Risk Factors of Symptoms Occurrence in SARS-CoV-2 Infection After Implementing Vaccination Program in Bali

Keywords: Covid-19, Covid-19 vaccines, Symptom occurrence, Risk factor

Abstract

          The real-world data have shown the effectiveness of many variants of Covid-19 vaccines. However, many people still get infected and indicate various symptoms after vaccination. This study aims to assess the risk factors of symptom occurrence in Covid-19 after implementing the vaccination program in Bali. This retrospective, case-control study used surveillance data include demographic, vaccination status, symptom occurrence, and severity from Pemecutan Kaja Village, North Denpasar district. Participants were included if they tested positive for SARS-CoV-2 with a minimum age of 18 years old. There was a total of 592 data on Covid-19 patients, the cases group was symptomatic and the control group was asymptomatic. Between May to September 2021, the vaccination program was implemented in Bali with Sinovac and Astra Zeneca. The risk factor analysis showed that age (OR 2.57, 95% CI 1.376-4.818; p = 0,003) and vaccination status (OR 3.104, 95% CI 2.089-4.611; p = < 0,001) were associated with symptom occurrence in Covid-19. Elderly and unvaccinated subjects have a higher risk of developing symptomatic SARS-CoV-2 infection. Vaccinations were not 100% effective in protecting people from infection, but almost all symptoms were reported as less frequent in vaccinated. A better understanding of the risk factor of severe infection has apparent implications for additional prevention and treatment for those with a higher risk of developing the severe condition. Adopting strategies are required to facing the probability of infection and controlling any future epidemic.

Author Biography

Ni Putu Udayana Antari, Fakultas Farmasi Universitas Mahasaraswati Denpasar

Social pharmacy

References

Al-Qazaz, H. K., Al-Obaidy, L. M., & Attash, H. M. (2022). COVID-19 Vaccination, Do Women Suffer from More Side Effects than Men? A Retrospective Cross-Sectional Study. Pharmacy Practice, 20(2), 1–6. https://doi.org/10.18549/PharmPract.2022.2.2678
Albalawi, O. M., Alomran, M. I., Alsagri, G. M., Althunian, T. A., & Alshammari, T. M. (2021). Analyzing the U.S. Post-marketing safety surveillance of COVID-19 vaccines. MedRxiv, 2021.07.10.21260304. http://medrxiv.org/content/early/2021/07/12/2021.07.10.21260304.abstract
Antonelli, M., Penfold, R. S., Merino, J., Sudre, C. H., Molteni, E., Berry, S., Canas, L. S., Graham, M. S., Klaser, K., Modat, M., Murray, B., Kerfoot, E., Chen, L., Deng, J., Österdahl, M. F., Cheetham, N. J., Drew, D. A., Nguyen, L. H., Pujol, J. C., … Steves, C. J. (2022). Risk Factors and Disease Profile of Post-Vaccination SARS-CoV-2 Infection in UK Users of the COVID Symptom Study App: a Prospective, Community-Based, Nested, Case-Control Study. The Lancet Infectious Diseases, 22(1), 43–55. https://doi.org/10.1016/s1473-3099(21)00460-6
Centers for Disease Control and Prevention. (2021a). Possibility of Covid-19 Illness after Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html
Centers for Disease Control and Prevention. (2021b). Science Brief : Covid-19 Vaccines and Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people
Chen, T., Wu, D., Chen, H., Yan, W., Yang, D., Chen, G., Ma, K., Xu, D., Yu, H., Wang, H., Wang, T., Guo, W., Chen, J., Ding, C., Zhang, X., Huang, J., Han, M., Li, S., Luo, X., … Ning, Q. (2020). Clinical Characteristics of 113 Deceased Patients with Coronavirus Disease 2019: Retrospective Study. The BMJ, 368, 12. https://doi.org/10.1136/bmj.m1091
Cucunawangsih, C., Wijaya, R. S., Lugito, N. P. H., & Suriapranata, I. (2021). Post-vaccination Cases of COVID-19 Among Healthcare workers at Siloam Teaching Hospital, Indonesia. International Journal of Infectious Diseases, 107, 268–270. https://doi.org/10.1016/j.ijid.2021.05.020
Dong, Y., Dai, T., Wei, Y., Zhang, L., Zheng, M., & Zhou, F. (2020). A Systematic Review of SARS-CoV-2 Vaccine Candidates. Signal Transduction and Targeted Therapy, 5(1), 1–14. https://doi.org/10.1038/s41392-020-00352-y
Dorman, C., Perera, A., Condon, C., Chau, C., Qian, J., Kalk, K., & DiazDeleon, D. (2021). Factors Associated with Willingness to be Vaccinated Against COVID-19 in a Large Convenience Sample. Journal of Community Health, 46(5), 1013–1019. https://doi.org/10.1007/s10900-021-00987-0
Fadila, N. R., & Holik, H. A. (2020). Review Artikel : Fenomena Panic Buying Terhadap Obat-Obatan Pada Masa Pandemi Covid-19. Farmaka, 18(1), 1–15.
Gebhard, C., Regitz-Zagrosek, V., Neuhauser, H. K., Morgan, R., & Klein, S. L. (2020). Impact of Sex and Gender on COVID-19 Outcomes in Europe. Biology of Sex Differences, 11(1), 1–13. https://doi.org/10.1186/s13293-020-00304-9
Gomes, D., Beyerlein, A., Katz, K., Hoelscher, G., Nennstiel, U., Liebl, B., Überla, K., & von Kries, R. (2021). Is the BNT162b2 COVID-19 Vaccine Effective in Elderly Populations? Results from Population Data from Bavaria, Germany. PLoS ONE, 16(11 November), 1–11. https://doi.org/10.1371/journal.pone.0259370
Guo, T., Shen, Q., Guo, W., He, W., Li, J., Zhang, Y., Wang, Y., Zhou, Z., Deng, D., Ouyang, X., Xiang, Z., Jiang, M., Liang, M., Huang, P., Peng, Z., Xiang, X., Liu, W., Luo, H., Chen, P., & Peng, H. (2020). Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study. Gerontology, 66(5), 467–475. https://doi.org/10.1159/000508734
Hamer, M., Kivimäki, M., Gale, C. R., & Batty, G. D. (2020). Lifestyle Risk Factors, Inflammatory Mechanisms, and COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK. Brain, Behavior, and Immunity, 87, 184–187. https://doi.org/10.1016/j.bbi.2020.05.059
Hanifah, L., & Siregar, K. N. (2022). COVID-19 in Indonesia: Is There a Shift from Pandemic to Endemic? National Public Health Journal, 17(1), 4–10. https://doi.org/10.21109/KESMAS.V17ISP1.6006
Harapan, H., Wagner, A. L., Yufika, A., Winardi, W., Anwar, S., Gan, A. K., Setiawan, A. M., Rajamoorthy, Y., Sofyan, H., & Mudatsir, M. (2020). Acceptance of a COVID-19 Vaccine in Southeast Asia: A Cross-Sectional Study in Indonesia. Frontiers in Public Health, 8(July), 1–8. https://doi.org/10.3389/fpubh.2020.00381
Harder, T., Külper-Schiek, W., Reda, S., Treskova-Schwarzbach, M., Koch, J., Vygen-Bonnet, S., & Wichmann, O. (2021). Effectiveness of COVID-19 Vaccines Against SARS-CoV-2 Infection with the Delta (B.1.617.2) Variant: Second Interim Results of a Living Systematic Review and Meta-analysis, 1 January to 25 August 2021. Eurosurveillance, 26(41), 1–10. https://doi.org/10.2807/1560-7917.es.2021.26.41.2100920
Jin, J. M., Bai, P., He, W., Wu, F., Liu, X. F., Han, D. M., Liu, S., & Yang, J. K. (2020). Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Frontiers in Public Health, 8(April), 1–6. https://doi.org/10.3389/fpubh.2020.00152
Kang, S. J., & Jung, S. I. (2020). Age-Related Morbidity and Mortality among Patients with COVID-19. Infection and Chemotherapy, 52(2), 154–164. https://doi.org/10.3947/ic.2020.52.2.154
Kaplan, R. M., & Milstein, A. (2021). Influence of a COVID-19 Vaccine’s Effectiveness and Safety Profile on Vaccination Acceptance. Proceedings of the National Academy of Sciences of the United States of America, 118(10), 1–5. https://doi.org/10.1073/pnas.2021726118
Kaur, A., & Malik, G. (2020). Understanding the Psychology Behind Panic Buying: A Grounded Theory Approach. Global Business Review, 1–14. https://doi.org/10.1177/0972150920973504
Khoo, E. J., & Lantos, J. D. (2020). Lessons Learned from The COVID-19 Pandemic. Acta Paediatrica, International Journal of Paediatrics, 109(7), 1323–1325. https://doi.org/10.1111/apa.15307
Kopel, J., Perisetti, A., Roghani, A., Aziz, M., Gajendran, M., & Goyal, H. (2020). Racial and Gender-Based Differences in COVID-19. Frontiers in Public Health, 8(July), 1–8. https://doi.org/10.3389/fpubh.2020.00418
Kuodi, P., Gorelik, Y., Zayyad, H., Wertheim, O., Wiegler, K. B., Jabal, K. A., Dror, A. A., Nazzal, S., Glikman, D., & Edelstein, M. (2022). Association between Vaccination Status and Reported Incidence of Post-Acute COVID-19 Symptoms in Israel: a Cross-Sectional Study of Patients Tested between March 2020 and November 2021. MedRxiv, 2022.01.05.22268800. https://doi.org/10.1101/2022.01.05.22268800%0Ahttps://www.medrxiv.org/content/10.1101/2022.01.05.22268800v2%0Ahttps://www.medrxiv.org/content/10.1101/2022.01.05.22268800v2.abstract
Lopez Bernal, J., Andrews, N., Gower, C., Gallagher, E., Simmons, R., Thelwall, S., Stowe, J., Tessier, E., Groves, N., Dabrera, G., Myers, R., Campbell, C. N. J., Amirthalingam, G., Edmunds, M., Zambon, M., Brown, K. E., Hopkins, S., Chand, M., & Ramsay, M. (2021). Effectiveness of Covid-19 Vaccines Against the B.1.617.2 (Delta) Variant. New England Journal of Medicine, 385(7), 585–594. https://doi.org/10.1056/nejmoa2108891
Luxi, N., Giovanazzi, A., Capuano, A., Crisafulli, S., Cutroneo, P. M., Fantini, M. P., Ferrajolo, C., Moretti, U., Poluzzi, E., Raschi, E., Ravaldi, C., Reno, C., Tuccori, M., Vannacci, A., Zanoni, G., Trifirò, G., Trifirò, G., Moretti, U., Luxi, N., … Montresor, V. (2021). COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety. Drug Safety, 44(12), 1247–1269. https://doi.org/10.1007/s40264-021-01131-6
Meggiolaro, A., Sane Schepisi, M., Nikolaidis, G. F., Mipatrini, D., Siddu, A., & Rezza, G. (2022). Effectiveness of Vaccination Against SARS-CoV-2 Infection in the Pre-Delta Era: A Systematic Review and Meta-Analysis. Vaccines, 10(2), 1–16. https://doi.org/10.3390/vaccines10020157
Mo, P., Xing, Y., Xiao2, Y., Deng, L., Zhao, Q., Wang, H., Xiong, Y., Cheng, Z., Gao, S., Liang, K., Luo, M., Chen, T., Song, S., Ma, Z., Chen, X., Zheng, R., Cao, Q., Wang, F. W., & Zhang, Y. (2020). Clinical Characteristics of Refractory COVID-19 Pneumonia in Wuhan, China. Oxford University Press for the Infectious Diseases Society of America, 23. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L631270047%0Ahttp://dx.doi.org/10.1093/cid/ciaa270
Olson, S. M., Newhams, M. M., Halasa, N. B., Price, A. M., Boom, J. A., Sahni, L. C., Irby, K., Walker, T. C., Schwartz, S. P., Pannaraj, P. S., Maddux, A. B., Bradford, T. T., Nofziger, R. A., Boutselis, B. J., Cullimore, M. L., Mack, E. H., Schuster, J. E., Gertz, S. J., Cvijanovich, N. Z., … Oates, J. N. (2021). Effectiveness of Pfizer-BioNTech mRNA Vaccination Against COVID-19 Hospitalization Among Persons Aged 12–18 Years — United States, June–September 2021. MMWR. Morbidity and Mortality Weekly Report, 70(42), 1483–1488. https://doi.org/10.15585/mmwr.mm7042e1
Ophinni, Y., Hasibuan, A. S., Widhani, A., Maria, S., Koesnoe, S., Yunihastuti, E., Karjadi, T. H., Rengganis, I., & Djauzi, S. (2020). COVID-19 Vaccines: Current Status and Implication for Use in Indonesia. Acta Medica Indonesiana, 52(4), 388–412.
Pemerintah Provinsi Bali. (2021). Perkembangan Kasus Covid-19, 31 Juli 2021. Baliprov. https://infocorona.baliprov.go.id/2021/07/31/update-penanggulangan-covid-19-sabtu-31-juli-2021/
Perrotta, F., Corbi, G., Mazzeo, G., Boccia, M., Aronne, L., D’Agnano, V., Komici, K., Mazzarella, G., Parrella, R., & Bianco, A. (2020). COVID-19 and The Elderly: Insights Into Pathogenesis and Clinical DecisionMaking. Aging Clinical and Experimental Research, 32(8), 1599–1608. https://doi.org/10.1007/s40520-020-01631-y
Rahman, A., & Sathi, N. J. (2021). Risk Factors of The Severity of COVID-19: A Meta-analysis. International Journal of Clinical Practice, 75(7), 18. https://doi.org/10.1111/ijcp.13916
Ranzani, O. T., Hitchings, M. D. T., Dorion, M., D’Agostini, T. L., De Paula, R. C., De Paula, O. F. P., Villela, E. F. D. M., Torres, M. S. S., De Oliveira, S. B., Schulz, W., Almiron, M., Said, R., De Oliveira, R. Di., Vieira Da Silva, P., De Araújo, W. N., Gorinchteyn, J. C., Andrews, J. R., Cummings, D. A. T., Ko, A. I., & Croda, J. (2021). Effectiveness of the CoronaVac Vaccine in Older Adults During a Gamma Variant Associated Epidemic of Covid-19 in Brazil: Test Negative Case-Control Study. The BMJ, 374. https://doi.org/10.1136/bmj.n2015
Scobie, H. M., Johnson, A. G., Suthar, A. B., Severson, R., Alden, N. B., & Balter, S. (2021). Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status. Cdc Mmwr, 70(37), 1284–1290.
Shoaib, N., Noureen, N., Munir, R., Shah, F. A., Ishtiaq, N., Jamil, N., Batool, R., Khalid, M., Khan, I., Iqbal, N., & Zaidi, N. (2021). COVID-19 Severity: Studying the Clinical and Demographic Risk Factors for Adverse Outcomes. PLoS ONE, 16(8 August), 1–10. https://doi.org/10.1371/journal.pone.0255999
Toshkov, D. (2022). Explaining the Gender Gap in COVID-19 Vaccination Attitudes. 2022(February), 26.
WHO. (2020a). Coronavirus Disease 2019 (COVID-19) World Health Situation Report - 1. In WHO Indonesia Situation Report (Issue March). who.int/indonesia
WHO. (2020b). COVID-19 Vaccine Acceptance Survey in Indonesia. In World Health Organization (Vol. 1, Issue November).
WHO. (2021). Indonesia Situation. https://covid19.who.int/region/searo/country/id
Wingert, A., Pillay, J., Gates, M., Guitard, S., Rahman, S., Beck, A., Vandermeer, B., & Hartling, L. (2021). Risk Factors for Severity of COVID-19: A Rapid Review to Inform Vaccine Prioritisation in Canada. BMJ Open, 11(5), 1–13. https://doi.org/10.1136/bmjopen-2020-044684
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan, China: a Retrospective Cohort Study. The Lancet, 395(10229), 1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Published
2025-01-09
How to Cite
Mendra, N. N. Y., Sarjana, D. G. J., Suena, N. M. D. S., & Antari, N. P. U. (2025). Risk Factors of Symptoms Occurrence in SARS-CoV-2 Infection After Implementing Vaccination Program in Bali . Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.7108
Section
Research Article

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