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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 4
| Issue : 1 | Page : 3-6 |
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An assessment of COVID-19 infection after vaccination amongst health-care workers at a tertiary care centre, Kodagu, Karnataka
BC Narasimha1, Sharvanan Eshwar Udayar1, N Sabari Raja2, Ashwini Madeshan1, Jissun Katoch3
1 Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Kodagu, Karnataka, India
2 Department of Community Medicine, Government Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India
3 House Surgeon, Kodagu Institute of Medical Sciences, Government of Karnataka, Kodagu, Karnataka, India
| Date of Submission | 26-May-2022 |
| Date of Decision | 28-Jun-2022 |
| Date of Acceptance | 29-Jun-2022 |
| Date of Web Publication | 29-Sep-2022 |
Correspondence Address:
Dr. Ashwini Madeshan
Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Kodagu, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_61_22
Background: The equitable COVID-19 vaccination is an effective tool to end the pandemic globally. Many studies have reported, namely, in the western population, vaccination protected against the severe form of COVID-19 infection. Aims and Patients: To estimate the prevalence of COVID-19 infection amongst health-care professional's post vaccination at a Tertiary Care Centre in Kodagu, Karnataka. Methods: A cross-sectional study was conducted amongst 336 health-care workers in a Tertiary Care Centre Kodagu from November 2021 to January 2022. A convenient sampling technique was used to collect the data using a semi structured questionnaire. Data were entered into Excel and analysed using Epi-info version 7.2. Results: Of 336 study participants, females were 195 (58.04%), and males were 141 (41.96%). The mean (standard deviation) age of the participants was 25.80 (4.67) years. The total prevalence of infection was 83 (24.4%); after the first dose of the vaccine was 22 (6.52%), and after the second dose was 61 (21.73%). The total number of hospital admissions after the first and second dose was 1 and 9, respectively. None of them required intensive care in the hospital. Conclusions: The COVID-19 infection reported after vaccination amongst health care workers was minimal. None of them required intensive care in the hospital.
Keywords: COVID-19 vaccine, COVID-19, health-care worker
How to cite this article:
Narasimha B C, Udayar SE, Raja N S, Madeshan A, Katoch J. An assessment of COVID-19 infection after vaccination amongst health-care workers at a tertiary care centre, Kodagu, Karnataka. J Med Evid 2023;4:3-6 |
How to cite this URL:
Narasimha B C, Udayar SE, Raja N S, Madeshan A, Katoch J. An assessment of COVID-19 infection after vaccination amongst health-care workers at a tertiary care centre, Kodagu, Karnataka. J Med Evid [serial online] 2023 [cited 2023 Jun 3];4:3-6. Available from: http://www.journaljme.org/text.asp?2023/4/1/3/357539 |
| Introduction | |  |
Coronavirus disease 19 (COVID-19) is a highly contagious viral pneumonia caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The first case emerged in December 2019 in Wuhan, China.[1] On 30 January, 2020, following the recommendations of the Emergency Committee, the WHO Director General declared the COVID-19 outbreak as a Public Health Emergency of International Concern.[2] As of 11 May, 2022, more than 50 million confirmed cases have been reported worldwide.[1]
Wearing a mask and social distancing would help to reduce the chances of being exposed to the virus or spreading it to others but these measures alone are not enough. The equitable COVID-19 vaccination is an effective tool to end the pandemic globally.[3] The importance of mass vaccination has been stressed by the government all over the world and is the only long-term solution to the COVID-19 crisis in India.[4]
The Government of India initiated one of the large vaccination campaigns against COVID-19 on 16 January 2021, with 300 million priority beneficiaries; including health-care personnel, frontline workers and those over the age of 50 years,[5] and in India, more than 86.66% of the eligible population (12+) are fully vaccinated as of 13 May 2022.[6]
Health-care workers (HCWs) are at high risk of getting infected and re-infected by COVID-19 as they can contract the virus while taking care of patients in the hospital or even at home.[7]
They have a higher chance of reinfection even after the prescribed two doses of vaccination.[8] Studies conducted in Indonesia showed that among 1040 health-care workers, 13 (1.25%) tested positive for reverse transcription–polymerase chain reaction after the second vaccination dose.[9] A study conducted on HCW in California revealed a 1.19% chance of infection after the administration of two doses.[10] Even though the efficacies of COVID-19 vaccines vary with new variants, these vaccines protect against new variants and reduce the severity of infection when compared to unvaccinated individuals.[3],[11] Therefore, vaccination against COVID-19 can remove threats posed by severe infection and mortality caused by a rapid mutation in its variants.
Hence, this study was undertaken in the Indian population to give evidential support so that we can decrease the vaccine hesitancy amongst the target population by increasing vaccine uptake. Furthermore, mortality from severe COVID-19 can be prevented. The objective of the study is to estimate the prevalence of COVID-19 infection amongst HCWs at the Tertiary Care Centre, Kodagu.
| Materials and Methods | | |
A facility-based cross-sectional study was undertaken in a Government Tertiary Care Centre in Kodagu District, Karnataka, from November 2021 to February 2022. The HCWs who had taken at least one dose of vaccine were included in the study. A convenient sampling technique was used in the study, and data were gathered from 336 HCWs through personal interviews; using a pre-tested and semi-structured questionnaire. The questionnaire consisted of demographic details, vaccination details and COVID-19 infection details. The Institutional Ethical Committee Approval was obtained for the Study (Ref no: KoIMS/IEC/13/2021-22, dated 30 July 2021).
Inclusion criteria
The HCWs who had completed 14 days after the first or second dose of vaccination.
Exclusion criteria
The unvaccinated HCWs and those who were unwilling to participate in the study.
The data were entered into a Microsoft excel sheet and analysed using Microsoft Excel sheet and Epi Info ver7.2, Centre for Disease Control and Prevention, Atlanta, Georgia, United States. The data were analysed using descriptive statistics and presented in tables and graphs.
| Results | | |
Out of 336 study participants, females were 195 (58.04%) and males were 141 (41.96%). The mean (standard deviation) age of the participants was 25.80 (4.67) years. About 275 (81.84%) of HCWs had taken two doses of the COVID-19 vaccine. Among vaccinated HCWs, 289 (86%) had taken Covishield, and 47 (14%) had taken the Covaxin vaccine [Table 1]. | Table 1: Distribution of study participants based on the type of vaccine and number of doses (n=336)
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All the HCWs 336 (100%) from different categories in our study had received their first dose of the COVID-19 vaccine, but the second dose was completed by only clerks and Group D [Table 2]. About 45 participants had not taken the vaccine despite the due date. The reasons for the partial vaccination reported were due to fear of side effects (18), followed by doubtful vaccine efficacy (13), fear of reinfection from vaccination (12) and previous COVID-19 infection (2). | Table 2: Distribution of study participants based on designation and coronavirus disease 19 vaccination status (n=336)
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The proportion of COVID-19 infection after vaccination was 24.70%. Out of 360 HCWs, 83 (24.4%) had developed COVID-19 infection after completing their vaccination (two doses). Out of 83 participants who developed COVID-19 infection, 22 (6.52%) developed it after receiving the first dose and 61 (21.73%) after receiving the second dose.
The HCWs who had developed a COVID-19 infection after the first dose of vaccination had co-morbidities and risk factors such as diabetes (1), alcohol consumption (2) and after the second dose of vaccination, participants who developed COVID-19 had obesity (2), diabetes (1), kidney disease (1) and allergic rhinitis (1). However, the participants who did not develop COVID-19 also had risk factors and co-morbidities such as alcohol consumption (8), diabetes (6), smoking (5), coronary heart disease (4), obesity (2) and kidney disease (1).
After the first dose of vaccination, out of 22 participants who developed COVID-19, the majority 19 (18.36%) had symptoms suggestive of COVID-19, and 3 (13.63%) had exposure to confirmed or suspected cases. Whereas, after the second dose of vaccination, out of 61 participants, 45 (73.77%) had symptoms suggestive of COVID-19, and 16 (26.22%) had exposure to confirmed or suspected cases [Table 3]. Out of 83 HCWs who had an infection, 66 had got it for the first time, and 17 had got it for the second time. | Table 3: Distribution of study participants based on reason for reverse transcription-polymerase chain reaction testing after first and second doses of vaccination
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The majority of the HCW with COVID-19 infection following vaccination had fever 12 (63.15%) as the most common symptom, followed by cough 6 (31.57%), chills 5 (26.31%), sore throat 4 (21.05%), myalgia 4 (21.05%), dyspnoea 2 (10.52%), loss of smell 2 (10.52%) and loss of taste 1 (5.26%) [Figure 1]. Similar symptoms were reported by the participants when infection was contracted after the second dose [Figure 2]. | Figure 1: Presenting symptoms of COVID-19 infection after the first dose of vaccination (n = 22). Note: Numbers are not mutually exclusive
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 | Figure 2: Presenting symptoms of Coronavirus disease 19 infection after the second dose of vaccination (n = 61). Note: Numbers are not mutually exclusive
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Out of 22 HCWs who had COVID-19 infection after receiving the first dose of vaccine, 16 were in category A, and 2 were in category C according to the clinical categorisation of COVID-19 by the Indian Medical Association. The remaining 4 HCWs were asymptomatic. Similarly, who had infection after receiving the second dose (61), 51 were in category A, 3 were in category C and 7 were asymptomatic.
Of 83 participants who had developed COVID-19 after the first and the second doses, the majority 9 (40.90%) were tutors and 28 (45.90%) were paramedical staff [Table 4]. | Table 4: Designation-wise distribution of study participants based on coronavirus disease 19 infection after the first and second doses (n=336)
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The total number of hospital admissions after the first and second dose was 1 and 9, respectively. Out of nine, only 2 required oxygen support. None of them required intensive care in the hospital.
| Discussion | | |
In the present study, 275 (81.84%) study participants had taken two doses of the COVID-19 vaccine. Whereas the study conducted by Tyagi et al.,[8] reported that 107 (94.69%) of HCWs had taken two doses of the COVID-19 vaccine.
In our study, the total prevalence of infection was 83 (24.4%); after the first dose of the vaccine was 22 (6.52%) and after the second dose was 61 (21.73%). A comparable prevalence of infection was seen in studies conducted by Baltas et al.[12] (6.4%) and Cavanaugh et al.[13] (6.9%) after the first dose of vaccination. A similar prevalence of infection after the second dose of vaccination (20.3%) was reported by Cavanaugh et al. study.[13]
The prevalence of infection in our study was high when compared to the studies conducted by Tyagi et al.,[8] and Vaishya et al.,[14] which reported that the total prevalence of infection was 19 (16.81%) and 85 (2.63%), respectively. The rise in infection in our study could be due to the new SARS-COV-2 variant, and the peak of the second wave at the time of the study.
Fever was the major symptom reported due to COVID-19 infection in the present study. After the first dose of vaccination, only one got admitted with no oxygen support or intensive care unit (ICU) requirement. After two doses, 9 got admitted to the hospital and two were on oxygen support, but without admission to ICU. The study conducted by Parameswaran et al.[15] stated that after two doses of COVID-19 vaccination, the incidence and severity of COVID-19 infection were significantly lower when compared to one dose and concluded that vaccination confers a certain level of immunity against severe forms of infection. The study by Kalligeros et al.[16] stated that irrespective of the number of doses of vaccination the mortality was decreased significantly (adjusted odds ratio 0.44, 95% confidence interval: 0.20–0.98), and after one dose, the hospitalisation due to COVID-19 infection was observed in few patients. This result shows that we could decrease the infection by increasing the coverage of vaccination. The COVID-19 jab also reduced the severity of the infection, hospitalisation and ICU admissions.
| Conclusion | | |
In our study, the COVID-19 infection was reported amongst HCWs after taking the vaccine, but the rate of admission to the hospital and oxygen requirement was minimal, and none required ICU admission despite daily exposure to COVID-19 patients. Therefore, all eligible citizens should receive their COVID-19 vaccine during their turn.
Recommendation
Study findings can be used to decrease vaccine hesitancy amongst the public. There is a need to carry out more case–control studies to compare infection rates between vaccinated and unvaccinated individuals.
To follow the COVID-19 appropriate behaviour irrespective of vaccination status till the pandemic gets over. Routine laboratory testing is essential to identify COVID-19 amongst HCWs and prevent secondary SARS-CoV-2 transmission to patients, other HCWs and throughout health-care settings.
Limitation
The responses were not uniform across all cadres of HCWs in the Tertiary Care Centre.
Acknowledgement
We sincerely thank all the participants for participating in the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 13. | Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter K. Reduced risk of reinfection with SARS-CoV-2 after COVID-19 vaccination-Kentucky, May-June 2021. MMWR Morb Mortal Wkly Rep 2021;70:1081-3. |
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
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