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COVID-19 Health Alert # 26:
Guidance for Evaluation and Management of Systemic Signs and Symptoms Associated with COVID-19 Vaccine
Bureau of Communicable Diseases, February 11, 2021
Summary
- COVID-19 vaccine side effects can occur following COVID-19 vaccination, some of which may overlap with signs and symptoms of SARS-CoV-2 infection.
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Healthcare facilities should appropriately evaluate and manage post-vaccination signs and symptoms among healthcare personnel (HCP) in order to minimize unnecessarily excluding HCP with only post-vaccination signs and symptoms from work or inadvertently allowing HCP with SARS-CoV-2 or another transmissible infection to work.
- Systemic signs and symptoms are more common after the second dose of COVID-19 vaccination, and anecdotal evidence is emerging that they may be particularly robust among HCP who have previously recovered from COVID-19. At this time, CDC and DHS continue to recommend that all HCP be offered COVID-19 vaccination, regardless of prior infection history.
Dear Colleagues,
Systemic signs and symptoms, such as fever, fatigue, headache, chills, muscle pain, and joint pain can occur following COVID-19 vaccination. Preliminary data from mRNA COVID-19 vaccine trials indicate that most systemic post-vaccination signs and symptoms are mild to moderate in severity, occur within the first three days of vaccination (the day of vaccination and following two days, with most occurring the day after vaccination), resolve within 1-2 days of onset, and are more frequent and severe among younger persons compared to those who are older (>55 years). Additional details are available at Post Vaccine Considerations for Healthcare Personnel. Below are the frequencies of vaccine side effects observed in clinical trials.
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Pfizer-BioNTech COVID-19 Vaccine: pain at the injection site (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%), injection site swelling (10.5%), injection site redness (9.5%), nausea (1.1%), malaise (0.5%), and lymphadenopathy (0.3%).
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Moderna COVID-19 Vaccine: pain at the injection site (92.0%), fatigue (70.0%), headache (64.7%), muscle pain (61.5%), chills (45.4%), joint pain (46.4%), nausea/vomiting (23.0%), axillary swelling/tenderness (19.8%), fever (15.5%), injection site swelling (14.7%), and injection site redness (10.0%).
Immediate allergic reactions (including anaphylaxis) typically occur within 15-30 minutes of vaccination. Vasovagal reactions typically occur within 15 minutes of vaccination.
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.
HCP with the presence of ANY systemic signs and symptoms (e.g., fever, fatigue, headache, chills, myalgia, arthralgia) that are consistent with post-vaccination signs and symptoms, SARS-CoV-2 infection, or another infectious etiology (e.g., influenza) may be considered for return to work without viral testing for SARS-CoV-2 if they meet ALL of the following criteria:
- Feel well enough to work,
- Are willing to work,
- Are afebrile, AND
- Systemic signs and symptoms are limited only to those observed following COVID-19 vaccination (i.e., do not have other signs and symptoms of COVID-19 including cough, shortness of breath, sore throat, or change in smell or taste).
If symptomatic HCP return to work, they should be advised to contact occupational health services (or another designated individual) if symptoms are not improving or persist for more than two days. Pending further evaluation, they should be excluded from work and viral testing should be considered. If feasible, viral testing could be considered for symptomatic HCP earlier to increase confidence in the cause of their symptoms.
If performed, a negative SARS-CoV-2 antigen test in HCP who have symptoms that are limited only to those observed following COVID-19 vaccination (i.e., do not have cough, shortness of breath, sore throat, or change in smell or taste) may not require confirmatory SARS-CoV-2 NAAT testing.
When evaluating HCP with the presence of ANY systemic signs and symptoms consistent with SARS-CoV-2 infection (e.g., cough, shortness of breath, rhinorrhea, sore throat, loss of taste or smell) or another infectious etiology (e.g., influenza) that are not typical for post-vaccination signs and symptoms:
These HCPs should be considered for exclusion from work pending evaluation for possible etiologies, including SARS-CoV-2 infection, as appropriate. Criteria for return to work depend on the suspected or confirmed diagnosis. Information on return to work for HCP with SARS-CoV-2 infection is available in HAN #16 and from CDC.
If performed, a negative SARS-CoV-2 antigen test in HCP who have signs and symptoms that are not typical for post-vaccination signs and symptoms should be confirmed by SARS-CoV-2 nucleic acid amplification test (NAAT). This is consistent with recommendations for retesting, and further information on testing is available from CDC.
Systemic signs and symptoms related to COVID-19 vaccination can be managed with over-the-counter analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs. HCPs should be advised that symptoms are typically more pronounced after the second dose in the vaccine series. Anecdotal evidence has emerged that post-vaccination symptoms may be particularly robust among persons who have previously recovered from COVID-19. At this time, CDC and DHS continue to recommend that all HCP be offered both doses of COVID-19 vaccine, regardless of prior infection history.
Additional guidance can be found here:
Sincerely,
Ryan Westergaard, MD, PhD, MPH Chief Medical Officer and State Epidemiologist for Communicable Diseases Wisconsin Department of Health Services
About the COVID-19 Health Alert Network
The content of this message is intended for public health and health care personnel and response partners who have a need to know the information to perform their duties. The HAN will be the primary method for sharing time-sensitive public health information with clinical partners during the COVID-19 response. Health care providers and other officials can subscribe and unsubscribe using their preferred email address at the DHS COVID-19 website.
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