Post-Vaccination Side Effects Following The Second Dose of COVID-19 Vaccine Among Health Care Workers
Post-Vaccination Side Effects Following The Second Dose of COVID-19 Vaccine Among Health Care Workers
Timsi Jain1, Balaji Selvaraju1, Catherine Jude1, Ganesan Dinesh Kumar1, Yogesh Mohan1,
Anantha Eashwar2
1
Department of Community Medicine, Saveetha Medical College & Hospital, Chennai, India
2
Community Medicine Faculty, Sree Balaji Medical College & Hospital, Chennai, India
Corresponding Author:
Ganesan Dinesh Kumar
Department of Community Medicine, Saveetha Medical College & Hospital
Saveetha Nagar, Thandalam, Chennai 602 105, India
Email: [email protected]
1. INTRODUCTION
The world health organization (WHO) had declared the coronavirus disease 2019 (COVID-19) as a
public health emergency due to the rapid spread from Wuhan to neighbouring parts of China and other
countries in 2020 [1], [2]. The new virus has challenged the economy, medical, and public health cadre of
countries globally. There is an epidemiological burden that is constantly evolving concerning the number of
people infected, hospital admissions, morbidity, and mortality [3], [4]. Vaccines were developed for this new
virus and vaccination drives were carried out in various countries to slow down the spread of this infection.
The Government of India had initially approved two vaccines, namely Covishield
(ChAdOx1 nCoV-19) and Covaxin (BBV152) for use from January 2021 [5]–[7]. Health care and frontline
workers were given the priority to be vaccinated first. This was followed by the elderly population, then
followed by people aged more than 45 [8]. Recently vaccination has been opened up for all people aged 18
and above. As of 30th June 2021 India’s cumulative vaccination coverage exceeded 33.57 crores with the
union government committed to accelerating the pace and expanding the scope of COVID-19 vaccination
throughout the country [9]. An interim data from the trial done in Brazil, the UK, and South Africa showed
that most of the adverse reactions were mild to moderate in severity and got resolved within a few days
following the vaccination [10]. Beyond this, there was very limited data on the side-effects following
vaccination in our country and thus this study was carried out to determine the same. This paper in particular
focuses on the side effects after the second dose of Covishield vaccination and the severity of the symptoms
in comparison to that of the first dose among the recipients of Covishield vaccines.
2. RESEARCH METHOD
This was longitudinal study among those who have received their Covishield vaccine at a tertiary
care hospital in Thiruvallur, Tamil Nadu, India. The study participants included all healthcare workers
(HCWs) at the hospital who had taken their vaccine at this centre. The participants were followed up after the
first and second doses respectively. The first dose of vaccination had begun on January 20, 2021 and the
second dose of vaccination had begun on February 19, 2021 in the hospital. This particular paper is a follow-
up study that focuses on the second dose side effects after vaccination. A total of 1,659 participants had taken
their second dose during the study period between February 15 to April 30, 2021. All the HCWs who
received the Second dose were followed at the vaccination centre. Only the Participants who attended the
follow-up calls were included in the final analysis and thus we ended up with a sample size of 1,577.
Information was also collected using a pre-tested semi-structured questionnaire which included their
demographic details, date of first dose vaccination, any delay in the second dose of COVID-19 vaccination
and the reasons for the same, severity of the reactions if any, and comparing them to the first dose reactions
and medications taken to alleviate the symptoms. At the vaccination centre, the patients were first screened
and then their height, weight, and vitals were noted before the vaccination. Post-vaccination, the HCWs were
observed at the vaccination centre for a brief period of 30 minutes, and their vitals were noted again.
Any reaction that occurred at the moment of vaccination was termed as “immediate reactions” and
those that occurred during the 30 minutes (observation period) were termed as “reactions during
observation”. Participants were followed up with the help of phone calls, 48 hours post-vaccination, and
reactions occurring then were termed as “delayed reactions” and symptoms if any, were treated adequately.
Perception of the vaccine reactions was termed as mild, moderate, and severe. If the reactions did not affect
or interfere with their daily activities, they were termed as ‘mild reactions’ and if it interfered with their daily
activities, were termed as ‘moderate reactions’. Any reactions that required hospital admission were termed
as a ‘severe reaction’ [10].
Data collected were entered into an Excel spreadsheet (Microsoft, Redmond, WA, USA). Data were
analyzed using statistical package for the social sciences (SPSS) version 20 (IBM, Armonk, NY, USA).
Proportions were used to describe the socio-demographic variables and the Chi-square test was used to
measure the association between the study variables, p-values<0.05 were considered statistically significant.
Ethical clearance for this study has been obtained from the institutional ethical committee.
Table 2. Association between timing of adverse reactions following COVID-19 vaccination and related
variables among study participants
No Variable Immediate reaction Reaction within 30 mins Reaction after observation period Total
n=37 n=106 n=400 N=1,577
n (%) n (%) n (%) n (%)
1 Gender
Female 26 (2.7) 72 (7.7) 265 (28.4) 933 (59.16)
Male 11 (1.7) 34 (5.2) 135 (20.96) 644 (40.84)
χ2=1.935 χ2=3.611 χ2=12.96
p=0.103 p=0.057 p=0.02*
2 Age
<25 years 25 (2.8) 65 (7.6) 239 (28.3) 845 (53.6)
26-40 11 (2.4) 23 (4.9) 100 (21.6) 463 (29.4)
41-55 1 (0.66) 13 (8.6) 36 (23.8) 151 (9.6)
>55 0 5 (4.2) 24 (20.3) 118 (7.4)
χ2-5.62 χ2-2.681 χ2-2.763
p=130 p=0.443 p=0.838
3 Designation
Doctor 6 (2.4) 12 (4.83) 57 (23) 248 (15.7)
Nursing staff 11 (2.9) 30 (7.9) 106 (27.8) 381 (24.2)
Student 13 (2.01) 52 (8.04) 160 (24.7) 646 (41)
Other hospital staff 7 (2.31) 12 (3.97) 76 (25.16) 302 (19.1)
χ2=0.808 χ2=7.664 χ2=7.387
p=0.84 p=0.053 p=0.287
4 Obesity
Yes 6 (1.2) 25 (5.1) 135 (27.2) 496 (31.4)
No 31 (2.86) 81 (7.46) 265 (24.5) 1,081 (68.6)
χ2=4.079 χ2=0.129 χ2=1.564
p=0.043* p=0.719 p=0.457
*p-value<0.05. (Statistically Significant)
Table 3. Side effects after COVID-19 vaccination among study participants (multiple response)
Immediate reaction Reaction within 30 mins* Reaction after observation period
No Variable n=37 n=106 n=400
N (%) N (%) N (%)
1 Headache 2 (5.4) 8 (7.5) 50 (12.5)
2 Pain/Tenderness at injection site 22 (59.4) 63 (59.4) 180 (45)
3 Giddiness/Dizziness 4 (10.8) 10 (9.4) 6 (1.5)
4 Fever 3 (8) 8 (7.5) 98 (24.5)
5 Swelling/Lump on site of injection 0 (0) 1 (0.9) 3 (0.75)
6 Unwell/Tiredness 0 (0) 1 (0.9) 3 (0.75)
7 Body pain 1 (2.7) 4 (3.8) 85 (21.25)
8 Stomach pain 2 (5.4) 0 7 (1.75)
9 Nausea/Vomiting 0 6 (5.6) 12 (3)
10 Anxiety 0 1 (0.9) 2 (0.5)
11 Allergic reaction 1 (2.7) 2 (1.8) 5 (1.25)
*Observation period
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Table 5. First dose versus second dose severity comparison of COVID-19 vaccine side effects
N-1,577 Percentage
Severity
Frequency (N)
No symptoms for both doses 653 41.4
Symptoms only for the first dose 456 29
Symptoms only for the second dose 63 4
Mild symptoms compared to the first dose 280 17.8
Severe symptoms compared to the first dose 54 3.4
Same severity as the first dose 71 4.4
Vaccines of varied origin have adverse events which are mainly due to the immune response and not
the allergic reaction [11], [12]. This implies that every vaccine is associated with side effects which is not a
new phenomenon. Though the development of the COVID-19 vaccine was fast, it did not skip the steps of
testing its safety and efficacy. Covishield is based on viral vector technology and this has been used earlier in
Post-vaccination side effects following the second dose of ChAdOx1 nCoV-19 vaccine … (Timsi Jain)
402 ISSN: 2252-8806
the production of the Ebola virus vaccine [13]. This implies that the Covishield vaccine was not developed in
a hurry and the safety and efficacy were not compromised. Nevertheless, there is a misinterpretation
regarding the COVID-19 vaccines and their adverse effects. Hence this study was done to explore the extent
of adverse events related to the second dose of COVID-19 vaccination.
4. CONCLUSION
Every vaccine will have some side effects but it is important to understand that in the COVID-19
pandemic, vaccines are our “best shot” to fight against this virus. Though no vaccine is 100% effective, they
do play a major role in limiting the severity of the illness. On weighing the pros and cons of the vaccine side
effects, these symptoms contribute to a smaller percentage or severity when compared to the disease
outcome.
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Post-vaccination side effects following the second dose of ChAdOx1 nCoV-19 vaccine … (Timsi Jain)
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BIOGRAPHIES OF AUTHORS
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