The Impact of Vaccination Against SARS-CoV-2 Virus on the Outcome of COVID-19 Disease

Figures & data

Table 1 COVID-19 Vaccine Types, Doses and Contraindications

	Vaccine	Type	Doses	Contraindications
1	Pfizer BioNTech (BNT162b2)	mRNA	2 (3 weeks apart) 2 booster dose	• History of severe allergic reaction to any component of the vaccine.
2	Oxford/AstraZeneca (ChAdOx1-S)	Viral vector (non-replicating)	2 (3 weeks apart)	• History of severe allergic reaction to any component of the vaccine • Age younger than 18 years.
3	Janssen Ad26.COV2.S	Viral vector (non-replicating)	2 (2–6 months apart)	• History of anaphylaxis to any component of the vaccine. • Body temperature over 38.5°C. • Age younger than 18 years.
4	Moderna COVID-19 (mRNA-1273)	mRNA	2 (4 weeks apart) 2 booster doses	• History of severe allergic reaction to any component of the vaccine. • Individuals who developed myocarditis or pericarditis following the first dose. • Age younger than 12 years.
5	Sinopharm	Inactivated virus	2 (3–4 weeks apart)	• History of anaphylaxis to any component of the vaccine. • Body temperature over 38.5°C
6	Nuvaxovid & Covovax (NVX-CoV2373)	Protein subunit	2 (3–4 weeks apart)	• History of anaphylaxis to any component of the vaccine. • Body temperature over 38.5°C. • Persons with acute PCR-confirmed COVID-19. • Age younger than 18 years.

Note: Data from World Health Organization.³⁴

Table 2 Advantages and Disadvantages of Different Types of COVID-19 Vaccines

	Vaccine Type	Advantages	Disadvantages
1	Inactivated virus	• Good safety profile. • Better transportation and storage stability. • Long shelf life.	• Immunogenicity deficit. • Protection lasts less time. • Adjuvants are required. • A higher dose is required.
2	Protein subunit	• Fewer adverse effects.	• Immunogenicity is limited. • Adjuvants are required.
3	mRNA	• High adaptability to control immunogenicity. • Immunogenicity is high. • Long-term immunity.	• In-vivo stability.
4	Recombinant viral vector	• Unwanted antigens can be removed. • No adjuvants are required. • High efficiency in stimulating immune responses.	• The existence of pre-existing host immunity reduces efficacy. • Expensive.

Notes: Adapted from: Loo KY, Letchumanan V, Ser HL, et al. Covid-19: insights into potential vaccines. Microorganisms. 2021;9(3):605. doi:10.3390/microorganisms9030605.³⁵ Creative Commons Attribution License Attribution 4.0 International (CC BY 4.0); https://creativecommons.org/licenses/by/4.0/legalcode. 

Table 3 Association of Severity and Outcome of COVID-19 with the Vaccination Status

Variable	Vaccination Status			P-value
	Partially Vaccinated (PV)	Fully Vaccinated (FV)	Unvaccinated
MOH Severity Criteria
Mild-Moderate	36 (24.7%)	12 (30.8%)	78 (17.8%)	<0.001
Severe	59 (40.4%)	10 (25.6%)	96 (21.9%)
Critical	51 (34.9%)	17 (43.6%)	265 (60.3%)
Severe
Pneumonia on chest x-ray	105 (71.9%)	25 (64.1%)	367 (84%)	0.014
Respiratory rate >30/minute	53 (36.3%)	9 (23.1%)	228 (52.2%)	0.001
SpO2 less than 93% on room air	99 (67.8%)	20 (51.3%)	328 (75.1%)	0.179
PaO2 and FiO2 ratio less than 300	10 (6.8%)	3 (7.7%)	26 (5.9%)	0.758
Lung infiltration >50% of lung fields within 24–48 hours	74 (50.7%)	19 (48.7%)	257 (58.8%)	0.29
Critical
ARDS	33 (22.6%)	6 (15.4%)	169 (38.7%)	<0.001
Sepsis	11 (7.5%)	1 (2.6%)	82 (18.8%)	<0.001
Altered mental status	8 (5.5%)	1 (2.6%)	23 (5.3%)	0.57
Multiorgan failure	6 (4.1%)	2 (5.1%)	23 (5.3%)	0.448
Cytokine storm syndrome	67 (45.9%)	18 (46.2%)	265 (60.6%)	<0.001
Outcomes
Length of hospitalization (> 7 days)	60 (40.3%)	14 (35.9%)	282 (64.8%)	<0.001
Need for ICU admission	28 (19.2%)	5 (12.8%)	217 (49.7%)	<0.001
Need for ventilation	10 (6.8%)	2 (5.1%)	87 (19.9%)	<0.001
Death	8 (5.5%)	2 (5.1%)	94 (21.5%)	<0.001

Note: significant p-values are shown in bold.

Abbreviations: SpO2, oxygen saturation; PaO2, partial pressure of oxygen; FiO2, fraction of inspired oxygen; ARDS, acute respiratory distress syndrome; ICU, intensive care unit.

Table 4 Demographics

Variable		Frequency	Vaccinated		Unvaccinated	P-values
			Partially	Fully
Gender	Male	352 (56.4%)	86 (58.9%)	20 (51.3%)	246 (51.3%)	0.87
	Female	272 (43.6%)	60 (41.1%)	19 (48.7%)	193 (48.7%)
Age	≤ 40	191 (30.6%)	41 (28.1%)	5 (12.8%)	145 (12.8%)	0.05
	> 40	433 (69.4%)	105 (71.9%)	34 (87.2%)	294 (87.2%)
Comorbidities	Diabetes Mellitus	315 (50.5%)	68 (46.6%)	17 (43.6%)	230 (43.6%)	0.4
	Cardiac Disease	153 (24.5%)	31 (21.2%)	9 (23.1%)	113 (23.1%)	0.7
	Respiratory diseases	56 (9%)	17 (11.6%)	3 (7.7%)	36 (7.7%)	0.9
	Hematological Diseases	19 (3%)	2 (1.4%)	2 (5.1%)	15 (5.1%)	0.2
	Gastrointestinal diseases	26 (4.2%)	6 (4.1%)	1 (2.6%)	19 (2.6%)	0.3
	Rheumatological diseases	13 (2.1%)	3 (2.1%)	2 (5.1%)	8 (5.1%)	0.8
Number of Comorbidities	< 1 Comorbidity	197 (31.6%)	46 (31.5%)	13 (33.3%)	138 (28.7%)	0.65
	1–3 Comorbidities	413 (66.2%)	96 (65.8%)	25 (64.1%)	292 (60.8%)	0.8
	>3 Comorbidities	14 (2.2%)	4 (2.7%)	1 (2.6%)	9 (1.9%)	0.78

Table 5 The Results of Vaccine Information

Status of Vaccination		Frequency	Percent (%)
Vaccinated	Yes	185	29.6
	No	439	70.4
Status of Vaccination	Partially Vaccinated	146	78.9
	Fully Vaccinated	39	21.1
Type of vaccine (first dose)	Pfizer	102	69.9
	AstraZeneca	44	30.1
Type of vaccine (second dose)	Pfizer	38	97.4
	AstraZeneca	1	2.6
Date of the last dose	< 14 days	36	19.5
	≥ 14 days	149	80.5

Table 6 Comparison of Laboratory Parameters Between Vaccinated and Unvaccinated Groups

Variable		Vaccinated Median (IQR)		Unvaccinated Median (IQR)	P-values
		Partially Vaccinated	Fully Vaccinated
WBC	(4.0–10.0 k/ul)	10.8 (6.8–14.8)	11.6 (8.1–15)	12.2 (8.4–18.5)	0.003
Hemoglobin	Males (13.0–18.0 g/dl)	13.6 (12.3–14.8)	10.2 (8.3–13.5)	13.6 (12.6–14.7)	0.027
	Females (12.0–16.0 g/dl)	11.9 (10.3–13.4)	12.6 (12.5–12.7)	12.3 (11.4–13)	0.614
Platelets	(140–450)	220.5 (163–318)	240 (200–353)	232.5 (174–345.5)	0.282
Lymphocytes	(1.0–5.0 k/ul)	1.735 (1.2–2.7)	1.8 (1.3–2.7)	1.5 (1–2.4)	0.011
Neutrophils	(2.0–7.5 k/uL)	7.2 (4.8–10.3)	7.4 (5.9–9.8)	8.8 (5.8–12)	0.001
BUN	(7–26 mg/dl)	11 (8–19.5)	13 (5.4–21.5)	10.35 (6–18)	0.346
Creatinine	(0.6–1.2 mg/dl)	0.84 (0.71–1.2)	0.88 (0.7–1.5)	0.83 (0.69–1.2)	0.553
NA	(136–146 mEq/L)	136 (132–139)	136 (131.25–139.75)	137 (134–139)	0.553
K	(3.5–5.1 mEq/L)	4.1 (3.8–4.6)	4.35 (4–4.95)	4.1 (3.8–4.58)	0.191
Cl	(98–107 mEq/L)	101 (98–105)	103.5 (100.25–106.75)	102 (99–105)	0.107
Co2	(20–31mEq/L)	21 (20–23)	22 (17.75–25.75)	22.5 (20–24)	0.227
LDH	(20–31mEq/L)	416 (278.5–627)	255 (216–414)	383 (292–578.5)	0.003
ESR	(0–20 mm/hour)	66 (37–88)	51 (31–92)	56 (33–83.5)	0.507
CRP	(0.1–0.5 mg/dl)	16.3 (6.34–50.3)	28 (11.22–64)	33 (11.3–108.4)	<0.0001
D-dimer	≤0.5 ug/mL	0.86 (0.48–2.14)	1.22 (0.55–2.96)	1.6 (0.745–5.26)	<0.0001
Ferritin	(21.81–274.66 ng/mL)	950.41 (201.9–1482)	343 (108–1025.56)	865(345.8–1781.7)	0.031

Note: significant p-values are shown in bold.

Abbreviations: IQR, interquartile range; WBCs, white blood cells; BUN, blood urea nitrogen; Na, sodium; K, potassium; Cl, chloride; CO2, carbon dioxide; LDH, lactate dehydrogenase; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.

Table 7 Multivariate Analysis of the Association Between the Severity of COVID-19 with Age, Gender, Co-Morbidities, and Vaccination Status

Variable	Severity
	Severe		Critical
	OR (95% CI)	P-values	OR (95% CI)	P-values
Age	1.27 (0.76–2.12)	0.37	1.78 (1.11–2.85)	0.017
Gender (Male)	1.09 (0.67–1.77)	0.724	1 (0.64–1.56)	0.992
Diabetes mellitus	2.52 (1.49–4.27)	0.001	3.18 (1.96–5.16)	<0.001
Cardiac Disease	1.13 (0.67–1.91)	0.034	0.52 (0.28–0.95)	0.637
Respiratory diseases	1.13 (0.49–2.63)	0.771	1.31 (0.6–2.86)	0.507
Gastrointestinal diseases	0.63 (0.2–1.98)	0.427	0.25 (0.08–0.86)	0.027
Hematological diseases	1.48 (0.49–4.5)	0.487	0.76 (0.24–2.38)	0.637
Rheumatologic diseases	3.24 (0.54–19.47)	0.199	3.14 (0.53–18.42)	0.206
Unvaccinated	0.86 (0.53–1.4)	0.538	2.31 (1.44–3.7)	<0.001
Partially Vaccinated (PV)	1.97 (0.77–5.01)	0.157	1 (0.43–2.35)	1
Fully Vaccinated (FV)	0.36 (0.158–0.82)	0.01	1 (0.43–2.35)	1

Note: significant p-values are shown in bold.

Abbreviations: OR, odds ratio; CI, confidence Interval.

Table 8 Multivariate Analysis of the Association Between Outcome of COVID-19 with Age, Gender, Co-Morbidities, and Vaccination Status

Variable	Outcome
	Hospital Stay		ICU Admission		Ventilation		Death
	OR (95% CI)	P-values	OR (95% CI)	P-values	OR (95% CI)	P-values	OR (95% CI)	P-values
Age	3 (2–4.4)	<0.001	1.5 (1–2.3)	0.04	1.7 (1–2.9)	0.08	1.2 (0.7–2)	0.62
Gender (Male)	0.7 (0.5–1.1)	0.10	1.1 (0.8–1.6)	0.52	1.2 (0.7–1.9)	0.54	3 (1.7–5.1)	<0.001
Diabetes mellitus	1.9 (1.3–2.7)	<0.001	2.5 (1.7–3.6)	<0.001	2.3 (1.4–4)	<0.001	4.1 (2.4–7.2)	<0.001
Cardiac Disease	1.4 (0.9–2.2)	0.10	1.7 (1.1–2.6)	0.01	4.9 (3–8)	<0.001	3.9 (2.4–6.6)	<0.001
Respiratory diseases	1.2 (0.7–2.3)	0.49	0.8 (0.4–1.6)	0.61	1.8 (0.9–4)	0.12	1.7 (0.7–3.9)	0.21
Gastrointestinal diseases	0.6 (0.2–1.7)	0.38	0.6 (0.2–1.8)	0.34	0.3 (0–2.9)	0.32	0.4 (0–3.6)	0.39
Hematological diseases	1.6 (0.6–4)	0.32	1.8 (0.7–4.5)	0.20	1.5 (0.5–4.7)	0.50	0.8 (0.2–3.3)	0.78
Rheumatologic diseases	1.4 (0.4–4.9)	0.59	2.7 (0.7–10)	0.13	1.1 (0.2–6.3)	0.94	0.7 (0.1–6.2)	0.72
Unvaccinated	3 (2.1–4.4)	<0.001	4.7 (3–7.4)	<0.001	3.6 (1.9–7.1)	<0.001	4.8 (2.3–9.8)	<0.001
Partially Vaccinated (PV)	1.2 (0.6–2.6)	0.56	1.6 (0.6–4.4)	0.38	1.3 (0.3–6)	0.77	1.1 (0.2–5.3)	0.93
Fully Vaccinated (FV)	0.8 (0.4–1.7)	0.56	0.49 (0.245–0.99)	0.045	0.8 (0.2–3.8)	0.77	0.9 (0.2–4.6)	0.93

Note: significant p-values are shown in bold.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 9 The Effect of Vaccination Status on the Severity and Outcome of COVID-19 Disease in Relation to Age, Male Gender, Diabetes Mellitus, and Cardiac Diseases

Variable	Severe/Critical n=331		P- value	Hospital Stay n = 356		P-value	ICU Admission n = 250		p-value	Ventilation n = 99		p-value	Death n = 104		p-value
	Vaccinated	Unvaccinated		Vaccinated	Unvaccinated		Vaccinated	Unvaccinated		Vaccinated	Unvaccinated		Vaccinated	Unvaccinated
Age > 40 years	53 (16.1%)	186 (56.2%)	<0.0001	69 (19.4%)	208 (58.4%)	<0.0001	28 (11.2%)	155 (62%)	<0.0001	11 (11.1%)	66 (66.7%)	<0.0001	10 (9.6%)	65 (62.5%)	<0.0001
Male Gender	43 (13%)	151 (45.6%)	<0.0001	43 (12.1%)	153 (43%)	<0.0001	20 (8%)	131 (52.4%)	<0.0001	7 (7.1%)	56 (56.6%)	<0.0001	8 (7.7%)	73 (70.2%)	<0.0001
Diabetes Mellitus	25 (7.6%)	112 (33.8%)	<0.0001	42 (11.8%)	162 (45.5%)	<0.0001	18 (7.2%)	141 (56.4%)	<0.0001	7 (7.1%)	65 (65.7%)	<0.0001	4 (3.8%)	80 (76.9%)	<0.0001
GI diseases	2 (0.6%)	8 (2.4%)	0.06	4 (1.1%)	14 (3.9%)	0.017	2 (0.8%)	10 (4%)	0.019	1 (1.01%)	4 (4.04%)	0.17	1 (0.96%)	2 (1.92%)	0.56
Cardiac diseases	15 (4.5%)	80 (24.2%)	<0.0001	12 (3.4%)	88 (24.7%)	<0.0001	7 (2.8%)	71 (28.4%)	<0.0001	5 (5.1%)	48 (48.5%)	<0.0001	3 (2.9%)	48 (46.2%)	<0.0001

Note: Significant p-values are shown in bold.

Abbreviations: n, number; GI, gastrointestinal.

Table 10 Association Between Severity and Outcome of COVID-19 Disease and Type of Vaccine

	Variable	The Study Groups Based on the Type of Vaccine		P-value
		Patients Who Received Pfizer-BioNTech Vaccine	Patients Who Received Oxford-AstraZeneca Vaccine
Severity	Mild-Moderate	25 (17.9%)	10 (22.2%)	0.854
	Severe	38 (27.1%)	15 (33.3%)
	Critical	39 (27.9%)	19 (42.2%)
Outcome	Hospital Stay Median (IQR) (days)	8.5 (5–14.5)	7 (5–14.5)	0.582
	ICU Admission n (%)	32 (22.8%)	9 (20%)	0.36
	Mechanical ventilation n (%)	13 (9.2%)	3 (6.7%)	0.301
	Death n (%)	9 (6.4%)	4 (8.8%)	0.93

Abbreviations: IQR, interquartile range; N, number; %, percentage.

Coronavirus disease (covid-19): Vaccines. World Health Organization; 2022. Available from: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-vaccines?gclid=Cj0KCQjwmuiTBhDoARIsAPiv6L91ecmYWZ16a2_QXNynlgUKnClcrua0JQ38PywMl763wN1n85tGGAcaApfuEALw_wcB&topicsurvey=v8kj13. Accessed June 13, 2022.

 Google Scholar

Loo KY, Letchumanan V, Ser HL, et al. Covid-19: insights into potential vaccines. Microorganisms. 2021;9(3):605. doi:10.3390/microorganisms9030605

 PubMed Web of Science ®Google Scholar