CDC Interim Recommendations for Fully Vaccinated People An Important First Step - ACMS

Athalia Christie, MIA Centers for Disease Control and

Prevention, Atlanta, Georgia.

Sarah A. Mbaeyi, MD Centers for Disease Control and

Prevention, Atlanta, Georgia.

Rochelle P. Walensky, MD

Centers for Disease Control and

Prevention, Atlanta, Georgia.

On December 11, 2020, the US reached an extraordi nary milestone in the efforts to end the COVID-19 pan demic: the Food and Drug Administration authorized emergency use of the first COVID-19 vaccine, manufac tured by Pfizer-BioNTech. Since then, 2 additional COVID-19 vaccines, Moderna and Janssen (Johnson & Johnson), have received Emergency Use Authoriza tion in the US and, as of March 8, 2021,more than 31mil lion people, or 9.4% of the total population, have com pleted a vaccination series.1

With the number of people vaccinated each week continuing to increase, the Centers for Disease Control and Prevention (CDC) has released its initial public health recommendations for fully vaccinated people (individu als who are at least 2 weeks out from having received their second Pfizer-BioNTech or Moderna vaccine dose, or from their Janssen single-dose vaccine).2 These rec ommendations represent the first step for individuals in resuming their prepandemic lives.

When creating this guidance, the risks to both vac cinated and unvaccinated people were considered. Cur rent data demonstrate that theauthorizedCOVID-19vac cines are efficacious among adults of different ages,

Despite these unknowns, fully

COVID-19 vaccines perform, some questions remain. Researchers are still investigating how long protection from natural infection or vaccination lasts and how well the vaccines protect against emerging SARS CoV-2 variants. A recent analysis that assessed the 4 major types of immune memory found substantial durability 6 months after natural infection.4 Although they remain rare, cases of reinfection have been re ported.5 Because of these data, vaccination is recom mended for individuals who have recovered from COVID-19.6 Data from the phase 3 vaccine trials and vaccine effectiveness studies will help to understand how well COVID-19 vaccines provide long-term pro tection. If and when the level of neutralizing antibody that correlates with protection against SARS-CoV-2 is identified, more will be learned about how natural and vaccine-derived immunity may compare.

Additionally, the authorized COVID-19 vaccines may provide protection against many well-described SARS-CoV-2 variants.3 However, reduced vaccine efficacy and antibody neutralization have been ob served for the B.1.351 variant,3 originally identified in South Africa, and currently reported from 20 US jurisdictions.7 CDC and state, local, and

academic partners are rapidly scaling up

genomic surveillance to understand

vaccinated people can resume several activities now, at low risk to themselves

how widely these variants have dis persed across the US and to identify new variants as they emerge. The CDC and others are also monitoring the

Corresponding

Author: Athalia

Christie, MIA, Centers for Disease Control and Prevention, 1600

Clifton Rd, Atlanta, GA 30333 ([email protected]).

races, and ethnicities, and among those with underly ing medical conditions.3 Even if fully vaccinated people do become infected, they are much less likely to de velop severe disease, be hospitalized, or die.3

In addition, preliminary but rapidly increasing evi dence suggests that fully vaccinated people likely pose little risk of transmission to unvaccinated people. Studies from the US, UK, and Israel found that 2 doses of Pfizer-BioNTech or Moderna vaccines were 86% to 92% effective against asymptomatic and sympto matic SARS-CoV-2 infection.3 More specifically, stud ies from Israel demonstrated that the Pfizer-BioNTech COVID-19 vaccine was 90% effective against asymp tomatic infection, and vaccinated people who devel oped COVID-19 had a substantially lower viral load than unvaccinated people.3 Viral load has been identi fied as a key driver of transmission and this observa tion may indicate reduced transmissibility. Collec tively, these findings demonstrate that vaccination has the potential to substantially reduce the COVID-19 disease burden in the US.

Although scientists have already learned a great deal about SARS-CoV-2 and how well the authorized

effects of specific mutations on the authorized COVID 19 vaccines, therapeutics, and diagnostic tests. Despite these unknowns, fully vaccinated people can resume several activities now, at low risk to them selves, while being mindful of the potential risk of becoming infected and transmitting the virus to other people. With the new CDC recommendations (Box), fully vaccinated people can share a meal or movie night in their private residence, without masks or physical distancing. Fully vaccinated people can also do these things with unvaccinated family and friends; however, prevention measures (such as wearing masks and physical distancing) should be maintained if any unvaccinated people are at risk of severe COVID-19 or if multiple households of unvaccinated people are mixing together.

In addition,most fully vaccinated people will no lon ger have to be tested for SARS-CoV-2 infection or quar antine if they are exposed to someone with COVID-19, allowing them to go to work, take care of their families, and continue their daily lives (exceptions to this recom mendation include patients and residents of congre gate settings).

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Opinion Viewpoint

Box. Background Rationale and Data for Public Health Recommendations for Fully Vaccinated People

COVID-19 vaccines currently authorized in the US are effective against COVID-19, including severe disease.
Preliminary evidence suggests that the currently authorized COVID-19 vaccines may provide some protection against a variety of strains, including B.1.1.7 (originally identified in the UK). However, reduced antibody neutralization and efficacy have been observed for the B.1.351 strain (originally identified in South Africa).
A growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection and potentially less likely to transmit SARS-CoV-2 to others. However, further investigation is ongoing.
Modeling studies suggest that preventive measures such as mask use and social distancing will continue to be important during vaccine implementation. However, there are ways to take a balanced approached by allowing vaccinated people to resume some lower-risk activities.
Taking steps toward relaxingcertainmeasures forvaccinatedpersons may help improve COVID-19 vaccine acceptance and uptake. • The risks of SARS-CoV-2 infection in fully vaccinated people cannot be completely eliminated as long as there is continued community transmission of the virus. Vaccinated people could potentially still get COVID-19 and spread it to others. However, the benefits of relaxing some measures, such as quarantine requirements, and reducing social isolation may outweigh the residual risk of fully vaccinated people becoming ill with COVID-19 or transmitting the virus to others.
Guidance for fully vaccinated people is available and will continue to be updated as more information becomes available.

From the CDC recommendations.3

CDC guidance will evolve as vaccination coverage increases, dis ease dynamics in the country change, and new data emerge. Until then, the CDC will rely on other proven prevention strategies dur ing this critical juncture. With high levels of community transmis sion and the threat of SARS-CoV-2 variants of concern, CDC still rec ommendsa number of preventionmeasures forall people, regardless of vaccination status. These include continuing to wear a well fitted mask when in public or with people at risk of severe COVID 19,avoiding large gatherings,and postponing travel.Inaddition, com munity-level prevention strategies must be maintained. To reduce transmission, layered prevention strategies such as universal face maskmandates, and restrictions on occupancy of indoor spaces and the size of social gatherings, are essential. Once vaccinated people make up a greater proportion of the general US population, these community-level restrictions will be readdressed, but not yet.

The promising early data of the COVID-19 vaccines offer a path toward ending this pandemic that has affected everyone’s daily lives in somanyways. Yet some reports suggest that approximately a third of US adults still do not want to get vaccinated.3 As highlighted at the recent National Forum on COVID-19 Vaccine, barriers to vac cine accessmust be removed andevidence-based approaches to im proving vaccine confidence and acceptance are essential.

Day by day, arm by arm, millions of vaccines are being admin istered across the US in the largest vaccination effort in this coun try’s history. As vaccine supply increases, and distribution and ad ministration systems expand and improve, more and more people will become fully vaccinated and eager to resume their prepan demic lives. Giving vaccinated people the ability to safely visit their family and friends is an important step toward improved well being and a significant benefit of vaccination.

ARTICLE INFORMATION

Published Online: March 10, 2021.

doi:10.1001/jama.2021.4367

Conflict of Interest Disclosures: None reported.

Additional Contributions: We wish to

acknowledge Heidi M. Soeters, PhD (CDC).

REFERENCES

1. Centers for Disease Control and Prevention. CDC COVID data tracker: COVID-19 vaccinations in the United States. Accessed March 7, 2021. https:// covid.cdc.gov/covid-data-tracker/#vaccinations
2. Centers for Disease Control and Prevention. Public health recommendations for fully vaccinated people. March 8, 2021. https://www.cdc.gov/

coronavirus/2019-ncov/vaccines/fully-vaccinated guidance.html

3. Centers for Disease Control and Prevention. Science Brief: background rationale and data for public health recommendations for fully vaccinated people. March 8, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/more/fully-vaccinated people.html
4. Dan JM, Mateus J, Kato Y, et al. Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science. 2021;371(6529): eabf4063. doi:1126/science.abf4063
5. Centers for Disease Control and Prevention. Interim guidance on retesting and quarantine of adults recovered from laboratory-diagnosed

SARS-CoV-2 infection with subsequent re-exposure. Accessed March 7, 2021. https://www. cdc.gov/coronavirus/2019-ncov/hcp/duration isolation.html#anchor_1613167560916

6. Centers for Disease Control and Prevention. Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. Accessed March 7, 2021. https://www.cdc.gov/ vaccines/covid-19/info-by-product/clinical considerations.html
7. Centers for Disease Control and Prevention. US COVID-19 cases caused by variants. Accessed March 7, 2021. https://www.cdc.gov/coronavirus/ 2019-ncov/transmission/variant-cases.html

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