People with prior or current SARS-CoV-2 infection
People should be offered vaccination regardless of their history of symptomatic or asymptomatic SARS-CoV-2 infection; this includes people with prolonged post-COVID-19 symptoms. Data from clinical trials indicate that the currently authorized COVID-19 vaccines can be given safely to people with evidence of a prior SARS-CoV-2 infection. Viral testing to assess for acute SARS-CoV-2 infection or serologic testing to assess for prior infection is not recommended for the purposes of vaccine decision-making.
Vaccination of people with known current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. This recommendation applies to people who experience SARS-CoV-2 infection before receiving any vaccine dose and those who experience SARS-CoV-2 infection after the first dose of an mRNA vaccine but before receipt of the second dose.
While there is no recommended minimum interval between infection and vaccination, current evidence suggests that the risk of SARS-CoV-2 reinfection is low in the months after initial infection but may increase with time due to waning immunity.
People with a history of multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A)
Currently, there are no data on the safety and efficacy of COVID-19 vaccines in people with a history of multisystem inflammatory syndrome in children (MIS-C) or in adults (MIS-A). The mechanisms of MIS-C and MIS-A are not well understood but include a dysregulated immune response to SARS-CoV-2 infection. It is unclear if people with a history of MIS-C or MIS-A are at risk of recurrence of the same dysregulated immune response following reinfection with SARS-CoV-2 or in response to vaccination. These theoretical concerns should be weighed against the known risks of COVID-19 from reinfection and the benefits of protection from a COVID-19 vaccine. Children with MIS-C have high antibody titers to SARS-CoV-2external icon; however, it is unknown if this correlates with protection against reinfection and for how long protective antibody levels persist.
People with a history of MIS-C or MIS-A may choose to be vaccinated. Considerations for vaccination may include:
Clinical recovery from MIS-C or MIS-A, including return to normal cardiac function
Personal risk of severe acute COVID-19 (e.g., age, underlying conditions)
Level of COVID-19 community transmission and personal risk of reinfection
Lack of safety data of COVID-19 vaccines following these illnesses
Timing of any immunomodulatory therapies (ACIP’s general best practice guidelines for immunization can be consulted for more information)
A conversation between the patient, their guardian(s), and their clinical team or a specialist may assist with decisions about the use of a COVID-19 vaccine, though a conversation with a healthcare professional is not required before vaccination.
Current evidence suggests that the risk of SARS-CoV-2 reinfection is low in the months after initial infection but may increase with time due to waning immunity. Thus, people with a history of MIS-C or MIS-A should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis of MIS-C or MIS-A, recognizing that the risk of reinfection and, therefore, the benefit from vaccination, might increase with time following initial infection.
For people who develop MIS-C or MIS-A that is associated with a confirmed SARS-CoV-2 infection but occurs after receipt of a COVID-19 vaccine, referral to a specialist in infectious diseases, rheumatology, or cardiology should be considered. Healthcare professionals and health departments may also request a consultation from the Clinical Immunization Safety Assessment COVIDvax. In addition, information about these cases should be reported to VAERS.
People who previously received passive antibody therapy
Currently, there are no data on the safety and efficacy of COVID-19 vaccines in people who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment. Based on the estimated half-life of such therapies and evidence suggesting that reinfection is uncommon within the 90 days after initial infection, vaccination should be deferred for at least 90 days. This is a precautionary measure until additional information becomes available, to avoid potential interference of the antibody therapy with vaccine-induced immune responses. This recommendation applies to people who receive passive antibody therapy before receiving any vaccine dose and to those who receive passive antibody therapy after the first dose of an mRNA vaccine but before the second dose, in which case the second dose should be deferred for at least 90 days following receipt of the antibody therapy. Receipt of passive antibody therapy in the past 90 days is not a contraindication to receipt of COVID-19 vaccine. COVID-19 vaccine doses received within 90 days after receipt of passive antibody therapy do not need to be repeated.
For people receiving antibody therapies not specific to COVID-19 treatment (e.g., intravenous immunoglobulin, RhoGAM), administration of COVID-19 vaccines either simultaneously with or at any interval before or after receipt of an antibody-containing product is unlikely to substantially impair development of a protective antibody response. Thus, there is no recommended minimum interval between antibody therapies not specific to COVID-19 treatment and COVID-19 vaccination.
Vaccinated people who subsequently develop COVID-19
For people who have received one or more doses of COVID-19 vaccine and subsequently experience SARS-CoV-2 infection, prior receipt of a COVID-19 vaccine should not affect treatment decisions (including use of monoclonal antibodies, convalescent plasma, antiviral treatment, or corticosteroid administration) or timing of such treatments.
If a person who has SARS-CoV-2 RNA or antigen detected on a respiratory specimen collected ≥14 days after they complete all recommended doses of an FDA-authorized COVID-19 vaccine (defined as a COVID-19 vaccine breakthrough case), CDC encourages local health departments, healthcare professionals, and clinical laboratories to:
Request the respiratory specimen be held for further testing
Report the case to the state health department where the individual resides for further investigation and reporting to the national system
COVID-19 vaccine breakthrough cases that result in hospitalization or death should be reported to VAERS