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?

eConsult Response

1. 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.
2. 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.