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COVID-19 Management

Are the Presence of Post-Vaccination Symptoms Associated with COVID-19 Vaccine Effectiveness?

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BACKGROUND AND PURPOSE:

  • Some individuals who receive an mRNA COVID-19 vaccine have worse post-vaccination symptoms than others
    • Whether presence of symptoms is associated with effectiveness is unknown
  • Debes et al. (JAMA Internal Medicine, 2021) evaluated post-vaccine symptoms and serum antibody levels following vaccination among hospital workers who received an SARS-CoV-2 mRNA vaccine

METHODS:

  • Longitudinal study
    • Healthcare workers in Johns Hopkins Health System
  • Population
    • Participated in a study visit between March 10 and April 8, 2021
    • Serum sample collected ≥14 days after receiving the second dose of an mRNA vaccine
  • Exposures
    • Moderna or Pfizer vaccine
  • Study design
    • An ELISA was used to measure IgG antibodies
    • Participants self-reported symptoms following vaccination as
      • None
      • Mild: E.g., injection site pain, mild fatigue, headache
      • Clinically significant: E.g., fatigue, fever, chills
    • Logistic regression models used to explore the association of prior SARS-CoV-2 infection and vaccine type with symptoms following each dose, adjusting for sex and age
    • Linear regression model used to explore the association between magnitude of antibody response (log-transformed) and age, sex, prior infection, vaccine type, symptoms, and time after 2 doses of vaccine

RESULTS:

  • 954 healthcare workers
  • Clinically significant post-vaccination symptoms reported
    • After first dose: 5%
    • After second dose: 43%
  • After adjustment, odds of clinically significant symptoms following either dose were higher with Moderna vs Pfizer
    • Dose 1: Odds ratio (OR) 1.83 (95% CI, 0.96 to 3.50)
    • Dose 2: OR 2.43 (95% CI, 1.73 to 3.40)
  • Prior SARS-CoV-2 exposure was associated with increased odds of clinically significant symptoms following dose 1 but not dose 2
    • Dose 1: OR 4.38 (95% CI, 2.25 to 8.55)
    • Dose 2: OR 0.60 (95% CI, 0.36 to 0.99)
  • Symptom severity varied
    • However, spike IgG antibodies ≥14 days following dose 2 was found in >99.9% (953 of 954) of participants
  • The following were independently associated with higher median IgG measurements
    • Reporting clinically significant symptoms
    • Age younger <60 years
    • Female sex
    • Receipt of Moderna vaccine
    • Prior SARS-CoV-2 exposure

CONCLUSION:

  • While symptoms and health history varied, all study participants had a strong antibody response following second dose of mRNA SARS-CoV-2 vaccine
  • Clinically significant symptoms following dose 1 were associated with prior SARS-CoV-2 infection
  • Individuals receiving their second dose, or the Moderna vaccine, were more likely to report clinically significant symptoms
  • The authors state

The role of higher antibody levels in preventing COVID-19 and providing lasting immunity remains unknown

Overall, the findings suggest that regardless of vaccine reactions or prior SARS-CoV-2 infection, either spike mRNA vaccine will provide a robust spike antibody response 

Learn More – Primary Sources:

Association of Vaccine Type and Prior SARS-CoV-2 Infection With Symptoms and Antibody Measurements Following Vaccination Among Health Care Workers

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Related ObG Topics:

Vaccines in Pregnant and Lactating Women: Is Immune Response Similar to that of Non-Pregnant Patients?
How does Vaccination Impact Viral Load and Duration of Illness in Those with Breakthrough SARS-CoV-2 Infection?
AstraZeneca and Pfizer Side Effects and Efficacy: Real World Data from the UK

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