Postvax symptoms or COVID-19 disease? Make the call

Distinguishing between systemic signs of the COVID-19 vaccine and symptoms of coronavirus infection in healthcare professionals receiving the newly licensed vaccine will depend on many factors, including the type of symptoms and clinical judgment, according to the CDC.

In a call with doctors on Monday, the latter were advised to pay more attention to those that were not reported as post-vaccination symptoms in clinical trials, but are related to the COVID-19 infection itself: cough, sore throat, shortness of breath, runny nose, and loss of taste or smell.

However, when it comes to symptoms such as fever, fatigue, headache, chills, myalgia, and arthralgia, healthcare professionals (HCPs) must rely on their clinical skills and judgments about factors such as exposure to the virus and the duration and severity of the symptoms.

Importantly, David Kuhar, MD, of the CDC’s COVID-19 Response Healthcare Infection Control Team, noted that COVID-19 vaccination does not influence viral (nucleic acid or antigen) test results for SARS-CoV-2, which means positive viral tests should not be attributed to the vaccine.

Clinical judgment will be critical in determining COVID-19 symptoms versus post-vaccination symptoms, starting with whether the healthcare provider had “unprotected exposure to SARS-CoV-2 in the previous 14 days,” Kuhar said. . He also emphasized that in clinical trials, symptoms are likely to resolve within 3 days of vaccination and 1 to 2 days after initiation, so any symptoms beyond that time period or worsening of symptoms are more suggestive of COVID.

If a healthcare worker exhibits systemic symptoms that could be post-vaccination or infection, Kuhar said healthcare professionals can return to work if they do not have a fever, feel well enough and are willing to work, and their symptoms are only limited to those observed. after vaccination.

When asked if HCPs can return to work if they need pain medication, Kuhar noted that the guide is not specific on this topic. Although these drugs can mask fever or worsen symptoms, “people who take pain relievers are not prohibited from returning to work.” Once again, he said, clinical judgment is key.

He suggested a 2-day period for symptoms to improve or resolve, at which point healthcare workers should be evaluated with viral tests.

Similar approaches apply to residents of long-term care facilities, Kuhar said, where residents showing any systemic signs and symptoms more suggestive of infection than vaccination should be treated as if they were infected – placed in a single-person room , if available, with “appropriate personal protective equipment” worn by the personnel who interact with them.

However, potentially infected residents should not be grouped with those confirmed to be infected, unless they test positive for SARS-CoV-2.

When residents have post-vaccination symptoms that may overlap with COVID, Kuhar said these residents should be restricted to their current rooms and evaluated until the fever clears and symptoms improve.

Like HCPs, residents should be screened for SARS-CoV-2 if symptoms do not improve within 2 days, and all healthcare professionals caring for these residents should wear all PPE recommended for those with COVID-19 suspected or confirmed until infection can be ruled out. outside.

New safety reporting program

Tom Shimabukuro, MD, from the CDC COVID-19 Response Vaccine Safety Team Leader, discussed a new layer of vaccine safety that the CDC implemented specifically for the COVID-19 vaccine. V-safe is a smartphone-based monitoring program that uses text messages and online surveys to communicate with patients after vaccination.

Shimabukuro urged providers to ensure that their vaccinated patients enroll in v-safe. CDC is providing a sheet to providers with a QR code and a URL that will allow patients to enroll in the program. If providers cannot deliver the sheet individually to patients, the agency requested that it be posted somewhere in the clinic where patients can see it.

“We understand that healthcare professionals will be quite busy at the vaccination clinics, and this is an additional step in the vaccination process,” he said.

HCPs themselves were also encouraged to participate in v-safe after their vaccination.

Additionally, Shimabukuro reviewed the importance of reporting all clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS), where they are reviewed by the CDC and FDA. He said the FDA has specific guidance on how to report to VAERS under the terms of the emergency use authorization. Specifically, providers must report all vaccine administration errors, serious adverse events, cases of multi-system inflammatory syndrome in children or adults, and COVID-19 cases that result in hospitalization or death.

Shimabukuro emphasized that such filings do not violate HIPAA; CDC and FDA are acting in a public health capacity, and agencies may contact for additional information or patient records.

CDC will periodically report summaries of safety findings at meetings of the Advisory Committee on Immunization Practices, on the CDC website, and at Weekly morbidity and mortality report, he said.