Interim Public Health Recommendations for Fully Vaccinated People

Summary of Recent Changes

● Updated information for fully vaccinated people given new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States.
● Added a recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission.
● Added information that fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated.
● Added a recommendation for fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.
● CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

Key Points

The following recommendations apply to non-healthcare settings. For related information for healthcare settings, visit Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.

Fully vaccinated people can:

● Participate in many of the activities that they did before the pandemic; for some of these activities, they may choose to wear a mask.
● Resume domestic travel and refrain from testing before or after travel and from self-quarantine after travel.
● Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States.
● Refrain from routine screening testing if feasible.

Infections happen in only a small proportion of people who are fully vaccinated, even with the Delta variant. However, preliminary evidence suggests that fully vaccinated people who do become infected with the Delta variant can spread the virus to others. To reduce their risk of becoming infected with the Delta variant and potentially spreading it to others: CDC recommends that fully vaccinated people:

● Wear a mask in public indoor settings if they are in an area of substantial or high transmission.
- Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. People who are at increased risk for severe disease include older adults and those who have certain medical conditions, such as diabetes, overweight or obesity, and heart conditions.
● Get tested if experiencing COVID-19 symptoms.
● If you came into close contact with someone with COVID-19 get tested 3-5 days after the date of your exposure and wear a mask in public indoor settings for 14 days after exposure or until a negative test result.
● Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
● Follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.
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Overview

People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and to follow current prevention measures (including wearing a mask, staying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces) regardless of their vaccination status to protect themselves against COVID-19 until advised otherwise by their healthcare provider.

Currently authorized vaccines in the United States are highly effective at protecting vaccinated people against symptomatic and severe COVID-19. Fully vaccinated people are less likely to become infected and, if infected, to develop symptoms of COVID-19. They are at substantially reduced risk of severe illness and death from COVID-19 compared with unvaccinated people.

Infections in fully vaccinated people (breakthrough infections) happen in only a small proportion of people who are fully vaccinated, even with the Delta variant. Moreover, when these infections occur among vaccinated people, they tend to be mild. However, preliminary evidence suggests that fully vaccinated people who do become infected with the Delta variant can be infectious and can spread the virus to others.

For the purposes of this guidance, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson & Johnson [J&J]/Janssen)†. There is currently no post-vaccination time limit on fully vaccinated status. People are considered not fully vaccinated if they have not completed a two-dose vaccination series or have not received a single-dose vaccine, regardless of age, including children under the age of 12.

Data suggest an immune response to COVID-19 vaccination might be reduced in some immunocompromised people including, but not limited to, people receiving chemotherapy for cancer, people with hematologic cancers such as chronic lymphocytic leukemia, people receiving stem cells or organ transplants, people receiving hemodialysis, and people using certain medications that might blunt the immune response to vaccination (e.g.,  mycophenolate, rituximab, azathioprine, anti-CD20 monoclonal antibodies, Bruton tyrosine kinase inhibitors).

People with moderately to severely compromised immune systems should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses.

People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and the need to continue to follow current prevention measures (including wearing a mask, staying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces) to protect themselves against COVID-19 until advised otherwise by their healthcare provider. Close contacts of immunocompromised people should also be encouraged to be vaccinated against COVID-19.

This guidance provides recommendations for fully vaccinated people, including:

● How fully vaccinated people can safely resume many activities while protecting others.
● How fully vaccinated people should approach domestic and international travel.
● How fully vaccinated people should approach isolation, quarantine, and testing.

CDC will continue to evaluate and update public health recommendations for fully vaccinated people like more information, including on Delta and other new variants become available. Further information on evidence and considerations related to these recommendations is available in the Science Brief.

Guiding Principles for Fully Vaccinated People

● Outdoor activities pose minimal risk to fully vaccinated people.
● Most indoor activities pose a low risk to fully vaccinated people, especially in areas with low or moderate transmission.
● Infections happen in only a small proportion of people who are fully vaccinated, even with the Delta variant.
● Fully vaccinated people who become infected with the Delta variant can transmit it to others.

To reduce their risk of becoming infected with the Delta variant and potentially spreading it to others, CDC recommends that fully vaccinated people:

● Wear a mask in public indoor settings if they are in an area of substantial or high transmission.
● Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.
● Get tested if experiencing COVID-19 symptoms.
● Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
● Get tested 3-5 days after exposure to someone with suspected or confirmed COVID-19 and wear a mask in public indoor settings for 14 days after exposure or until they receive a negative test result.

Continue to follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.

Recommendations for Indoor Settings

The risk of SARS-CoV-2 infection, severe disease, and death is reduced for fully vaccinated people. Though they happen in only a small proportion of people who are fully vaccinated, some infections do occur among fully vaccinated people. Fully vaccinated people who do become infected with the Delta variant can transmit it to others. Therefore, fully vaccinated people can further reduce their risk of becoming infected with the Delta variant and transmitting it to others by wearing a mask in public indoor settings in areas of substantial or high community transmission. Wearing a mask in public is most important for people who are immunocompromised. Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. People at increased risk for the severe disease include older adults and those who have certain medical conditions, such as diabetes, overweight or obesity, and heart conditions. Members of the household who are unvaccinated include any persons who have not completed vaccination, who cannot be vaccinated, and those who are not eligible for vaccines, including children less than 12 years of age. Fully vaccinated people should also continue to wear a mask where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance, and in correctional facilities and homeless shelters. Prevention measures are still recommended for unvaccinated people.

CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with proper prevention strategies in place.