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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