CDC Issues Updated Guidance on Quarantine Recommendations for Vaccinated Persons

Last week, the Centers for Disease Control and Prevention (CDC) issued new guidance regarding quarantine recommendations for vaccinated persons and updated recommendations for testing for tuberculosis (TB) infection and timing of the COVID-19 vaccination. In reviewing the guidance, it is important to note that while the State embraces the CDC guidance, they have yet to issue industry-specific guidance, and therefore it is uncertain if the Department of Health (DOH) will apply guidelines to DOH-regulated settings and providers.

Updated Guidance Regarding Quarantine of Fully Vaccinated Persons and Exposures

According to CDC guidance, 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 two-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

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.

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.

The risk of transmission from vaccinated persons to others is still uncertain. Vaccinated persons should continue to follow current guidance to protect themselves and others, including all other SARS-CoV-2 testing recommendations and State and local guidance.

The CDC guidance makes an exemption to this guidance for vaccinated inpatients and residents in health care settings, however. Given the unknown vaccine effectiveness in this population and the higher risks of severe disease and death and difficulty social distancing, residents should continue to quarantine following an exposure. That being said, the Department has not issued industry-specific guidance adopting this guidance for nursing homes, adult care facilities (ACFs), home care, and hospice. DOH confirmed that the Jan. 7^th guidance regarding furloughing after exposures remains intact regardless of vaccination status at this time. We will inform members of any changes to this policy.

Tuberculosis Testing and COVID-19 Vaccination

The updated CDC guidance also provides an update on the use of immune-based tests for TB infection, such as the tuberculin skin test and interferon-gamma release assay.

The guidance states:

The mRNA COVID-19 vaccine should not be delayed because of testing for TB infection. Testing for TB infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA), can be done before or during the same encounter as the mRNA COVID-19 vaccination. When testing with TST or IGRA cannot be done at the same time as mRNA COVID-19 vaccination, these tests should be delayed ≥4 weeks after the completion of mRNA COVID-19 vaccination but generally should not be cancelled.

Patients who have active TB disease or an illness that is being evaluated as active TB disease can receive an mRNA COVID-19 vaccine (note: the presence of a moderate or severe acute illness is a precaution to administration of all vaccines). Whereas a TST or IGRA test is part of a comprehensive evaluation for TB disease, positive TST or IGRA results are not required to diagnose active TB disease.

When considering a tuberculin skin test or interferon-gamma release assay:

The TST is not expected to have an effect on the safety or the effectiveness of the mRNA COVID-19 vaccine. IGRAs are blood tests and thus do not affect vaccine safety or effectiveness.
The reliability of a positive TST or IGRA result after mRNA COVID-19 vaccination is expected to be the same as without the vaccination. mRNA COVID-19 vaccination is not expected to cause false positive results from a TB test that is done at the same encounter as or after mRNA COVID-19 vaccination.
The reliability of a negative TST or IGRA result after mRNA COVID-19 vaccination has not been studied.
The TST is not a vaccine. The guidance for separating other vaccines from mRNA COVID-19 vaccination by at least 2 weeks in time does not apply to the TST because the TST is not a vaccine.

When a tuberculin skin test or interferon gamma release assay is required by policy:

A TST or IGRA to meet administrative requirements, (for example, for healthcare employment or for admission to long-term care), can be done prior to mRNA COVID-19 vaccination or at the same encounter. The mRNA COVID-19 vaccine should not be delayed because of testing for TB infection.
A TST or IGRA should be deferred until ≥4 weeks after the completion of mRNA COVID-19 vaccination. If testing requirements or policies cannot be modified for the COVID-19 pandemic to accept this delay in TST or IGRA testing, it should be understood that a false negative TST or IGRA cannot be excluded, and consideration should be given to repeating negative TST or IGRA tests at least 4 weeks after the completion of COVID-19 mRNA vaccination. If TST was the initial test, boosting could be a factor if the result of the repeat test is positive.

When a tuberculin skin test or interferon gamma release assay is indicated for medical care:

The decision as to whether a TST or IGRA that is being done for medical diagnosis of latent TB infection, (for example, during a contact investigation after exposure to contagious TB disease) should be delayed for 4 weeks after completion of COVID-19 mRNA vaccination is at the discretion of the responsible medical provider and local tuberculosis program overseeing the contact investigation. Medical providers and local tuberculosis programs may not wish to delay testing for persons at high risk for progression to TB disease. However, patients who have a negative result in this context should be considered for retesting >4 weeks after the completion of mRNA COVID-19 vaccination.
Patients who have symptoms or diagnostic findings consistent with active TB disease should receive further medical evaluation, for example, with chest radiography and sputum bacteriology for Mycobacterium tuberculosis, regardless of TST or IGRA results.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828