COVID-19 Vaccine-Related eConsults: Case 15
eConsult Clinical Question
A 50-year-old female patient tested positive for COVID-19 without severe respiratory symptoms but shortly thereafter onset with acute cerebrovascular accident (CVA) and was hospitalized. I recommend that she get COVID-19 vaccine now (has not been vaccinated yet from this) but patient would like e-consult with infectious disease to verify that they recommend the vaccine in the context of recent CVA and COVID-19 infection. Do you recommend COVID-19 vaccination now for this patient?
- Thanks for this consultation on your 50-year-old female patient with hypertension, hypothyroidism, and morbid obesity- who contract COVID-19 without severe respiratory symptoms but then developed an acute CVA requiring hospitalization. Certainly, COVID caused the stroke - I have no doubt about that; and probably her primary risk factor is the morbid obesity. Since this was 3+ months ago, and we're heading into the cooler season now - when COVID could be expected to flare up more significantly, immunization makes very good sense. If she wanted to wait for one or two months more, I would be fine with that... since natural infection does provide some protection.
- What we know, is that 'more immunity' is certainly better and given she had this devastating stroke, she cannot afford to get 'sick' again. In Israel, they are doing a 5-month 'reboosting' after the two primary series shots, and I think immunologically this makes good sense. In her case, maybe the primary infection is the initial immunological event - and the vaccine administration at five months out would mirror this strategy. So, to summarize: YES - I strongly recommend immunization.
These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.