Available online on 15.03.2024 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2024 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                                                                         Research Article

Relationship between antibody titer than the Incidence of Infection After Complete Dose of COVID-19 Astrazeneca Vaccination Based on Sociodemographics

Stefanus Lukas ^1,2*, Diana Laila Ramatillah ², Yufri Aldi ¹, Fatma Sri Wahyuni ¹

¹ Faculty of Pharmacy, Universitas Andalas, Padang, Indonesia.

² Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, Indonesia

Background: Vaccine is an essential tool to limit the health of the COVID -19 pandemic and one of the vaccines that got permitted to used is AstraZeneca Vaccine. The base of the AstraZeneca is the viral vector vaccine. This vaccine has a more advanced method that uses a modified virus to trigger antibodies to make herd immunity for people. 

Objective: To found correlation between antibody titer than the incidence of Covid infection after complete dose vaccination base on sociodemographics 

Method: Observasional prospective Cohort method was use in this study with a convenience sampling design. Inclusion criteria were all Indonesian citizens above 18 years old (n=113) who were vaccinated at UTA 45 Jakarta Vaccine Center with no history of COVID -19 before the vaccination and had filled up the informed consents. 

Results: there were 43 (38%) respondents infected Covid-19 after vaccinated full doses

Conclusion: Base on this study, it was found that there was a correlation between sociodemographics after vaccinated full doses AstraZeneca, gender, age, comorbid, smoking, and drinking than infected Covid -19 (P-value < 0.05)).

Keywords: Astrazeneca vaccine, Antibody titer, COVID-19.

Introduction

The COVID-19 virus has spread in various countries, including Indonesia. On March 2^nd 2022 President Joko Widodo reported two confirmed cases of COVID-19 infection for the first time in Indonesia. Knowledge as of April 2 reached 1,790 confirmed cases, 113 new cases, 170 deaths and 112 recoveries ^1,2. The pandemic caused by the new coronavirus, SARS-CoV-2, has become one of the public health problems in human history. One effort to suppress the Covid-19 pandemic is by administering mass vaccines to all elements of society ³. By administering the AstraZeneca vaccine, it is hoped that the body's immune system will immediately increase so that antibodies will appear. The main aim of Covid-19 vaccination is to create herd immunity so that people become more productive in carrying out their daily activities ⁴.

Covid-19 vaccination is an important part of efforts to handle the Covid-19 pandemic in a comprehensive and integrated manner, including preventive aspects, with the hope of building community immunity. The main objective of this research is to prove that administration of the AstraZeneca Covid-19 vaccine affects antibody titer values. These vaccines may vary in terms of side effects, immunogenicity, efficacy and duration of protection ⁵. 

One of the things that can trigger the formation of antibodies and give rise to active immunity in preventing disease is vaccination, namely biological treatment that contains antigens ^6,7. Vaccination aims to prevent transmission of the virus from an infected host to the recipient ⁸. Vaccination creates an immune system in the body so that it can prevent or reduce the possibility of pathogen infection occurring in the future ⁹. There are 2 categories of the antibody titer values: the low antibody (< 110 U/mL) and high antibody (> 110 U/mL) ¹⁰.

AstraZeneca is one of the COVID-19 vaccines, developed at the University of Oxford which consists of a replication-deficient adenoviral vector containing the SARS-CoV-2 structural glycoprotein antigen gene ¹¹. According to the research that held on England and Brazil AstraZeneca vaccine or ChAdOx1nCoV-19 (AZD1222) had proven 70.4% of the society (18-55 years old) that got AstraZeneca vaccine more than 14 days had mild symptoms ^11,12.

Material and Methods

This study used a prospective cohort observational method with a convenience sampling design. The inclusion criteria were all Indonesian citizens aged over 18 years (n=113) who had been vaccinated at the UTA 45 Jakarta Vaccine Center, had no history of COVID-19 before vaccination and had fulfilled the informed consent.

Results

Table 1: Antibodies Titer After Vaccination with Respondents Infected with Covid-19 after a Complete Dose of Vaccination.

Fisher exact

Table 2: Correlation between Sociodemographics and Clinical Outcome of the Respondents which Infected by Covid-19

According to Table 1, the results show 5 of 6 respondents who had a lower antibody titer were exposed by the covid-19 virus. But Respondents who had higher antibody titer only had 35.514% chance to expose by covid-19 virus.

From Table 2, male respondents tend had a higher exposure of the covid-19 virus the female respondents. More 44% male respondents had infected by covid-19 virus. A higher percentage of the covid-19 infection had found on participants with age between 35-45 years old (66.7%).

The respondent who has comorbidity had a higher chance to expose covid-19 virus. There were 31 respondents (58.5%) with comorbidities had exposure to Covid-19, but only 12 of 60 respondents (20.0%) who were exposed to Covid-19 with no comorbidities. Either participant which had a habit of smoking and drinking alcohol tend to higher percentage exposed by Covid-19. 

Discussion

This research was carried out for 2 years, during the research process it was discovered that there were vaccination participants at UTA'45 Jakarta. It was found that there was a relationship between vaccine participants who were exposed to Covid-19 after the second vaccination and the second antibody in the vaccination participants. This is comparable to research in 2021 which said there was a strong relationship between antibody titer values and vaccine efficacy ¹³. Previously infected participants resulted in high positive and quantitative levels of antibodies, anti-spike IgG ¹⁴.

Viral serology testing is an effective diagnostic method to determine the presence/absence of SARS-CoV-2 infection. Where the presence of SARS-CoV-2 infection is indicated by the positive rate and variance in IgG titers which are higher than IgM in Covid-19 patients ^15,16.

Most people with mild to moderate Covid-19 infections have a strong immunoglobulin G antibody response to the viral spike. The antibody titer and anti-spike binding titer were relatively stable for at least a period of about 4 months and there was a significant correlation between antibody titer and neutralizing serum levels (nAbs) ^17,18. The level of neutralization could predict immune protection and provide immune protection against Covid-19, this titer is relatively stable for 12.5 months after infection ^19,20. Another study found that SARS-CoV 2 antibody titer values persisted for up to 1 year after initial seropositivity, indicating the existence of long-term natural immunity ²¹.

In this study, it was found that there was a significant relationship between sociodemographics such as comorbidities, smoking and drinking alcohol and vaccine exposure among participants. Vaccination participants who have comorbidities will be more easily exposed to Covid-19 by 58% and may even be at risk of the disease becoming more severe and causing death ²². In addition, the genetic diversity of the person who inherits it influences the immunological response ²³.

According to the table 2, male respondents had a higher percentage to be infected by covid-19 virus then female respondents. Most of the males according to the several journals tend to habit of smoking and drinking alcohol ^24–29, and this has been found correlated in this journal. Most of the respondents that had habit of smoking dan drinking alcohol tend to be infected by covid-19.

Smoking habits can reduce the number of lymphocytes and platelets, so that immunity can be reduced ³⁰. Apart from that, smoking habits can also increase gene expression for C-reactive protein, lipopolysaccharide and lipoteichoic acid which will explain the increase in IFNγ, IL-1β, IL-6, and TNFα ³¹. As a result of increased, people who have the habit of smoking and drinking alcohol have a lower recovery rate than people who do not smoke and drink alcohol ^30,31. According to another journal vaccination participants who have a smoking habit have a higher risk of contracting the Covid-19 virus and have a worse prognosis for the Covid-19 virus and its accompanying diseases ^32,33.

The relationship between bacterial and viral infections and alcohol use is caused by the following pathophysiological mechanisms, namely: reducing the number of T lymphocytes, preventing proliferation, increasing inflammatory cytokines such as TNF-α and interleukins (IL-1, IL-6), reducing the number of NK cells (Natural killer) which is responsible for removing infected cells, and disrupting the function of macrophages in lung alveolar cells. Another factor is also caused by malnutrition due to excess alcohol consumption which can damage the digestive tract, causing a decrease in the absorption and metabolism of vitamins such as Vitamin B (B1, B6, B9, folic acid) which slows leukocyte proliferation. Defense mechanisms in the mucosal immune system also cause dysfunction of IgA and IgG ^34,35.

Comorbidity had been shown a significant correlation with the covid-19 infection. Respondent with comorbidity had a higher risk of covid-19 infection. A higher ACE-2 expression had been found in the person who had comorbidity and higher age ³⁶. ACE-2 is a receptor of the binding side to covid-19 virus ^36–38.

Conclusions

There were several factors that impact on efficacy of the vaccine. Most of them are gender, age, comorbidity, smoking and drinking alcohol habits. Comorbidity, smoking and drinking alcohol had higher impact on production of the antibody titer. 

Acknowledgments

Authors would like to acknowledge all the responder and team that helped the process of this research

Conflicts of Interest

The authors declare no conflict of interest

 References

1. Djalante R, Lassa J, Setiamarga D, Sudjatma A, Indrawan M, Haryanto B, et al. Review and analysis of current responses to COVID-19 in Indonesia: Period of January to March 2020. Progress in Disaster Science. 2020 Apr;6:100091. https://doi.org/10.1016/j.pdisas.2020.100091 PMid:34171011 PMCid:PMC7149002

2. Michael, Ramatillah DL. TREATMENT PROFILE AND SURVIVAL ANALYSIS ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) COVID-19 PATIENTS. International Journal of Applied Pharmaceutics. 2022 Apr 1;54-6. https://doi.org/10.22159/ijap.2022.v14s2.44750

3. Araminda GN, Ramatillah DL. Evaluation Comparison Between Astrazeneca and Moderna Vaccine's Side Effects and Efficacy Among Indonesia Society Based On Sociodemography. International Journal of Applied Pharmaceutics. 2022 Apr 1;37-43. https://doi.org/10.22159/ijap.2022.v14s2.44747

4. Kementrian Kesehatan Republik Indonesia. Masyarakat Indonesia Sambut Baik Vaksinasi Covid-19 [Internet]. 2021 [cited 2023 Dec 20]. Available from: https://promkes.kemkes.go.id/masyarakat-indonesia-sambut-baik-vaksinasi-covid-19.

5. Alharbi NK, Al-Tawfiq JA, Alwehaibe A, Alenazi MW, Almasoud A, Algaisi A, et al. Persistence of Anti-SARS-CoV-2 Spike IgG Antibodies Following COVID-19 Vaccines. Infect Drug Resist. 2022;15:4127-36. https://doi.org/10.2147/IDR.S362848 PMid:35937784 PMCid:PMC9348632

6. Tanriover MD, Doğanay HL, Akova M, Güner HR, Azap A, Akhan S, et al. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey. The Lancet. 2021 Jul;398(10296):213-22.

7. Kezia V, Ramatillah DL. Intensive Monitroing of Sinovac Vaccine For Safety And Efficacy Among Indonesian Population. International Journal of Applied Pharmaceutics. 2022 Apr 1;44-8. https://doi.org/10.22159/ijap.2022.v14s2.44748

8. Raghotham S, Balamuralidhara V, Karuna K. Registration Requirement and Approval Procedure of Vaccines in Saudi Arabia. Res J Pharm Technol. 2019;12(9):4531. https://doi.org/10.5958/0974-360X.2019.00780.7

9. Sette A, Crotty S. Immunological memory to <scp>SARS‐CoV</scp> ‐2 infection and <scp>COVID</scp> ‐19 vaccines. Immunol Rev. 2022 Sep 22;310(1):27-46. https://doi.org/10.1111/imr.13089 PMid:35733376 PMCid:PMC9349657

10. Lukas S, Laila Ramatillah D, Aldi Y, Sri Wahyuni F. The Impact of Body Mass Index on the Antibody Titer after Astra Zeneca Vaccination at UTA'45 Vaccine Center. Res J Pharm Technol. 2023 Jun 26;2689-93. https://doi.org/10.52711/0974-360X.2023.00441

11. Knoll MD, Wonodi C. Oxford-AstraZeneca COVID-19 vaccine efficacy. The Lancet. 2021 Jan;397(10269):72-4. https://doi.org/10.1016/S0140-6736(20)32623-4 PMid:33306990

12. World Health Organization. Interim recommendations for the use of the inactivated COVID-19 vaccine, CoronaVac, developed by Sinovac [Internet]. 2021 [cited 2023 Oct 8]. Available from: https://www.who.int/indonesia/news/novel-coronavirus.

13. Earle KA, Ambrosino DM, Fiore-Gartland A, Goldblatt D, Gilbert PB, Siber GR, et al. Evidence for antibody as a protective correlate for COVID-19 vaccines. Vaccine. 2021 Jul;39(32):4423-8. https://doi.org/10.1016/j.vaccine.2021.05.063 PMid:34210573 PMCid:PMC8142841

14. Aho Glele LS, Simon E, Bouit C, Serrand M, Filipuzzi L, Astruc K, et al. Association between SARS-Cov-2 infection during pregnancy and adverse pregnancy outcomes: A re-analysis of the data reported by Wei et al. (2021). Infect Dis Now. 2022 May;52(3):123-8. https://doi.org/10.1016/j.idnow.2022.02.009 PMid:35182802 PMCid:PMC8847095

15. Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses. 2020 Mar 27;12(4):372. https://doi.org/10.3390/v12040372 PMid:32230900 PMCid:PMC7232198

16. Jin Z, Du X, Xu Y, Deng Y, Liu M, Zhao Y, et al. Structure of Mpro from SARS-CoV-2 and discovery of its inhibitors. Nature. 2020 Jun 11;582(7811):289-93. https://doi.org/10.1038/s41586-020-2223-y PMid:32272481

17. Gudbjartsson DF, Norddahl GL, Melsted P, Gunnarsdottir K, Holm H, Eythorsson E, et al. Humoral Immune Response to SARS-CoV-2 in Iceland. New England Journal of Medicine. 2020 Oct 29;383(18):1724-34. https://doi.org/10.1056/NEJMoa2026116 PMid:32871063 PMCid:PMC7494247

18. Burton DR. Antiviral neutralizing antibodies: from in vitro to in vivo activity. Nat Rev Immunol. 2023 Nov 17;23(11):720-34. https://doi.org/10.1038/s41577-023-00858-w PMid:37069260 PMCid:PMC10108814

19. Khoury DS, Cromer D, Reynaldi A, Schlub TE, Wheatley AK, Juno JA, et al. Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection. Nat Med. 2021 Jul 17;27(7):1205-11. https://doi.org/10.1038/s41591-021-01377-8 PMid:34002089

20. Dobaño C, Ramírez-Morros A, Alonso S, Vidal-Alaball J, Ruiz-Olalla G, Vidal M, et al. Persistence and baseline determinants of seropositivity and reinfection rates in health care workers up to 12.5 months after COVID-19. BMC Med. 2021 Dec 28;19(1):155. https://doi.org/10.1186/s12916-021-02032-2 PMid:34183003 PMCid:PMC8237770

21. Franco-Luiz APM, Fernandes NMGS, Silva TB de S, Bernardes WP de OS, Westin MR, Santos TG, et al. Longitudinal study of humoral immunity against SARS-CoV-2 of health professionals in Brazil: the impact of booster dose and reinfection on antibody dynamics. Front Immunol. 2023 Jul 14;14. https://doi.org/10.3389/fimmu.2023.1220600 PMid:37520570 PMCid:PMC10376701

22. World Health Organization. Introduction to Vaccine Safety, AEFI Classification 2021. Available from: https://in.vaccine-safety-training.org/adverse-events-classification.html .

23. Kleebayoon A, Wiwanitkit V. Adverse effects and antibody responses following homologous and heterologous COVID19 prime-boost vaccinations. Journal of the Formosan Medical Association. 2023 May;122(5):432-3. https://doi.org/10.1016/j.jfma.2022.12.018 PMid:36610888 PMCid:PMC9800810

24. Garwahusada E, Wirjatmadi B. Correlation of Sex, Smoking Habit, Physical Activity and Hypertension among Office Employee. Media Gizi Indonesia. 2020 Jan 2;15(1):60-5. https://doi.org/10.20473/mgi.v15i1.60-65

25. Putri RN. HUBUNGAN STATUS MEROKOK, KONSUMSI ALKOHOL, DAN JENIS KELAMIN DENGAN OBESITAS SENTRAL PADA REMAJA USIA 15-18 TAHUN (ANALISIS RISKESDAS 2018). [Semarang]: Universitas Diponegoro. 2021. Available from: https://eprints2.undip.ac.id/id/eprint/4965/ 

26. Syahrir M, Sabilu Y, Salma WO. HUBUNGAN MEROKOK DAN KONSUMSI ALKOHOL DENGAN KEJADIAN PENYAKIT HIPERTENSI PADA MASYARAKAT WILAYAH PESISIR. Jurnal Ilmiah Ilmu Keperawatan. 2021;12(3).

27. Yue Y, Hong L, Guo L, Gao X, Deng J, Huang J, et al. Gender differences in the association between cigarette smoking, alcohol consumption and depressive symptoms: a cross-sectional study among Chinese adolescents. Sci Rep. 2015 Dec 7;5(1):17959. https://doi.org/10.1038/srep17959 PMid:26639938 PMCid:PMC4671152

28. Cui Y, Zhu Q, Lou C, Gao E, Cheng Y, Zabin LS, et al. Gender differences in cigarette smoking and alcohol drinking among adolescents and young adults in Hanoi, Shanghai, and Taipei. Journal of International Medical Research. 2018 Dec 15;46(12):5257-68. https://doi.org/10.1177/0300060518807292 PMid:30442048 PMCid:PMC6300939

29. Lukas S, Ramatillah DL, Aldi Y, Wahyuni FS, Gloria F, Michael, et al. Hubungan Sosiodemografi dengan Hasil Klinis Pasien Covid-19 di RSUD Bengkulu. JFIOnline | Print ISSN 1412-1107 | e-ISSN 2355-696X. 2022 Jan 31;14(1):25-31. https://doi.org/10.35617/jfionline.v14i1.59

30. Dai M, Tao L, Chen Z, Tian Z, Guo X, Allen-Gipson DS, et al. Influence of Cigarettes and Alcohol on the Severity and Death of COVID-19: A Multicenter Retrospective Study in Wuhan, China. Front Physiol. 2020 Dec 9;11. https://doi.org/10.3389/fphys.2020.588553 PMid:33362576 PMCid:PMC7756110

31. Gaydos J, McNally A, Guo R, Vandivier RW, Simonian PL, Burnham EL. Alcohol abuse and smoking alter inflammatory mediator production by pulmonary and systemic immune cells. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2016 Mar 15;310(6):L507-18. https://doi.org/10.1152/ajplung.00242.2015 PMid:26747782 PMCid:PMC4796259

32. Haddad C, Bou Malhab S, Sacre H, Salameh P. Smoking and COVID-19: A Scoping Review. Tob Use Insights. 2021 Jan 15;14:1179173X2199461. https://doi.org/10.1177/1179173X21994612 PMid:33642886 PMCid:PMC7890709

33. Uysal EB, Gümüş S, Bektöre B, Bozkurt H, Gözalan A. Evaluation of antibody response after COVID‐19 vaccination of healthcare workers. J Med Virol. 2022 Mar;94(3):1060-6. https://doi.org/10.1002/jmv.27420 Mid:34704620 PMCid:PMC8661654

34. Sari IP, Sriwidodo S. Perkembangan Teknologi Terkini dalam Mempercepat Produksi Vaksin COVID-19. Majalah Farmasetika. 2020 Aug 24;5(5):204. https://doi.org/10.24198/mfarmasetika.v5i5.28082

35. ARNANDA N, RAMATILLAH DL. SYSTEMATIC REVIEW: EVALUATION OF CYTOKINE STORM TREATMENT FROM COVID 19 PATIENT BASE ON CLINICAL TRIAL. International Journal of Applied Pharmaceutics. 2022 Apr 1;5-9. https://doi.org/10.22159/ijap.2022.v14s2.44739

36. Rodrigues R, Costa de Oliveira S. The Impact of Angiotensin-Converting Enzyme 2 (ACE2) Expression Levels in Patients with Comorbidities on COVID-19 Severity: A Comprehensive Review. Microorganisms. 2021 Aug 9;9(8):1692. https://doi.org/10.3390/microorganisms9081692 PMid:34442770 PMCid:PMC8398209

37. Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. European Journal of Clinical Microbiology & Infectious Diseases. 2021 May 3;40(5):905-19. https://doi.org/10.1007/s10096-020-04138-6 PMid:33389262 PMCid:PMC7778857

38. Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020 Dec 13;24(1):422. https://doi.org/10.1186/s13054-020-03120-0 PMid:32660650 PMCid:PMC7356137