Health Update
RECOMMENDATIONS FOR PERSONS WHO HAVE RECEIVED COVID-19 VACCINE

The Delaware Division of Public Health (DPH) is issuing this health update to provide the health care community with updated information regarding recommendations for persons who have received the COVID-19 vaccine should they be exposed to persons with SARS-CoV-2 infection.

Background

While mRNA COVID-19 vaccines have demonstrated high efficacy at preventing severe and symptomatic COVID-19, there is currently limited information on how much the vaccines might reduce transmission and how long protection lasts.

Summary

At this time, vaccinated persons should continue to follow current guidance to protect themselves and others, including wearing a mask, staying at least six feet away from others, avoiding crowds, avoiding poorly ventilated spaces, covering coughs and sneezes, washing hands often, and following any applicable workplace or school guidance, including guidance related to personal protective equipment use or SARS-CoV-2 testing.

However, vaccinated persons* with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet all of the following criteria^†:

• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine)
• Are within three months following receipt of the last dose in the series
• Have remained asymptomatic since the current COVID-19 exposure

Persons who do not meet all three of the above criteria should continue to follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19.

Recommendations

Although the risk of SARS-CoV-2 transmission from vaccinated persons to others is still uncertain, vaccination has been demonstrated to prevent symptomatic COVID-19; symptomatic and pre-symptomatic transmission is thought to have a greater role in transmission than purely asymptomatic transmission. Additionally, individual and societal benefits of avoiding unnecessary quarantine may outweigh the potential but unknown risk of transmission, and facilitate the direction of public health resources to persons at highest risk of transmitting SARS-CoV-2 to others.

This recommendation to waive quarantine for people with vaccine-derived immunity aligns with quarantine recommendations for those with natural immunity, which eases implementation.

Fully vaccinated persons who do not quarantine should still watch for symptoms of COVID-19 for 14 days following an exposure. If they experience symptoms, they should be clinically evaluated for COVID-19, including SARS-CoV-2 testing, if indicated. In addition, vaccinated persons should continue to follow current guidance to protect themselves and others, including all other SARS-CoV-2 testing recommendations and requirements.

Recommendations for Vaccinated Health Care Personnel, Patients, and Residents in Health Care Settings

These criteria could also be applied when considering work restrictions for fully vaccinated health care personnel with higher-risk exposures, as a strategy to alleviate staffing shortages. Of note, exposed health care personnel would not be required to quarantine outside of work.

*As an exception to the above guidance no longer requiring quarantine for fully vaccinated persons, vaccinated inpatients and residents in health care settings should continue to quarantine following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions. This exception is due to the unknown vaccine effectiveness in this population, the higher risk of severe disease and death, and challenges with social distancing in health care settings.

Although not preferred, health care facilities could consider waiving quarantine for vaccinated patients and residents as a strategy to mitigate critical issues (e.g., lack of space, staff, or PPE to safely care for exposed patients or residents) when other options are unsuccessful or unavailable. These decisions could be made in consultation with DPH by emailing OIDE@delaware.gov or other infection control experts.

Additional Information

• State of Delaware COVID-19 website: https://coronavirus.delaware.gov/
• DPH Guidance for Management of Persons With Suspected COVID-19 Exposure, Discontinuation of Home Isolation and Return to Work: https://coronavirus.delaware.gov/wp-content/uploads/sites/177/2021/02/02.12.21-Return-to-Work_RTW_Guidance-final.pdf
• Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html