Question: My friend was just diagnosed with shingles, and also just found out she can get a covid vaccine tomorrow. Her doctor, who diagnosed her mild case of shingles, told her not to get the shot. She has a daughter who has a double lung transplant and she really wants to get the inoculation to protect her daughter. Can you tell me if she should decline the shot? She doesn’t like or trust this new doctor. She wonders if she goes ahead and gets the shot, would that be worse than waiting to get the vaccine.

Answer: As you know, I’m not a medical doctor.  First things first, your friend should get a second opinion, ideally from a doctor she trusts.  If the doctor is unsure, I recommend that they reach out to vaccine specialists associated with CDC’s Clinical Immunization Safety Assessment (CISA) Project.  CISA is designed for US-based healthcare providers and health departments to receive consultation on questions that are (1) about an individual patient or vaccine safety issue and (2) not readily addressed by CDC or Advisory Committee on Immunization Practices (ACIP) guidelines.  Her doctor can make the request by calling 800-CDC-INFO.

Broadly speaking, mild illness is not a contraindication for vaccination.  Indeed, CDC’s clinical guidelines for mRNA vaccination against COVID list “moderate to severe acute illness” as a precaution to vaccination, however, “mild illness” is neither listed as a precaution nor a contraindication. (Table 1)  ACIP’s General Best Practices for Immunization confirm that “the safety and efficacy of vaccinating persons who have mild illnesses have been documented.”  Again, mild illness should not preclude a person from being vaccinated.  

In the case of COVID, note this important exception:  If you are mildly sick with COVID, have recently been exposed to COVID and are still in your quarantine window, or are asymptomatically infected and within the 10 day window since having tested positive you should wait to get vaccinated until you are recovered and/or out of quarantine/isolation so that you do not further spread the virus.

Table 1. Triage for individuals coming for vaccination (from CDC)