Feature Article: When the Whole Family Has Not Yet Been Vaccinated Against COVID-19

As COVID-19 vaccines roll out, it is likely that for many families, not everyone in their home or “bubble” will be immunized at the same time. Not only will different priority groups cause different times for immunization, but some family members may not be able to get the first doses of COVID-19 vaccines because of their age, medical history or COVID-19 infection status.

So, what should you know?

Who may not be able to get vaccinated

Most people can get the COVID-19 mRNA vaccines once supplies are sufficient, but a few groups of people will either need to delay or forgo these vaccines:

• No vaccine: People with severe allergies to vaccine ingredients should not get the COVID-19 mRNA vaccines.
  • Severe allergies are defined as those that cause anaphylaxis or a reaction that is severe enough to require medical intervention. Anaphylaxis usually occurs in the first few minutes after exposure to the allergen. Symptoms can include hives, drop in blood pressure, swelling of the tongue or throat (resulting in difficulty breathing), rapid pulse, dizziness or fainting. People may also experience nausea, vomiting or diarrhea. People who experience anaphylaxis need immediate medical attention, which typically includes getting a shot of epinephrine.
  • The ingredients in the mRNA vaccines are few:
    • The mRNA blueprint for the SARS-CoV-2 spike protein.
    • A group of lipids (fats) that create the protective coating for delivery of the mRNA. This ingredient is the most likely cause of allergic reactions.
    • A small number of salts or amines that keep the pH of the vaccine at a level safe for administration.
    • Sugar to prevent the mRNA-lipid particles from sticking to one another or the vaccine vial.
• No vaccine: Those younger than 16 years of age cannot yet get the COVID-19 mRNA vaccines, while studies of safety and efficacy are being conducted in this age group.
• Delay vaccine: Individuals who currently have COVID-19 symptoms or who are still isolating according to the recommendations outlined by the Centers for Disease Control and Prevention (CDC) should wait until they are better before getting the vaccine.
• Delay vaccine: People who had COVID-19 and were treated with antibody preparations should wait until 90 days after the treatment before getting the vaccine.
• Delay vaccine: People who are currently quarantining due to a recent COVID-19 exposure should wait until their quarantine is over before getting the vaccine. An exception to this rule is that people who live in group settings can get the vaccine even if they are currently quarantining.
• Delay vaccine: People who got a non-COVID-19 vaccine should wait until 14 days after getting that vaccine before receiving the COVID-19 vaccine.
• Maybe get vaccine: People with severe allergies to other (non-COVID-19) vaccines or to injectable medications. These people should discuss their medical history with their doctors to consider the relative risks and benefits of receiving the vaccine.
• Maybe get vaccine: Pregnant or breastfeeding women can be vaccinated once they have considered, or been counseled regarding, the potential risks and benefits.
• Maybe get vaccine: People with immune-compromising conditions should talk with their doctors to determine whether their particular condition precludes vaccination. Often, they are at higher risk of severe disease, so the benefits of vaccination may still outweigh potential risks.
• Maybe get vaccine: People taking blood thinners should discuss the risks and benefits of vaccination with their healthcare provider, as intramuscular injections may cause bleeding.

Of note, people with allergies to other vaccines or injectable medications and those with any other known allergies who decide to get the vaccine should wait at the site where the vaccine was given for 30 minutes, instead of the 15 minutes recommended for the general population.

Considerations for vaccinated members of the family

We know that the new COVID-19 mRNA vaccines prevent disease, but because of the way the clinical trials were done, we don’t yet know if they prevent infection. If someone can get infected, that means the virus can reproduce in their body. The expectation would be that in a vaccinated person this reproduction would be at low enough levels that the person would not have symptoms. But, even if they don’t have symptoms, they might be able to spread the virus to others. If this happens, people in their home (or others they are in contact with) could be exposed. Studies will be done soon to determine if this is possible.

Likewise, the clinical trials showed that both of the mRNA vaccines worked for about 9 of every 10 people who were vaccinated in the trials. This means 1 of every 10 were not protected. Further, as these vaccines are given to the public, where people are not following trial instructions, there is a good chance that the number of people protected per every 10 will decrease. Public health officials actually have names for these two different numbers because this decrease occurs so commonly:

• Efficacy is the percent of people protected by the vaccine in a clinical trial.
• Effectiveness is the percent of people protected by the vaccine “in the real world.” 

As such, even once a person is vaccinated, they will not know if they could be infected because the vaccine did not work.

For these reasons, people who are vaccinated should still continue practicing public health measures when they go out, so they don’t inadvertently introduce the virus into their household.

Considerations for unvaccinated members of the family

Overall, it is better to be an unvaccinated person in a group of highly vaccinated individuals than a vaccinated person among a group of unvaccinated individuals; however, unvaccinated members of the home still need to be cautious:

• For those who have yet to receive their vaccine, the risk of being infected remains high, and recommended precautions, such as masks, physical distancing and handwashing, should be continued.
• As described above, it is important to realize that vaccinated people may still present a risk to unvaccinated individuals, so an unvaccinated person should be cautious regardless of whether those around them have been vaccinated or not.
• Likewise, if an unvaccinated person is exposed or infected, they could still potentially infect someone who has been vaccinated but for whom the vaccine did not work.

If someone in the family cannot be vaccinated, it is important that others in the home receive the vaccine (when supplies allow) in order to reduce the chance that the unvaccinated person will be exposed to the virus.

Considerations for the community at large

Even when all people in a home are vaccinated, it will be important to remember that as long as the virus is circulating widely in the community, recommended public health measures will be needed:

• In case the vaccine did not work for someone in the home
• To protect unvaccinated co-workers, neighbors, friends and others
• To decrease the ease with which the virus can spread in the community

Over time, as more people get immunized, the spread of SARS-CoV-2 will diminish, and we can all get back to more normal interactions.

For general information about these topics, check out “Vaccinated or unvaccinated: What you should know.”

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