How to Manage Post-COVID-19 Vaccination Reactions among Healthcare Staff

Considerations for Healthcare Personnel.

Strategies are needed for healthcare facilities/practices to appropriately evaluate & manage post-vaccination signs/ symptoms among healthcare personnel (HCP). Goal: reduce risks for disruptions in care and pathogen transmission related to the above.

Based on Current Knowledge, Vaccine Experience.

These considerations are based on the current understanding of signs/symptoms following COVID-19 vaccination, including timing and duration, and might change as experience with the vaccine accumulates.

Systemic Signs/Symptoms.

Systemic signs/symptoms following COVID-19 vaccination can include fever, fatigue, headache, chills, myalgia, and arthralgia. Most are: Mild to moderate in severity, occur within first 3 days of vaccination (most occurring the day after vaccination), and resolve within 1-2 days of onset.

Systemic Signs/Symptoms.

Were more commonly reported after the second vs the first dose and more frequent/severe in those aged 18-55 years vs those >55 years. Cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell are not consistent with post-vaccination symptoms, and instead may be symptoms of SARS-CoV-2 or another infection.

Post-vaccination Signs/Symptoms are Similar to Infection.

Post-vaccination signs/symptoms vs those from COVID-19, other ID may be a challenge to distinguish. After vaccination, HCP could be mistakenly considered infectious and restricted from work, affecting HCP, other staff, patients.

Strategies are needed to effectively manage any vaccination adverse effects and limit unnecessary work restrictions. Strategies apply to all HCP working in healthcare settings.

Strategies to Minimize Potential Impact.

Vaccinate HCP preceding 1-2 days off, during which they are not required to be in the facility. Stagger vaccine delivery to HCP in a facility so that not all members of a single department, service, or unit are vaccinated at the same time.

Minimize Potential Vaccine Impact.

Inform HCP about the potential for short-term systemic reactions and potential options for mitigating them. Develop a strategy to provide timely assessment of HCP with post-vaccination systemic reactions (eg, provide or identify options for SARS-CoV-2 viral testing, so it is readily available if indicated). Offer nonpunitive sick leave options (ie, paid) for HCP who do experience post-vaccination systemic reactions to remove barriers to reporting
these symptoms.

Approaches to Evaluating, Managing Post-Vaccination Systemic Reactions.

These approaches apply to HCP who have received COVID-19 vaccination in the prior 3 days (day of vaccination = day 1), and are not known to have had unprotected exposure to SARS-CoV-2 in in the previous 14 days. Ultimately clinical judgement should determine the likelihood of infection vs post-vaccination symptoms.

Signs/symptoms UNLIKELY to be from COVID-19 Vaccination.

ANY systemic signs/symptoms consistent with SARS-CoV-2 infection (eg, cough, SOB, rhinorrhea, sore throat, loss of taste/smell) or other infectious etiology (eg, influenza) that are not typical of those seen post-vaccination.

Suggested approach: Exclude affected HCP from work pending evaluation for possible etiologies, including SARS-CoV-2 infection, as appropriate. Criteria for return to work depends on suspected or confirmed diagnosis.

Signs/Symptoms that MAY BE from COVID-19 Vaccination, SARS-CoV-2, Other Infection.

These are: ANY systemic signs/symptoms (eg, fever, fatigue, headache, chills, myalgia, arthralgia) that are consistent with post-vaccination signs/symptoms, SARS-CoV-2 or other infectious etiology (eg, influenza).

Signs/Symptoms that MAY BE from COVID-19 Vaccination, SARS-CoV-2, Other Infection.

Suggested approach: HCP who meet the following criteria may be considered for return to work without viral testing for SARS-CoV-2: Feel well enough and are willing to work, are afebrile, and systemic signs/symptoms are limited to those observed following COVID-19 vaccination.

Signs/Symptoms that MAY BE from COVID-19 Vaccination, SARS-CoV-2, Other Infection.

Suggested approach (cont’d). If symptomatic HCP return to work and symptoms are not improving or persist for more than 2 days, exclude from work, pending evaluation, and consider viral testing. Earlier testing, if feasible, can be considered to increase confidence in cause of symptoms.

Signs/Symptoms that MAY BE from COVID-19 Vaccination,SARS-CoV-2, Other Infection.

Suggested approach (cont’d) HCP with fever should, ideally, be excluded from work pending further evaluation, including consideration for SARS-CoV-2 testing. If infectious etiology is not suspected/confirmed, they may return to work when they feel well enough.

Suggested approach when critical staffing shortages are
anticipated or occurring.

HCP with fever and systemic signs and symptoms limited only to those observed following vaccination could be considered for work if they feel well enough and are willing.

Suggested approach:

Any HCP who returns to work while experiencing signs/symptoms considered to be COVID-19 vaccination-related should be re-evaluated and viral testing for SARS-CoV-2 considered, if fever does not resolve within 2 days.