Timing of COVID-19 Vaccination After COVID-19 Infection

General Recommendations for Post-COVID Vaccination

Individuals who had COVID-19 and received monoclonal antibodies or convalescent plasma should defer vaccination for at least 90 days following receipt of antibody therapy 1
Those who develop COVID-19 between the first and second dose of a 2-dose vaccine series should delay the second dose until they have recovered from acute illness and have discontinued isolation 1
After recovery from acute illness, vaccination should proceed without unnecessary delay to ensure protection against reinfection 1

Patients on anti-CD20 medications should delay vaccination for at least 6 months after the last dose of therapy 2
Those on high-dose corticosteroids should wait 4-6 weeks after cessation of treatment 2
Patients with active underlying disease should prioritize immunosuppressive therapy over vaccination until the condition stabilizes 2

Cytotoxic chemotherapy: Vaccination should be given between courses of chemotherapy 3
Lymphocyte or plasma cell-depleting regimens: Vaccination should be administered either 2 weeks before starting or 3 months after completing treatment 3
For phase I clinical trials: Defer initiation of investigational therapy until at least 72 hours after vaccination and after all vaccine adverse effects have improved to grade ≤1 4

After transplantation, postpone vaccination for 3-6 months 5
For those who received a first dose before transplantation, the second dose should be administered at least 4 weeks after transplantation 5
Vaccination should be withheld in liver transplant recipients with active cellular rejection or those receiving high-dose corticosteroids until the condition resolves 2

Waiting too long after COVID-19 recovery to get vaccinated may leave individuals vulnerable to reinfection 4
Receiving vaccination too early during active infection may result in suboptimal immune response 3
Not considering medication interactions that could blunt vaccine response, particularly with immunosuppressive therapies 2

For most people, COVID-19 vaccination can proceed as soon as acute symptoms have resolved and isolation has ended 4
Special populations may require specific timing adjustments 5
The 90-day deferral applies specifically to those who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment 1

Patients who have completed a course of systemic corticosteroids (oral or intravenous) for an asthma exacerbation should wait 4–6 weeks before receiving a COVID‑19 vaccine to optimize antibody response. 6
High‑dose or prolonged systemic corticosteroid therapy can attenuate the immune response to vaccination, potentially reducing efficacy; therefore the waiting period applies specifically to systemic steroid exposure, not the asthma exacerbation itself. 6

Individuals who have used only inhaled corticosteroids or bronchodilators (no systemic steroids) may receive COVID‑19 vaccination without any timing modification. 7
Maintenance asthma medications do not affect vaccination timing and can be continued as prescribed:
- Inhaled corticosteroids – no timing adjustment needed. 7
- Long‑acting β‑agonists – no impact on vaccination timing. 7
- Leukotriene modifiers – no timing considerations. 7
- Biologic agents (e.g., omalizumab, mepolizumab, dupilumab) – can be vaccinated at any time during treatment. 6

The 4–6‑week post‑systemic‑steroid recommendation is consistent across other conditions requiring immunosuppression, not limited to asthma. 7

If a patient experiences another asthma exacerbation that necessitates a new systemic steroid course before vaccination, the 4–6‑week waiting period must be restarted after completion of the new course. 6

Only systemic (oral or intravenous) corticosteroids trigger the waiting interval; inhaled corticosteroids do not, and clinicians should avoid confusing the two categories. 6, 7