At a glance
- People who recently had SARS-CoV-2 infection may consider delaying a COVID-19 vaccine dose by up to 3 months.
- Additional considerations apply to people with a history of multisystem inflammatory syndrome (MIS).
COVID-19 vaccination and prior SARS-CoV-2 infection
COVID-19 vaccination recommendations apply regardless of prior symptomatic or asymptomatic SARS-CoV-2 infection, including people with Long COVID.
People who recently had SARS-CoV-2 infection may consider delaying a COVID-19 vaccine dose by up to 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination might result in an improved immune response to vaccination. Also, a low risk of reinfection has generally been observed in the months following infection. Individual factors such as risk of severe COVID-19 and current indicators of community transmission should be taken into account when determining whether to delay getting a COVID-19 vaccination after infection.
COVID-19 vaccination and MIS-C and MIS-A
Multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) are rare and potentially serious post-infectious complications of SARS-CoV-2 infection. Both are associated with a hyperinflammatory immune response to SARS-CoV-2 infection. In 2023, MIS-C incidence had declined 98% since the peak of the COVID-19 pandemic despite continued SARS-CoV-2 transmission.
There have been rare reports of multisystem inflammatory syndrome (MIS)-like illness after COVID-19 vaccination identified from U.S. surveillance (<1 MIS-C case per million vaccinated children without laboratory evidence of SARS-CoV-2 infection). However, whether there is a causal relationship between COVID-19 vaccination and MIS-like illness is unknown.
Considerations for initiating COVID-19 vaccination in people with a history of MIS-C or MIS-A
Two studies (published in 2022 and 2023) found that children with a history of MIS-C were not at increased risk for the reoccurrence of MIS-C or other serious adverse events including myocarditis. Experts consider the benefits of COVID-19 vaccination for people with a history of MIS-C or MIS-A to outweigh a theoretical risk of an MIS-like illness or the rare risk of myocarditis following COVID-19 vaccination for those who meet the following two recovery criteria:
- Clinical recovery has been achieved, including return to baseline cardiac function; and
- It has been at least 90 days after the diagnosis of MIS-C or MIS-A
COVID-19 vaccination may also be considered for people who had MIS-C or MIS-A and do not meet both criteria, at the discretion of their clinical care team. Experts view clinical recovery, including return to baseline cardiac function, as an important factor when considering COVID-19 vaccination. Additional factors, such as the risk of severe COVID-19 due to age or certain medical conditions, may also be considered.
Considerations for administration of subsequent COVID-19 vaccine doses in people diagnosed with MIS-C or MIS-A after COVID-19 vaccination
Onset of MIS more than 60 days after most recent COVID-19 vaccine dose
Administration of subsequent COVID-19 vaccine doses should be considered for those who meet the two recovery criteria described in the section immediately above.
Onset of MIS 60 days or fewer after most recent COVID-19 vaccine dose
For persons in this category who meet the recovery criteria described in the section immediately above, the decision whether to administer subsequent COVID-19 vaccine doses should be made on an individual basis by the clinical care team and patient or parent or guardian. Subsequent COVID-19 vaccine doses should especially be considered if there is strong evidence that the MIS-C or MIS-A was a complication of a recent SARS-CoV-2 infection.