I had COVID-19, is it still recommended I receive the vaccine? Would I still need two doses?

Yes, it is still recommended that you receive the vaccine. Experts do not yet know how long someone is protected from getting sick again after recovering from COVID-19.

Data from clinical trials indicate that mRNA COVID-19 vaccines can safely be given to persons with evidence of a prior SARS-CoV-2 infection. Some of the people who participated in the clinical trials had evidence of prior SARS-CoV-2 infection (based on a positive antibody test), and the vaccines were safe and effective in this group.

Vaccination should be offered to persons regardless of history of prior symptomatic or asymptomatic SARS-CoV-2 infection. Viral testing to assess for acute SARS-CoV-2 infection or serologic testing to assess for prior infection for the purposes of vaccine decision-making is not recommended.

Vaccination of persons 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 criteria have been met for them to discontinue isolation. This recommendation applies to persons who develop SARS-CoV-2 infection before receiving any vaccine doses as well as those who develop SARS-CoV-2 infection after the first dose 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. It is uncommon for people who do get COVID-19 again to get it within 90 days of when they recovered from their first infection. Thus, while vaccine supply remains limited, persons with recent documented acute SARS-CoV-2 infection may choose to temporarily delay vaccination, if desired, recognizing that the risk of reinfection, and therefore the need for vaccination, may increase with time following initial infection.

Monoclonal Antibodies/Convalescent Plasma

For vaccinated persons who subsequently develop COVID-19, prior receipt of an mRNA 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.

For people who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment, 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 persons who receive passive antibody therapy before receiving any vaccine doses as well as those who receive passive antibody therapy after the first dose 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.

Emerging Research on Number of Doses

The following two pre-print (not yet peer-reviewed) studies were posted online this week. While the results are interesting and merit full review, these studies were small and it is too soon to make definitive conclusions. At this time, it is still recommended that those with a history of COVID-19 receive 2 doses of a vaccine. Stay tuned.

Robust spike antibody responses and increased reactogenicity in seropositive individuals after a 2 single dose of SARS-CoV-2 mRNA vaccine

  • This study looked at antibody responses in 109 individuals with and without documented pre49 existing SARS-CoV-2 immunity (seronegative: 68, seropositive: 41) who received their first vaccine dose in 2020.
  • Participants who were previously infected with COVID-19 showed antibody levels equal to or above those of participants who had gotten both doses but never been infected. Those with previous infections also appeared to have more generalized side effects after the first dose, such as fatigue, fever and muscle pain — similar to what other participants might be expected to have after a second dose of an mRNA vaccine.

Single Dose Vaccination in Healthcare Workers Previously Infected with SARS-CoV-2

  • This study looked at antibody responses to a single dose of the Pfizer-BioNTech or Moderna vaccines in 59 healthcare workers (HCW) with IgG confirmed COVID-19 infection (both symptomatic and asymptomatic) and compared them to antibody responses of HCW who were IgG negative to COVID-19.
  • HCW with prior COVID-19 (both symptomatic and asymptomatic) showed clear secondary antibody responses to vaccination with IgG spike binding titers rapidly increasing by 7 days and peaking by days 10 and 14 post-vaccination.
  • At all time points tested, HCW with prior COVID-19 infection showed statistically significant higher antibody titers of binding and functional antibody compared to HCW without prior COVID-19 infection.
  • Although they did not have peak titers for these individuals after natural infection, the titers developed after single vaccination was higher than peak titers in inpatients and outpatients with COVID-19, similar to what has been described in primary vaccination after 2 doses of the spike-based mRNA vaccines.

Sources

Updated: February 2, 2021

ICSI

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