Clinician Advisory: Paxlovid Rebound

May 24, 2022

Requested actions

• Be aware that cases of rebound in COVID-19 symptoms and/or viral test positivity have been reported, generally occurring 2-8 days after recovery. For further information, see the full text of the Health Advisory from the Centers for Disease Control & Prevention. 
• Advise people with COVID-19 rebound to follow CDC’s guidance on isolation and take precautions to prevent further transmission. Patients should re-isolate for at least 5 days. Per CDC guidance, they can end their re-isolation period after 5 full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The patient should wear a mask for a total of 10 days after rebound symptoms started. 
• Consider clinical evaluation of patients who have COVID-19 rebound and symptoms that persist or worsen. 
• Healthcare providers are encouraged to report cases of COVID-19 rebound to Pfizer after Paxlovid treatment using the following online tool: Pfizer Safety Reporting and to FDA MedWatch. Complete and submit a MedWatch form, or complete and submit FDA Form 3500 (health professional) by fax (1-800-FDA-0178). Call 1-800-FDA-1088 for questions. 

Additional Information

• The frequency of this occurrence has not been specified and the magnitude of its implications for further transmission and community disease control are uncertain. At least one case report did include household transmission during the rebound episode.  
• This phenomenon has not been associated with subsequent development of severe disease nor with resistance to Paxlovid.  
• There is currently no evidence that additional treatment for COVID-19 is needed for COVID-19 rebound.
• Paxlovid remains the treatment of choice for eligible patients with COVID-19.   

Monkeypox Alert Correction 

• The Monkeypox alert of May 23, 2022, contained an error in the text regarding the duration of the incubation period.  The corrected statement is as follows:  “The incubation period is generally 7-14 days with a maximum range of 5-12 5-21 days.”
• To see the full alert, visit here.