International Journal on Infectious Disease and Epidemiology (IJIDE)

Review Article Volume3-Issue1

Evaluation of Vaccines Effective against Coronavirus

Salma Ebrahimi Shah Abadi1, Ali Rahmanian2, Melika Asadsangabi3, Faezeh yousefie4, Seyedeh Mahsa Mortazavi5, Shaqayeq Keshtgar6, Ashkan Rezvani Joybari7, Hossein Esmaeili8*

1Student Research Committee, Islamic Azad University, Zahedan branch, Zahedan, Iran
2Molecular cell biology student, Department of biology, Shiraz university, Iran
3Molecular cell biology student, Department of biology, Shiraz University, Iran
4Student Research Committee, Islamic Azad University, Zahedan branch, Zahedan, Iran
5Student Research Committee, Islamic Azad University, Zahedan branch, Zahedan, Iran
6Student Research Committee, Islamic Azad University, Zahedan branch, Zahedan, Iran
7Medical Student, Department of Medicine, Islamic Azad University Zahedan Medical Sciences, Iran
8Medical Student, Department of Medicine, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
*Corresponding author: Hossein Esmaeili, Medical Student, Department of Medicine, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
Article History
Received: December 06, 2021 Accepted: February 01, 2022 Published: February 02, 2022
Citation: Abadi SES, Rahmanian A, Asadsangabi M, et al. Evaluation of Vaccines Effective against Coronavirus. Int. Jr. Infect Dis & Epidemlgy. 2022;3(1):8‒12. DOI: 10.51626/ijide.2022.03.00013

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Abstract

Given the COVID-19 virus epidemic and vaccination increment all around the world, after surveying the vaccination side effects it was clarified that 72.6% of individuals reported at least one symptom after the first and second injection of Pfizer-BioNTech vaccine which pain at injection site, fever and myalgia/arthralgia were most common among these symptoms. Furthermore, most common severe side effects like fever > 39 °C were perceived more after the second dose of vaccine. In the study of identifying body’s physiologic changed, heart rate variability (HRV) decreased after the first dose and the second dose without having considerable changes in resting heart rate (RHR) and respiratory rate (RR) and the duration of sleep also declined up to 4 days of both vaccination doses. Plus, Local and systemic reactogenicity were more intense after the second dose. Following the COVID-19 vaccination, various allergic reactions also started to promote all around the countries, a questionnaire was adjusted in Toronto-Canada and 65 patients had PEG-ASNase allergy. Rapid reactions like anaphylaxis occur following the first dose of Pfizer mRNA COVID-19 vaccine. In a study consisted of 175 individuals, 21 of them were afflicted with anaphylaxis and a number of 83 individuals experienced non-anaphylaxis allergic reactions but still further studies are required in order to identify the relation between anaphylaxis and COVID-19 vaccines. Disease background is an outstanding factor to intensify COVID-19 infection. In a research, a 40-year old woman who had experienced left peripheral facial nerve palsy 4 years ago and in another research 8 adolescents who visited Nicklaus Children’s Hospital with perimyocarditis within 4 days of receiving the second dose of BNT162b2 vaccine, were investigated in this context. In terms of gender and age relation, a study was carried out on German residents of Bavaria between Jan 9 to Apr 11, 2021 and, it was clarified that both doses of the BioNTech-Pfizer’s BNT162b2 are highly effective against the infection and adverse events of COVID-19 virus in elder people and according to another report, 82% of individuals experienced at least one symptom Following the first dose of Comirnaty vaccine which was more common in women under the age 55 (64%). In a study which was carried out among the workers of Mazandaran University of Medical Sciences in order to identify the side effects of the Sputnik V vaccine, a number of 3236 individuals in the 19-78 age range with the mean age of 38 years old submitted their report. According to a research which was conducted in Bavaria, Germany, the mortality rate was considerably lower in individuals who had received vaccination in relation to not vaccinated individuals, however, 3 death cases were reported in individuals who suffered from comorbidities after receiving the Sputnik vaccine which was considered to be irrelevant to vaccination. A research was conducted to evaluate the effectiveness of Robust antibody after the first and second dose in individuals aged between 70 and 90. From 99 individuals who received the first dose of their vaccination after 3 weeks the existence of Robust antibody was proven in 95% of them and from 86 individuals who received their vaccine’s second dose after 3 weeks, all of them showed a positive result in the test. Furthermore, in another study from 75% of old individuals who were vaccinated at least once, the first dose led into COVID-19 infection decrease and had an effectiveness of 52% in clinical experiments. According to another report, the antibody was observed in 92% of individuals 21 days after the first dose and also in 97% of them 21 days after the second dose it was concluded that Symptoms following vaccination are not unusual and they occur because of body’s immune system response.

Keywords: Covid-19; Vaccines effective covid-19; Vaccines and covid-19

Introduction

It was at the end of December 2019 that the COVID-19 virus (SARS-CoV-2) was primarily identified in the Chinese city of Wuhan and the spread rate of this novel human coronavirus was so high that only by April 20, 2020 a number of 1,364 counties of 3,020 US counties reported the detection of COVID-19 cases [1,2].
Vaccination promotion is currently the most reliable approach to end the COVID-19 pandemic and that’s because increasing the proportion of eligible persons who are vaccinated decreases the risk for high community-wide transmission, and as a consequence reduces the risk for the appearance of new variants that could have the potential to overcome vaccine-induced immunity , however, some individuals may not opt for it due to various reasons thus it is essential for public health departments to enhance trust and acceptance of the COVID-19 vaccination [3,4].

That is to say, one of the major causes of many individual’s fear to receive SARS-CoV-2 vaccine is the health related consequences and the appearance of various short term and long term symptoms after the first and second dose [5].

For this reason, we are going to set a comparison between two well-known vaccines, Pfizer-BioNTech and Sputnik V, and survey the effectiveness of both vaccines along with their reported symptoms and also the possibility of experiencing several significant allergic reactions including Anaphylaxis after receiving both vaccine doses [6,7].

The immunogenicity and antibodies detection following the administration of vaccine doses is also an outstanding context which is discussed in this article [8].

What Symptoms can be Predicted after Receiving
COVID-19 Vaccine Doses?

A study was carried out among the workers of Mazandaran University of Medical Sciences in order to identify the side effects of the Sputnik V vaccine and a number of 3236 individuals in the 19-78 age range with the mean age of 38 years old submitted their report for this research [8].

After the first administration of the Comirnaty vaccine 82% of individuals experienced at least one side effect which was more frequent among women under the age of 55 (64%). Mild adverse events (98.6%) and moderate events including myalgia/arthralgia, lymphadenopathy, diarrhoea and local urticaria generally manifested themselves after 4-12 hours after the first dose and resolved by 24 hours. A small proportion of individuals reported other symptoms. Symptoms after the second dose were stated by 82.6% of individuals who were mainly women and people with the age of 40-41 and 97.2% of these side effects were mild pain, redness and swelling at the injection site. Most common severe side effects like fever >39°C were perceived more after the second dose of vaccine. Generally, 72.6% of individuals reported at least one symptom after the first and second injection of Comirnaty vaccine. Similar side effects of both doses were mainly relevant to sex, SARS-CoV-2 infection history and COVID-19 symptoms progress [9].

In another research a number of 705 individuals participated in an online survey. 196 of whom had received Pfizer vaccine and 506 individuals had administrated AstraZeneca vaccine, [10] reported at least one side effect after the injection such as pain at injection site, fever and myalgia. As a result, symptoms after vaccination are natural phenomena and indicate the body immunization response to vaccine [11]. In another study a group consisted of 19 individuals (mean age 28.8) who had received both vaccine doses were surveyed via a portable device with the aim of characterizing physiologic changes of body [12].

Changes in heart rate variability (HRV), resting heart rate (RHR), respiratory rate, rapid eye movement, deep sleep and also local and systemic reactogenicity following each dose were measured and as a conclusion, HRV decreased after the first dose (mean: 13.44%) and the second dose (mean: 9.25%) without having considerable changes in RHR and RR. The duration of sleep also declined up to 4 days of both vaccination doses. Plus, Local and systemic reactogenicity were more intense after the second dose [13].

This research was conducted in order to identify the changes in certain physiologic features such as heart rate variability (HRV), resting heart rate (RHR), respiratory rate (RR) and sleep stage duration after the first and second dose of Pfizer-BioNTech COVID-19 Vaccine. These changes were tracked by the WHOOP device after the first and second dose of the vaccine. The average baseline was reported as follows: RHR 63.09 (SD 6.36) bpm, HRV 52.09 (SD 21.58) ms, and RR 16.27 (SD 1.23) rpm. HRV percentage declined following the first and second dose but it returned to baseline after a few days, however, there was no specific shift in the percentage of RHR and RR after both doses. The percentage of sleep duration after both vaccine doses went above baseline in day 1 but it passed the mean percentage in day 2 and 3 and returned to baseline in day 5. Other than that, majority of people reported symptoms including arm soreness, fatigue and body aches. The intensity and frequency of which were higher after the second dose [15]. Generally vomiting [16], local pain, joint pain, fatigue, fever, arthralgia, myalgia, headache and palpitation were reported as the vaccination side effects [11,17].

Allergic reactions
Following the COVID-19 vaccination, various allergic reactions also started to promote all around the countries [18]. Women and individuals with a history of allergic reactions (food, medicine, …) made up a high percentage of the total vaccinated people [19]. Most reported allergic reactions were respectively related to inhaled allergens, food allergens, drugs and insect venoms. Individuals with the history of a specific allergic reaction submitted more reports of post-vaccination local symptoms like redness and swelling than non-allergic individuals. The duration of symptoms lasted longer in allergic people than none-allergic ones and they needed specific medications more frequently. Allergic people experienced more intense adverse events after the second dose, however, high severe symptoms were rare in both allergic and non-allergic people [17,20].

Currently in North America, only the Pfizer-BioNTech vaccine is available for 12-17 year-old individuals. The mRNA vaccines contain PEG-asparaginase and individuals who are afflicted with acute lymphoblastic leukemia, develop allergic reactions when they receive PEG-asparaginase [21].

A questionnaire was adjusted in Toronto-Canada and all the patients who had an age of 12 or older in The Hospital for Sick Children (SickKids) participated in it. A small number of adult patients in Princess Margaret Cancer Centre also took part in this questionnaire. They were asked to confirm their history of PEG-ASNase allergic reaction before receiving vaccination. A total number of 65 individuals were identified to have PEG-ASNase allergy and 32 of them were eventually present at the vaccination clinic and all of them had documented the grade 2 and 4 PEG-ASNase allergy and none of these individuals had taken the anti-allergy medicines. Consequently, no allergic reaction to BNT162b2 were observed in these individuals but since the number of patients were small, findings may not be reducible across a larger cohort [21,22].
Anaphylaxis
Rapid reactions like anaphylaxis occur following the first dose of Pfizer mRNA COVID-19 vaccine but biphasic anaphylaxis were not observed after the second dose. Other studies demonstrate that delayed phase reaction is because of uneven antigen absorption and in order to prevent sever events and anaphylaxis, the administration of epinephrine is recommended [18,23,24].
In a study consisted of 175 individuals, 21 of them were afflicted with anaphylaxis. The mean period between the first injection of vaccine and occurrence of anaphylaxis was 13 minutes. 20 of these 21 individuals recovered without any serious problem and no death case were reported. Meanwhile, 13 of them had a history of allergic reactions. A number of 83 individuals experienced non-anaphylaxis allergic reactions and 87% of them had no specific problem. Most common reported symptoms are pruritus, rash, itchy and scratchy sensations in the throat, and mild respiratory symptoms [7].

Anaphylaxis and anaphylactoid symptoms were reported commonly in Japan and factors like reporting bias and differences in the demography of the vaccinee population can be associated with that. The possibility of anaphylaxis has been highly publicized in the context of the attention given to coronavirus vaccines by the media. Further studies are required in order to identify the relation between anaphylaxis and COVID-19 vaccines [19].

Disease background
Disease background was an outstanding factor to intensify COVID-19 infection in one quarter of individuals [6].

The most common reported diseases among people who had received both doses of their vaccination were cardio-vascular diseases (9.43%), asthma (6.21%) and thyroid disease (7.53%) [17].

5 workers in healthcare facilities were hired secretly to record necessary patient’s information and the relation of the vaccination side effects (mild and severe) via Chi square and Fisher’s exact test. Some of the participants were under treatment for diabetes, thyroid and allergic diseases and they received such as antihistamines, antihypertensive, blood pressure medications (most common) and etc [9].

The administration of Pfizer-BioNTech COVID-19 vaccine can be associated with several nervous system diseases, whereas there is a slight relation between vaccination and the risk of developing multiple sclerosis (MS) disease [25]. Certain reports has been published in this context and one of them was a 40-year old woman who had experienced left peripheral facial nerve palsy 4 years ago but she was fully recovered. Nevertheless, she developed numbness and sensory disturbance in her right hand after receiving the second dose of BNT162b2 vaccine and it gradually advanced to her right shoulder after one week and she got transferred to Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital. She was afflicted with 38.5-degree fever after the vaccination. MRI scan of the head on admission revealed left periventricular and bilateral frontal subcortical high-intensity lesions and it was estimated that the patient had pre-existing subclinical inflammatory CNS disease before vaccination. However, it can’t be evaluated if this occurrence in relevant to vaccination or it is merely coincidental [26].

There was a study on 8 adolescents who visited Nicklaus Children’s Hospital with perimyocarditis within 4 days of receiving the second dose of BNT162b2 vaccine. All the patients were males and aged 15 to 17 years old they had visited the children hospital for the reason of chest pain or irregular heartbeat.
Disease backgrounds of the patients are noted bellow:
Patient 1: Vitiligo
Patient 3: Mild perimyocarditis
Patient 4: Marfan syndrome
Patient 6: Insulin resistance and dyslipidemia
Patients number 2, 5, 7, 8 had no record of background diseases.

Two patients had been already infected with COVID-19 virus and except patient 4 and 3 which respectively experienced Perimyocarditis after the first dose and both doses, other patients visited the hospital only after two days. The increment of Troponin-I was observed in all the patients. SARS-CoV-2 PCR was negative in all of the individuals and SRAS CoV-2 nucleocapsid IgG was positive in patient 1 and 3. Chest radiography didn’t show anything unusual in patients. Aside from patient number 4 and 6 who had normal sinus rhythm, the electrocardiogram demonstrated irregularity in other patients [27,28].

Gender and age effect
A study was carried out on 707187 individuals older than 80 years old (mean age 81.1 and 35.5% male) between Jan 9 to Apr 11, 2021. They were all the residents of Bavaria, Germany. AS a result, it was clarified that both doses of the BioNTech-Pfizer’s BNT162b2 are highly effective against the infection and adverse events of COVID-19 virus in elder people. The effectiveness of this vaccine seems to be equal in both genders [29].

But according to studies which were conducted in the US in December 14-23, 2020, after the administration of the BioNTech-Pfizer’s first dose 21 of 175 individuals were inflicted with anaphylaxis and they had an age range of 27 to 60 and 90 percent of them were women [7].

Following the first dose of Comirnaty vaccine, 82% of individuals experienced at least one symptom which was more common in women under the age 55 (64%) [9,30].

Mortality
According to a research which was conducted in Bavaria, Germany between 9 Jan and 19 Apr, 2021, a number of 1349 individuals were hospitalized and 1731 patients died because of Corona virus infection. Being vaccinated didn’t make a noticeable difference in not getting hospitalized after the vaccination but the mortality rate was considerably lower in individuals who had received vaccination in relation to not vaccinated individuals [11].

None of the vaccinated cases in this study faced severe respiratory side effects after the vaccination and only one none-vaccinated individual died during the infection. 8 of 9 infected individuals who hadn’t receive vaccination, experienced severe symptoms thus even a single dose of the BioNTech-Pfizer vaccine is proven to be beneficial for elder people [31].
Nonetheless, 3 death cases were reported in individuals who suffered from comorbidities after receiving the Sputnik vaccine which was considered to be irrelevant to vaccination [6].

The Relation between Antibody and Vaccine Doses
Gap

A research was conducted to evaluate the effectiveness of Robust antibody after the first and second dose in individuals aged between 70 and 90. They took blood sample of 99 individuals who received the first dose of their vaccination after 3 weeks and Roche anti-S test proved the existence of Robust antibody in 95% of them. This percentage was slightly lower among individuals older than 80 years old. Then they took blood sample of 86 individuals who received their vaccine’s second dose after 3 weeks and they observed that all of them showed a positive result in the test [6,32].

HRV percentage decreased following the first and second dose but it returned to its normal condition after a few days. No specific changes in RHR and RR were observed after both doses. Sleep duration went below the normal degree 1 day after both doses but it went over the mean percentage on days 2 and 3 and turned back to normal on day 5. Other than that, most of the cases had arm soreness, fatigue and body aches. Pain intensity and its frequency were higher after the second dose [15].

In a study in which 75% of old individuals were vaccinated at least once, the first dose led into COVID-19 infection decrease and had an effectiveness of 52% in clinical experiments and after surveying 20000 individuals older than 60 years old, it was revealed that a 33 percent decrease occurred in positive tests of COVID-19 virus [33].

Antibody density after receiving both doses was much higher in individuals who had already been infected with COVID-19 virus than the ones who hadn’t been infected [6].

Sputnik vaccine generates immunity only after the first dose, however, further immunization requires more doses of vaccination. Human body generates immediate antibodies against Sputnik protein which inhibits the virus binding to its receptor. T-cells also make immune response that should not wane quickly. The results show that essential body immunity formed 18 days after the first dose. The vaccine effectiveness after the first dose was reported to be 91.6% after 21 days and despite the criticisms about the hastiness in its production, the results were quite satisfactory [6].

According to another report, the antibody was observed in 92% of individuals 21 days after the first dose and also in 97% of them 21 days after the second dose [8].

COVID-19 Vaccine Comparison

A research through an online questionnaire was conducted among 705 individuals in which 196 of them had received the Pfizer-BioNTech vaccine and 506 of them had injected the AstraZeneca vaccine. A percentage of 93.9 of individuals who were vaccinated by the Pfizer-BioNTech and 96.5% of individuals who had received the AstraZeneca, reported at least of side effect after vaccination. As a result, Symptoms following the vaccination are not rare and they occur because of body’s immune system response. Studies also suggest that the first dose of the AstraZeneca vaccine lead into more side effects than both doses of the Pfizer-BioNTech vaccine [11].

Conclusion

Given the increasing trend of vaccination in the world and due to the epidemic of COVID-19 disease, complications after vaccination have also increased which include side effects after the first and the second doses of Pfizer vaccine, physiological changes and allergic and immediate reactions. Also, the history of the disease and the effect of age and sex on the adverse events after vaccination can be observed, however, these complications can also be the result of the immune system’s reaction to vaccination.

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