Pre-Existing Comorbidities Diminish the Likelihood of Seropositivity after SARS-CoV-2 Vaccination

The role of co-morbidities in the development of an AEFI after COVID-19 vaccination in a large prospective cohort with patient-reported outcomes in the Netherlands

BACKGROUND

The effect of a preexisting comorbidity on the occurrence of adverse events after immunization (AEFIs) has been studied poorly. In this longitudinal cohort study, we assess the association between co-morbidities and the occurrence of AEFIs after COVID-19 vaccination. Also, we described the occurrence of flare-ups and their manifestation after COVID-19 vaccination in people with rheumatic diseases.

RESEARCH DESIGN AND METHODS

We performed multivariable logistic regression to investigate the association between the occurrence of AEFIs and 10 common comorbidities using patient-reported data from people vaccinated with the AstraZeneca, Johnson&Johnson, Moderna, or Pfizer vaccine.

RESULTS

Occurrence of any AEFI, injection site reactions, headache, fatigue, and/or malaise was significantly associated with presence of comorbidities, including psychological disorders, musculoskeletal disorders, and endocrine disorders after the first and second doses (OR ranges 1.23-1.77). One participant with rheumatoid arthritis experienced a flare-up after receiving the first dose of the AstraZeneca vaccine.

DISCUSSION/CONCLUSION

The results showed that the odds of reporting an AEFI after COVID-19 vaccination is significantly higher in the presence of some comorbidities whilst flare-ups are uncommon after receiving COVID-19 vaccination in people with rheumatic disease. In-depth research is needed to validate our results and unravel the observed associations from a mechanistic perspective.

Post-COVID-19 Vaccination Infection Among Adults in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

While vaccines were one of the most effective tools to combat the COVID-19 pandemic, breakthrough infections have been reported.

AIM OF THE WORK

We aim to evaluate the effectiveness of Pfizer and AstraZeneca vaccines in preventing breakthrough infection, as well as to determine the possible risk factors and outcomes of post-vaccination infection.

METHODS

This is a cross-sectional study using self-reported data of adult Saudi residents, including Saudi and non-Saudi people who received at least two doses of either Pfizer or AstraZeneca vaccines. Based on the presence of COVID-19 symptoms that were confirmed by PCR, the participants were classified into three groups: (1) those with evidence of infection before vaccination, (2) those who had infection after vaccination, and (3) those who had infection before and after vaccination. For further evaluation, we compared the severity and outcomes in the participants who were infected before and after vaccination.

RESULTS

The study included 694 participants: 69.1% received three doses of the vaccine, and 71.1% of them were vaccinated with the Pfizer vaccine. COVID-19 infection was reported in 48.3% of the total subjects, with a higher infection rate (17.8%) after vaccination compared to 12.5% before vaccination. Additionally, 18.32% of participants experienced infection both before and after vaccination. Out of the total 694 participants, 137 (19.7%) had breakthrough infections. Pfizer vaccine was more prevalent among the non-infected group (74.25% vs. 65.5%), while AstraZeneca vaccine was more prevalent among the infected group (6.4% vs. 5.9% (p<0.039). Diabetes was significantly higher among the infected group (16.9% vs. 8.1%, p=0.001, OR=2.29, 95% CI=1.42-3.68). Among those who were infected before and after vaccination, 71.9% reported less severe symptoms after vaccination.

CONCLUSION

Breakthrough infections may occur after vaccination; however, vaccines are overall effective in preventing severe symptoms. Pfizer vaccine appeared to be more effective in preventing COVID-19 infection. The presence of comorbidities, including diabetes, may increase the risk of infection.

Antibody Response to COVID-19 Vaccines in Healthcare Workers: Which One is More Successful? Homologous or Heterologous?

Objectives

We aimed to determine the antibody levels created by COVID-19 vaccination in healthcare workers and the factors affecting the antibody response.

Methods

Our research is a single-center, observational study that was prospectively designed and retrospectively analyzed at the beginning of the COVID-19 pandemic, and included 103 healthcare workers who received the three-dose regimen of COVID-19 vaccine. In accordance with the recommendations of the Ministry of Health of Turkey, the first two doses of CoronaVac vaccine were administered routinely, while the booster dose was given as BioNTech or CoronaVac (heterologous or homologous vaccination) depending on the preference of the volunteers. Antibody titers against the SARS-CoV-2 were measured in all individuals at different time points (1 month after the second dose of CoronaVac, before the booster dose [BioNTech or CoronaVac] at the fifth month and one month after the booster dose) with AESKULISA® SARS-CoV-2 S1 IgG (AESKU DIAGNOSTICS, Wendelsheim, Germany).

Results

The mean age was 39.98±11.31 years, 62.1% of whom were women and 54.4% of them were accompanied by comorbid disease. After two doses of CoronaVac, the antibody titer averaged 49.50±33.15 U/mL in the 1st month (antibody seropositivity 86%) and the antibody titer decreased 24.01±33.48 U/mL (antibody seropositivity 49.5%) at 5th month. The mean antibody titer was found 59.73±60.20 U/ml in those who received the booster dose of homologous and 185.07±46.28 U/mL in those who were heterologous (p<0.001). Antibody levels were detected significantly lower after the booster dose of vaccination in patients with comorbidities (p<0.05).

Conclusion

Our study, which reflects the data within the scope of the Turkey Ministry of Health's COVID-19 vaccination program determined that the antibody response after heterologous vaccination is better than in homologous vaccination. Antibody titer level in the 5th month was 50% waned after two doses of inactivated vaccination. It was also shown that factors such as gender, age, body mass index, and smoking did not create a statistically significant difference in homologous and heterologous vaccination, but after the booster dose antibody levels decreased significantly in those with comorbidity.

Long-Term Antibody Response against SARS-CoV-2 in Health Care Workers: Effectiveness of Homologous and Heterologous Regimens and Their Relation to Systemic Vaccine-Associated Symptoms

This prospective study provides data on the long-term humoral immunogenicity of a heterologous off-label vaccine regimen combining the adenoviral-vectored ChAdOx1 nCoV-19 from Astra-Zeneca (ChAd) with the mRNA-1273 vaccine from Moderna (m1273) in comparison with two different homologous mRNA vaccine schedules. Of the 316 COVID-19 naïve adult health care workers (HCW) included to complete a survey on vaccine-associated symptoms (VAS), 197 had received the homologous BNT162b2 mRNA vaccine from Pfizer/BioNTech (BNT/BNT), 76 the homologous m1273/m1273, and 43 the heterologous ChAd/m1273 vaccine regimen. The concentration of antibodies against SARS-CoV-2 spike protein in plasma 5−7 months after the second vaccine dose was higher in the m1273/m1273 and ChAd/m1273 than the BNT/BNT vaccine group. The frequency of systemic VAS after the first vaccine dose was 86% after ChAd compared with 35% and 39% after BNT and m1273, respectively (p < 0.0001), and after the second vaccine dose, the highest (89%) in the m1273/m1273 group (p < 0.001). Individuals with systemic VAS achieved higher levels of antibodies irrespective of vaccine regimen. In conclusion, VAS serve as a strong predictor of long-term humoral immune response, and the heterologous ChAd/m1273 vaccine regimen provides an at least equal long-term humoral immune response compared with the standard vaccine regimens used in Denmark.