Covid after first vaccine shot, timing of second dose

[maize]

My six year old got her first Pfizer shot last Saturday. Today she tested positive for covid. 

I'm not very worried about her, but I'm wondering what you would do about the second vaccine dose. My inclination would be to maybe wait a couple months.

(She had a positive antigen test this morning; we also did a PCR test but won't have those results for a couple of days).

 

[Acadie]

I'd call the pediatrician to ask what they recommend once she's recovered, but like you would probably want to hold off a bit. 

I agree there's every likelihood she'll do just fine but I'm sorry you and your sweetie have to deal with this!

[KSera]

Oh darn! I’m sorry! If there had been a longer interval between her first shot and testing positive, I think it would be easier to say wait three months. With a one week interval, I’m not sure that she would have the same immune benefit as someone who recovered from Covid and had one shot. I would guess not. I agree with your inclination to wait a couple months. The pediatrician may have a recommendation, and I would definitely ask, but I honestly don’t know that it will be based on there being much known about what’s best in this particular scenario.

I hope she has an easy time a bit and the rest of you stay healthy! Is the rest of your household fully vaccinated? Are you boosted?

[maize]

21 minutes ago, KSera said:

Oh darn! I’m sorry! If there had been a longer interval between her first shot and testing positive, I think it would be easier to say wait three months. With a one week interval, I’m not sure that she would have the same immune benefit as someone who recovered from Covid and had one shot. I would guess not. I agree with your inclination to wait a couple months. The pediatrician may have a recommendation, and I would definitely ask, but I honestly don’t know that it will be based on there being much known about what’s best in this particular scenario.

I hope she has an easy time a bit and the rest of you stay healthy! Is the rest of your household fully vaccinated? Are you boosted?

12+ are fully vaccinated, 18+ boostered. I've got two more who got their first dose a week ago (the nine year old had covid in the spring as well, so probably has decent immunity), and a 4 year old unvaccinated.

Everybody else tested negative today.

We're masking, opening windows, and running air purifiers. 

I was hoping we'd make it to full vaccination for the youngers but...covid is running wild here and almost no-one takes precautions or bothers testing so I'm not surprised. Dd6 has neighborhood friends she plays with outdoors; she's supposed to mask but has been "forgetting" more often lately and none of them do. That's the probable source of infection.

 

[prairiewindmomma]

Personally, I would wait close to 90 days if you aren’t around high risk people. You will having waning antibodies from the natural infection at that point and since I don’t see kid boosters happening soon, you can stretch out another 4 months of good protection from that second dose.

Fwiw, I am in camp “no long lasting protection from natural infection” and camp “waning efficacy from vaccines” based on what I have read. I think the risk of hospitalization remains low for average kids, but being sick in and of itself is something to hope to avoid, iykwim, just like other illness. 

[Lori D.]

As I recall, 90 days after no longer symptomatic was the recommendation way back last spring for adults. That is what a friend of ours had to do, meaning he had to reschedule his second dose. I believe that was the policy for both Pfizer and Moderna (don't know which type our friend had).

[kbutton]

6 hours ago, Lori D. said:

As I recall, 90 days after no longer symptomatic was the recommendation way back last spring for adults. That is what a friend of ours had to do, meaning he had to reschedule his second dose. I believe that was the policy for both Pfizer and Moderna (don't know which type our friend had).

I have heard this is only for people who are treated with monoclonal antibodies, but I am not sure.

[SounderChick]

I would wait back in the spring they told DH to get his 2nd dose at the time at the 3 week interval unless he had symptoms.  But I think no evidence would have me waiting 90 days.

[wathe]

The current recommendation here is to wait 10 days after positive test, and after symptoms of acute illness have resolved.

The reasoning is 1)They don't want people who are infectious at vaccine clinics, and 2) they don't want complications of covid infection to be mistakenly attributed to the vaccine.

Blurb from the National Advisory Committee on Immunization regarding acute illness as a precaution for vaccination (note that it's a precaution, not a contraindication):

Acute illness

Vaccination of individuals who may be currently infected with SARS-CoV-2 is not known to have a detrimental effect on the illness. However, vaccination should be deferred in symptomatic individuals with confirmed or suspected SARS-CoV-2 infection, or those with respiratory symptoms, in order to avoid attributing any complications resulting from SARS-CoV-2 infection to vaccine-related AEFI and to minimize the risk of COVID-19 transmission at an immunization clinic/venue. If any persons are identified with symptoms on arrival at the venue, they should be instructed to follow current local public health measures.

As a precautionary measure and in light of the need to be able to monitor for COVID-19 vaccine adverse events without potential confounding from symptoms of COVID-19 or other co-existing illnesses, one should wait until all symptoms of an acute illness are completely resolved before vaccinating with an authorized COVID-19 vaccine.

Note that NACI doesn't specify number of days, because isolation periods are determined by the province and local health units.  My health unit specifies 10 days post symptom onset or positive test.

 

 

[Lori D.]

25 minutes ago, kbutton said:

I have heard this is only for people who are treated with monoclonal antibodies, but I am not sure.

Possibly. But our friend was specifically told by the medical facility administering his vaccine does that he had to reschedule and wait 90 days for his second dose because he had covid (tested positive). He had NOT received monoclonal antibodies, and was not hospitalized. That was back in March.

Yes -- what you say here (90 day wait if a person has been treated with monoclonal antibodies in the CURRENT recommendation (see the same CDC FAQ I link below). And since vaccinations for children is new, the current recommendations are from adult data -- that may change over time. The goal posts keep moving on all of the recommendations... 🤷‍♀️

I found this, currently on the CDC FAQ webpage: 

Can I get vaccinated against COVID-19 while I am currently sick with COVID-19?
No. People with COVID-19 who have symptoms should wait to be vaccinated until they have recovered from their illness and have met the criteria for discontinuing isolation; those without symptoms should also wait until they meet the criteria before getting vaccinated. This guidance also applies to people who get COVID-19 before getting their second dose of vaccine.

People who have had a known COVID-19 exposure should not seek vaccination until their quarantine period has ended to avoid potentially exposing healthcare personnel and others during the vaccination visit. This recommendation also applies to people with a known COVID-19 exposure who have received their first dose of an mRNA vaccine but not their second.

Edited November 14, 2021 by Lori D.

[wathe]

1 minute ago, Lori D. said:

Possibly. But our friend was specifically told by the medical facility administering his vaccine does that he had to reschedule and wait 90 days for his second dose because he had covid (tested positive). He had NOT received monoclonal antibodies, and was not hospitalized. That was back in March. Yes -- what you say here (90 day wait if a person has been treated with monoclonal antibodies in the CURRENT recommendation (see the same CDC FAQ I link below). The goal posts keep moving on all of the recommendations... 🤷‍♀️

I found this, currently on the CDC FAQ webpage: 

Can I get vaccinated against COVID-19 while I am currently sick with COVID-19?
No. People with COVID-19 who have symptoms should wait to be vaccinated until they have recovered from their illness and have met the criteria for discontinuing isolation; those without symptoms should also wait until they meet the criteria before getting vaccinated. This guidance also applies to people who get COVID-19 before getting their second dose of vaccine.

People who have had a known COVID-19 exposure should not seek vaccination until their quarantine period has ended to avoid potentially exposing healthcare personnel and others during the vaccination visit. This recommendation also applies to people with a known COVID-19 exposure who have received their first dose of an mRNA vaccine but not their second.

It's true that the guidance is evolving as the science evolves.  As it should.

When I first started as a vaccinator in February, we had a huge list of screening questions: pregnancy, breastfeeding,  immune compromise, recent other vaccination, multiple different allergy questions etc.  One by one they've been dropping off the list as we gain experience with the vaccine and gain safety data.  We've added a screening question about myocarditis.

We dropped the "have you had any other vaccine within 14 days" question a few weeks ago.  Next week we'll be offering flu shots and covid shots at the same appointment.  Things may change again as we start vaccinating 5-11 yo and gain more experience with adult boosters.  

[wathe]

UpToDate recommends vaccination as soon as isolation period is over and acute symptoms resolve.

It suggests that waiting a few months is reasonable to allow others to get vaccinated sooner, as the risk of reinfection in first few months post infection is low.  Implying that the earlier recommendation to wait was to mitigate vaccine scarcity, rather that because of any risk to the individual who had covid.  That would have been a sensible public health strategy in March, but not anymore now that vaccines are plentiful. 

[ieta_cassiopeia]

Currently, the advice I'm seeing is at least 28 days from the date of the first positive test (to give time for the cytokinal storm to reset itself as much as it is going to do, which also ensures quarantine will be respected) and no more than 6 months (since there is a good chance any natural resistance given by the infection will have gone again by that point). 3 months, as several others have suggested before me, seems like a good solid choice, but you have got some flexibility if you need to work around other things that are happening - for example, if your 6-year-old has a week-long sports meet in 3 months' time. either get the second dose 2+ weeks' prior, or have it 2+ days after the meet ends.

[TechWife]

I’d call her doctor and ask. They’ve probably already worked this out - your daughter isn’t the first one at this point, KWIM? Health of children is their area of expertise & they also can look at her history to take any specific circumstances into account. They are getting updates from the county &  state public health departments on the regular as well as CDC and FDA updates. Their access to these updates isn’t new - they’ve been synthesizing new information into their practice the entirety of their careers.  I don’t think this would be a hard question for them to answer. 

Edited November 14, 2021 by TechWife