COVID-19 vaccine contraindications and precautions

The COVID-19 UK advises that there are very few individuals who cannot receive the COVID-19 mRNA Vaccine BNT162b2 Pfizer BioNTech or AstraZeneca COVID-19 vaccines. Where there is doubt, rather than withholding vaccination, appropriate advice should be sought from the relevant specialist, or from the local screening and immunisation team or health protection team.

The vaccine should not be given to those who have had:
• a confirmed anaphylactic reaction to a previous dose of COVID-19 vaccine
• a confirmed anaphylactic reaction to any components of the vaccine

COVID-19 vaccine precautions
Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation may be postponed until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness (including COVID-19) by wrongly attributing any signs or symptoms of the illness as being possible reactions to the vaccine.

Current or previous history of COVID-19 disease
People currently unwell and experiencing COVID-19 symptoms should not receive COVID-19 vaccine until they have recovered. This is to avoid wrongly attributing any new symptom or the progression of symptoms to the vaccine. As deterioration in some people with COVID-19 can occur up to two weeks after infection, ideally vaccination should be deferred until they have recovered and at least four weeks after onset of symptoms or four weeks from the first PCR positive specimen in those who are asymptomatic.
There is no evidence from clinical trials of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody so people who have had COVID-19 disease (whether confirmed or suspected)
can still receive COVID-19 vaccine. This is because it is not known how long antibodies made in response to natural infection persist and whether immunisation could offer more protection. If antibodies have already been made to the disease following natural infection, receiving COVID-19 vaccine would be expected to boost any pre-existing antibodies.

Vaccination of people experiencing prolonged COVID-19 symptoms (‘Long COVID’)
Having prolonged COVID-19 symptoms is not a contraindication to receiving COVID-19 vaccine but if there is evidence of current deterioration, deferral of vaccination may be considered to avoid incorrect attribution of any change in the person’s underlying condition to the vaccine.

Time interval between treatments for COVID-19 disease (for example dexamethasone, convalescent plasma, monoclonal antibody or antiviral medicines) and vaccine administration
Dexamethasone is a steroid treatment given to patients experiencing severe COVID-19 symptoms to suppress the immune response and reduce inflammation.
Convalescent plasma is a preparation of pooled antibodies taken from people who have recently recovered from COVID-19. The antibodies bind to the surface of the SARS- CoV-2 virus and stop it from attaching to the body’s cells and replicating further.

Monoclonal antibody treatment works in the same way as convalescent plasma but is a specific preparation containing two specific man-made antibodies.
As the COVID-19 mRNA Vaccine BNT162b2 Pfizer-BioNTech and AstraZeneca COVID-19 vaccines are non-live vaccines, it is not anticipated that these treatments would contraindicate the vaccine. Although theoretically, high levels of antibodies in the convalescent plasma could interfere with the immune response to the vaccine, passively acquired antibodies from the plasma treatment are not thought to persist for long so by the time a person who has received this is well enough to receive a COVID- 19 vaccination, these antibodies are likely to have gone.
Antivirals prevent the further replication of viruses. As neither of the above mentioned COVID-19 vaccines contain live virus, response to the vaccine will not be affected by prior or recent receipt of anti-viral medication.