As long-term care facilities (“LTCFs”), such as nursing homes and assisted living facilities, implement plans for the immunization of their residents and staff, and as the first shipments of vaccine are being delivered across the country, the Centers for Disease Control and Prevention (CDC), on December 13th, published considerations for providers regarding post-vaccination signs and symptoms among residents and staff.
While some post-immunization signs and symptoms, such as pain, swelling, or redness at the injection site, are not associated with COVID-19, other signs and symptoms, such as fever, fatigue, headache, muscle aches, or joint pain, have been associated with COVID-19. Accordingly, providers must exercise caution with both residents and staff within three (3) days of immunization to ensure that the symptoms are due to the vaccine and not COVID-19.
Post-Vaccination Considerations for Residents
If a resident experience any systemic signs and symptoms consistent with SARS-CoV-2 infection that are not typical post-vaccination signs and symptoms, the resident should be placed in a single room and tested for SARS-CoV-2 or other conditions with similar symptoms, such as the flu. If the resident tests negative using an antigen test, a follow-up molecular test should be conducted. Symptoms in this category include cough, shortness of breath, runny nose, sore throat, or loss of taste or smell. Staff should wear personal protective equipment (“PPE”) and institute transmission-based precautions.
If a resident experiences only systemic signs and symptoms consistent with SARS-CoV-2 infection that are also typical post-vaccination signs and symptoms, the resident should be restricted to his or her current room until fever, if any, has been resolved and symptoms improve. Symptoms in this category include a fever of 100 degrees or higher (or repeated temperatures of 99 degrees), fatigue, headache, chills, body aches, and joint pain. If the resident tests negative using an antigen test, a follow-up molecular test need not be conducted unless (a) there is active transmission of SARS-CoV-2 in the facility, (b) the resident has had prolonged close contact with someone confirmed to be infected with SARS-CoV-2 during the past 14 days, or (c) if symptoms persist longer than two (2) days following immunization. Staff should wear personal protective equipment (“PPE”) and institute transmission-based precautions. Precautions can be discontinued if symptoms resolve within two (2) days and at least 24 hours have elapsed since the resident has exhibited a fever.
The CDC also made available to some categories of health care providers a COVID-19 vaccination communication toolkit and has promised the same for LTCF providers in light of anecdotal reports that staff are reluctant to take the vaccine. To date, however, the CDC has not released the communication toolkit, which is aimed at educating staff and answering questions about the vaccine as well as providing them with tools for educating residents and families.