Safety comparison of mRNA, viral vector, and inactivated Covid-19 vaccines: incidence of adverse events following primary and booster doses among medical professionals in Malaysia

Abstract

Background: This study aimed to examine adverse events following first, second, and booster doses of Covid-19 vaccines in Malaysia.

Methods: This was a prospective longitudinal cohort study conducted between September 2021 to September 2022. Recipients who received different Covid-19 vaccines (Comirnaty, Vaxzevria, and CoronaVac) completed a self-report questionnaire of adverse events on days 1, 2, 4, and 7 following their primary (first and second) and booster (third) vaccinations.

Results: A total of 1283 respondents had completed the questionnaire survey. The most frequent adverse events among Comirnaty recipients (n = 271) following the first dose were pain (87.4%), fatigue (56.9%), myalgia (37.2%), and fever (17.5%), which further increased to 92.1%, 72.8%, 51·2%, and 48%, respectively, following the booster. The most frequent adverse events following the first dose of Vaxzevria (n = 90) were pain (84.4%), fever (76.7%), headache (58.9%) and myalgia (53.3%). Adverse events were reduced after the second dose of Vaxzevria but sharply increased after the booster. The most common adverse events among CoronaVac recipients (1st dose) were pain at the injection site (69.1%), fatigue (49.1%) and increased hunger (34.5%). However, adverse events subsequently decreased after the second and booster doses. The average number of adverse events was highest for Vaxzevria after the first dose (n = 6) and booster dose (n = 6) and lowest for CoronaVac after the first (n = 3), second (n = 2) and booster doses (n = 2).

Conclusion: The incidence of adverse events following the first dose of the Covid-19 vaccine was highest among Vaxzevria recipients. Adverse events following Comirnaty vaccine increased gradually from primary to booster dose, whereas recipients with CoronaVac showed subsequent lesser adverse events following primary and booster doses.

Keywords: Adverse events; Booster dose; Comparative study; Covid-19 vaccines; Inactivated viral vaccine; Vaccine safety; Viral vectored vaccine; mRNA vaccine.

Fig. 1

A strobe flowchart of study planning and selection of subject. 7937 (75.94%) individuals had not responded the questionnaire. Only 2042 (19.54%) individuals had completed the questionnaire. Out of 18 severe adverse events, Chest pain and cardiac complications were the most commonly reported adverse events followed by anaphylactic shock, respiratory distress and kidney failure. Of the 41 recipients, 11, 5, 2, 7, 1, 6, and 9 had rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, psoriasis, Crohn’s disease, multiple sclerosis, and inflammatory bowel disease, respectively. In addition, 8, 3, and 2 recipients were eliminated due to significant clinical conditions such as cancer, liver cirrhosis, and chronic kidney failure (CKD). Ultimately, 1283 individuals had successfully finished the questionnaires for doses 1, 2, and 3 (booster) of various COVID vaccines on days 1, 4, and 7

Fig. 2

Short-term adverse events following Covid-19 vaccination: Panels A, B, and C represent the prevalence of self-reported adverse events associated with the Comirnaty, Vaxzevria, and CoronaVac vaccines following the first, second and third (booster) doses, respectively

Fig. 3

Duration of adverse events associated with Covid-19 vaccines. Figure 3A: Duration of adverse events following booster administration of the CoronaVac vaccine. Figure 3B and 3C show the duration of adverse events following the 2nd and 3rd doses of Comirnaty. vaccine. Figure 3D and 3E shows the duration of adverse events following the 2nd and 3rd doses of the Vaxzevria vaccine