olds unwell with COVID-19

Vaccination should ideally be deferred until twelve weeks from onset (or sample date) in children and those under 18 years who are not in high risk groups.

This interval may be reduced to eight weeks during periods of high incidence or where there is concern about vaccine effectiveness (for example a new variant).

The reason for the longer interval is because protection from natural infection is likely to be high for a period of months in younger people, and vaccination in those recently infected may increase the chance of side effects.

Paediatric Multisystem Inflammatory Syndrome

In children with Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) current advice suggests that an interval of 12 weeks should be observed, although earlier administration can be considered in those at risk of infection and/ or who are fully recovered.

High risk children with current COVID-19

Vaccination should be deferred until clinical recovery to around four weeks after onset of symptoms, or until at least four weeks from the first PCR positive specimen if asymptomatic, according to the Green Book.

This is to avoid wrongly attributing any new symptom or the progression of symptoms to the vaccine.

There is no need to defer immunisation in individuals after recovery from a recent episode with compatible symptoms who were not tested unless there are strong clinical and epidemiological features to suggest the episode was COVID-19 infection.

Prolonged COVID-19 symptoms (“long COVID”)

This group can be vaccinated.

However, vaccination may be deferred if the individual is seriously debilitated, still under active investigation or has evidence of recent deterioration This to avoid incorrect attribution of any change in the person’s underlying condition to the vaccine.

COVID-19 past history or detectable antibodies

This group can be vaccinated.

There is no convincing evidence of any safety concerns from vaccinating such individuals. This is because it is not known how long antibodies made in response to natural infection persist and whether immunisation could offer more protection. If antibodies have already been made to the disease following natural infection, receiving COVID-19 vaccine would be expected to boost any pre-existing antibodies.

 

Change history

  1. Content reviewed, no change
  1. Added information about vaccine deferral intervals in care home residents and the housebound with COVID-19, and for individuals recovering from a recent episode with compatible symptoms who were not tested
  1. Resources checked and information remains correct
  1. Document re-formatted with additional subheadings and updates summary. Content remains the same
  1. Added information on delaying vaccination in children and those under 18 years not in high risk groups, and on deferring vaccination in children with PIMS-TS
  1. Current content is still accurate
  1. Removed information regarding scheduling of second dose as this is covered on the page: Dosing information for COVID-19 Vaccines
  1. Published