Does a History of MIS-C Preclude COVID Vaccination?

People with a history of multi-inflammatory syndrome for children or adults (MIS-C or MIS-A) may choose to be vaccinated against COVID-19, CDC staff said in a call with clinicians on Friday.

However, these patients should consider delaying vaccination for 90 days until after the date of their diagnosis. Other factors may include clinical recovery from MIS-C or MIS-A, including a normal return to cardiac function, as well as personal risk of severe acute COVID-19 due to age or underlying condition, level of community transmission, and the timing of any immunomodulatory therapies.

Kate Woodworth, MD, MPH, of the CDC, added that there is “no data specifically on the safety of COVID-19 vaccine after MIS-C.”

When asked if there was other specific guidance for people with primary immune disorders, such as Kawasaki syndrome, Woodworth noted guidance for immunosuppressed people can be found under clinical considerations on the agency’s website.

Another special population clinicians were curious about was the effect of COVID-19 vaccination on menstruation in female adolescents.

“At this time, there haven’t been any studies on changes to the menstrual system,” Woodworth said, though she added there were reports of heavier menstrual periods, earlier or later onset of menstrual periods and cramps. However, she said many things can affect the menstrual cycle, and clinicians should talk to patients about their concerns.

Sara Oliver, MD, MPH, of the CDC, responded to a question on whether different adverse events were being observed in adolescents versus adults. Oliver said that because adolescents are younger, healthier, and likely have fewer underlying medical conditions, there were less serious adverse events seen in this population following vaccination in general.

Clinicians also heard the new guidance on co-administration of the COVID-19 vaccine and other vaccines, in both adolescents and adults.

Agency staff reiterated the clinical guidance from Wednesday’s Advisory Committee on Immunization Practices (ACIP) meeting, stating that COVID-19 vaccines and other vaccines may now be administered simultaneously or can be co-administered within 14 days.

They also offered specific guidance for administration, reminding clinicians the deltoid muscle can be used for more than one intramuscular injection. Other best practices included:

  • Labeling each syringe to identify the vaccine it contains
  • Separating injection sites by an inch or more, if possible
  • Administer COVID-19 and vaccines more likely to cause a local reaction (such as tetanus toxoid vaccines) in different limbs, if possible

CDC staff also reiterated that the Pfizer/BioNTech vaccine dose is the same for adolescents as adults (two intramuscular injections, delivered 3 weeks apart), and is not a “weight-based dose.” They added it is also appropriate for adolescents to take over-the-counter pain relievers to alleviate mild post-vaccination symptoms.

When a question arose about how soon the vaccine will be available for even younger populations, Oliver explained that the process was more complicated than going from adults to adolescents.

“As we go younger, both Pfizer and Moderna are doing dose-finding” studies, making sure the dose is correct for a younger and physically smaller population, she said. They will then do safety and immunobridging studies, similar to the adolescent vaccine.

Oliver said it’s harder to pinpoint the timing on that, but researchers are hopeful that data will be available by the end of the year or early 2022.

“We’ll see how the data evolves,” she said.

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    Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage. Follow








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