[MCOH-EH] COVID Vaccination Dose #2 in employees who become positive after dose #1

[Abhijay Karandikar]

 Interesting. The CDC has a section on antibody treatments and the COVID vaccine, as you probably know. 

"Currently, there are no data on the safety and efficacy of mRNA COVID-19 vaccines in persons who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment. Based on the estimated half-life of such therapies as well as evidence suggesting that reinfection is uncommon in the 90 days after initial infection, vaccination should be deferred for at least 90 days, as 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."

We had discussed this at our institution; however, based on feedback from our ID folks and leadership, this was not placed in our screening questionnaire. Of course, we have not encountered this commonly in our employee population.
Abhijay
    On Monday, January 11, 2021, 03:43:44 PM EST, Radke, Laura L. M.D. <laura.radke at froedtert.com> wrote:  
 
 
To add to the discussion:
 
  
 
We have a number of positive employees who have been treated with BAM protocol, some under EUA down to age 18, as we are participating in the clinical trial.  Most became ill after receiving their first dose of vaccine
 
  
 
We are deferring the second dose of vaccine in these individuals for 90 days at present.
 
  
 
Laura
 
Laura L Radke, MD
 
Medical Director, F&MCW Occupational Health Services
 
Phone:  262-253-8197  | Fax:  262-253-5152 Cell Phone:  414-530-0723
 
E-mail:laura.radke at froedtert.com
 
 
 
Froedtert & the Medical College of Wisconsin Workforce Health / North Hills Health Center Building B First Floor
 
W129 N7055 Northfield Dr.
 
Menomonee Falls, WI 53051
 
  
 
  
 
  
 
From: MCOH-EH <mcoh-eh-bounces+laura.radke=froedtert.com at mylist.net>On Behalf Of Abhijay Karandikar via MCOH-EH
Sent: Saturday, January 9, 2021 5:29 PM
To: mcoh-eh at mylist.net; Jeremy Biggs <jerbiggs at yahoo.com>
Cc: Abhijay Karandikar <dr_abhik at yahoo.com>
Subject: Re: [MCOH-EH] COVID Vaccination Dose #2 in employees who become positive after dose #1
 
  
 
Our recommendations are similar and based on current CDC guidelines. An employee can receive the COVID vaccine as long as they are not currently infected and/or symptomatic and as long as they have met our system criteria for ending isolation (10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever or 10 days have passed since the date of a positive test in an asymptomatic employee). 
 
  
 
As Melanie and others have stated, it is prudent to adhere to the 21/28 day timeline of the second dose as much as possible, depending on the vaccine, since those were the conditions under which clinical trials were conducted and efficacy studied and measured. 
 
  
 
An employee may defer receiving vaccination for 90 days after a confirmed COVID-19 infection if they have not received any dose of the vaccine; that is their personal choice.
 
  
 
Abhijay
 
  
 
Abhijay P. Karandikar, MD, MPH, FACOEM
 
Chief, Section of Occupational Medicine & Employee Health
 
Reading Hospital
 
  
 
  
 
  
 
On Friday, January 8, 2021, 01:19:01 PM EST, Jeremy Biggs via MCOH-EH <mcoh-eh at mylist.net> wrote:
 
  
 
  
 
What are your policies for the following:
 
  
 
Employee has first vaccine and then becomes positive for COVID before the second dose. We have decided, based on the CDC site, COVID before or after 1st dose and before 2nd, don't need to interrupt the schedule, reschedule as long as symptoms resolved and at least 10 days from symptom onset or positive test in an asymptomatic employee.
 
  
 
I have talked with other institutions and some are postponing the second dose for 90 days from symptom onset or positive test in an asymptomatic positive. This they have said is to use the vaccine for others.
 
  
 
Anyone else doing anything different?
 
  
 
 
 
Jeremy Biggs MD MSPH FACOEM 
 
Associate Professor
 
PPE “Czar”
University of Utah, Department of Family and Preventive Medicine
Rocky Mountain Center for Occupational and Environmental Health
 
Medical Director Rocky Mountain Specialty Services Clinic
 
Medical Director of the University Hospital and University Campus Employee Clinics
 
Medical Director of Occupational Medicine and Health, EHS and University Hospital and Clinics
 
 
 
  
 

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