COVID-19 vaccination does not worsen symptoms in ‘long-haulers’

Patients in a small case series who had prolonged symptoms of COVID-19 did not experience a decrease in quality of life or worsened symptoms after receiving one dose of the COVID-19 vaccine, according to researchers.

“Because the immunologic basis for [prolonged symptoms after acute SARS-CoV-2 infection] is unknown, uncertainty exists about whether vaccination against SARS-CoV-2 might worsen the associated symptoms,” David T. Arnold, MBChB, BSc, a National Institute for Health Research doctoral research fellow at the University of Bristol in the U.K., and colleagues wrote in Annals of Internal Medicine. “Anecdotal reports have suggested both a potential benefit and worsening of symptoms after vaccination, with the uncertainty leading to vaccine hesitancy among some affected persons.”

Arnold and colleagues prospectively enrolled 163 patients to a single-center observational study. The researchers administered the Short Form-36 Health Survey and the Warwick-Edinburgh Mental Wellbeing Scale as well as performed a standardized review on patients’ ongoing symptoms every 12 weeks. The researchers then identified patients who had symptoms at 8 months and received either the Pfizer-BioNTech or Oxford-AstraZeneca vaccine, and followed up with these patients a median of 1 month after vaccination.

At 8 months, the participants “had a high burden of persistent symptoms.” Among the 159 symptoms reported by participants, the most common were fatigue (75%), breathlessness (61%) and insomnia (53%).

Among 44 participants who had received one dose of the vaccine, 82% (median age, 64 years; 58% men; 86% white) reported at least one persistent symptom. One month after vaccination, 23.2% of symptoms had improved, 5.6% had worsened and 71.1% were unchanged.

The researchers wrote that there were no statistically significant differences in quality-of-life measures before vs. after vaccination.

Although the researchers noted the small sample size was a limitation, they also wrote that “these observations may provide reassurance to the increasing number of persons experiencing long-term symptoms after acute SARS-CoV-2 infection that receipt of a messenger RNA or adenoviral vector vaccine is not associated with a decrease in quality of life or worsening of symptoms.”