Prior COVID-19 infection but not Long-COVID linked to increased adverse events after BNT162b2/Pfizer vaccination

 Rachael K. Raw, Clive Kelly, Jon Rees, Caroline Wroe, David R. Chadwick

doi: https://doi.org/10.1101/2021.04.15.21252192

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2021.04.15.21252192v1.full.pdf

Abstract

Importance Understanding Adverse Events (AEs) associated with SARS-CoV-2 vaccination has public health implications, especially with regards to vaccine hesitancy.

Objective To establish whether individuals with prior history of COVID-19 were more likely to experience AEs after BNT162b2/Pfizer vaccination, than those without previous COVID-19, and whether COVID-19-vaccination interval influenced AE severity.

Design An observational study explored AEs after vaccination. Participants were invited to complete an electronic survey, capturing self-reported COVID-19 symptoms, PCR/antibody results, and AEs following first dose of BNT162b2/Pfizer vaccine. In a subset where PCR/antibody results could be verified, a sensitivity analysis was conducted.

Setting Three North-East England hospital Trusts in the United Kingdom.

Participants Healthcare workers formed an opportunistic sample – 265 of 974 reported prior positive SARS-CoV-2 PCR and/or antibody.

Exposure All participants had received their first dose of BNT162b2/Pfizer vaccine.

Main Outcomes and Measures Nature, severity, duration, and onset of self-reported AEs (reported via a modified version of the FDA Toxicity Grading Scale for vaccine-associated AEs), was compared between those with and without a prior history of COVID-19, using 2-way ANCOVA and logistic regression. Effects of age, gender, illness-vaccine interval, and ongoing symptoms (‘Long-COVID’) on AEs, were also explored.

Results Of 974 respondents (81% female, mean age 48), 265 (27%) reported previous COVID-19 infection. Within this group (symptoms median 8.9 months pre-vaccination), 30 (11%) complained of Long-COVID. The proportion reporting one moderate/severe symptom was higher in the previous COVID-19 group (56% v 47%, OR=1.5 [95%CI, 1.1–2.0], p=.009), with fever, fatigue, myalgia-arthralgia and lymphadenopathy significantly more common. There was no significant relationship between illness-vaccine interval and symptom composite score (rs=0.09, p=.44). Long-COVID was not associated with worse AEs in comparison to the group without previous COVID-19. In the smaller sensitivity analysis cohort (412 people) similar findings were obtained although only myalgia and arthralgia remained significant.

Conclusions and Relevance Prior COVID-19 infection but not ongoing Long-COVID symptoms were associated with an increase in the risk of self-reported adverse events following BNT162b2/Pfizer vaccination. COVID-19 illness-vaccination interval did not significantly influence AEs. This data can support education around vaccine-associated AEs and, through improved understanding, help to combat vaccine hesitancy.

Question Does previous COVID-19 infection or ‘Long-COVID’ increase the frequency of Adverse Events (AEs) following first dose of BNT162b2/Pfizer vaccination?

Findings In a survey-based observational study, healthcare workers in the United Kingdom reported AEs experienced after their first dose of BNT162b2/Pfizer vaccine. Prior COVID-19 infection, but not Long-COVID, were associated with increased risk of self-reported AEs including lymphadenopathy post-vaccination. Duration since COVID-19 infection did not affect severity of AEs.

Meaning Our study can inform education and understanding of AEs associated with COVID-19 vaccination and help to combat vaccine hesitancy.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Funding for the CHOIS study is from the North East and North Cumbria Academic Health Sciences Network (AHSN) and Siemens Healthcare Ltd, who provided biomarker and serological assays, but had no input into the study design, analysis or interpretation.

https://www.medrxiv.org/content/10.1101/2021.04.15.21252192v1