Date of Award

12-2023

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Junaid Iqbal

Second Advisor

Dr. Sajid Bashir Soofi

Third Advisor

Dr. Zehra Jamil

Department

Community Health Sciences

Abstract

Background: Undernutrition is a cause of numerous physiological disorders and a reason why different vaccines don't work well. Micronutrient deficiencies have been linked to lower antibody production in COVID-19 and may also influence response to the SARS-CoV-2 vaccination, thus increasing the risk of breakthrough infection. Since 91% of Pakistani adolescents have at least one micronutrient deficiency, so the regional variance in the SARS-CoV-2 vaccine response may be due to undernutrition. The micronutrient deficiency has been proven to affect immune response to other vaccines also like rotavirus and hepatitis B vaccines. In this study, we investigated the impact of undernutrition (low BMI, and micronutrient deficiencies) on the response to SARS-CoV-2 BNT162b2 booster vaccine dose. For this, we compared the plasma antibody titers between low and normal BMI cohorts at the 1st and 3rd month postvaccination.
Methods: We recruited 250 adolescents (12–18 years old) from Government High School, Thehri, Sindh where a booster shot of bivalent SARS-CoV-2 vaccine (BNT162b2, Pfizer) was being administered in a government-held camp. Baseline anthropometry, hemoglobin (an anemia biomarker), and micronutrients (zinc and vitamins A, B12, B9, and D) were measured at the time of enrollment. The participants were divided into Low BMI cohort and normal BMI cohorts based on WHO’s criterion. Anti-S-RBD SARS-CoV-2 IgG antibodies concentrations were compared between the two cohorts at 1st and 3rd -month post-vaccination.
Results: The difference in the Anti-S-RBD SARS-CoV-2 IgG antibodies were nonsignificant between the low and normal BMI cohorts i.e., at one month after vaccination, median (IQR)=432 (123.5-823) versus 544 (196-904), (p=0.196) and at 3 months following vaccination, median (IQR)=151.5 (63.6-330.5) versus 189(113-397), (p=0.635). However, BMI showed an interactive effect with serum zinc level (β=383.50, p=0.027). Additionally, serum folic acid levels showed a significantly positive effect on the serological response when adjusted for other variables in the model (β=183.32, p=0.023).
Conclusion: Our results reflect a negative impact of undernutrition on the serological response to SARS-CoV-2 vaccination, emphasizing the role of essential micronutrients in immunomodulation. According to literature, these micronutrients exhibit synergistic effects, reducing infection risk [1]. However, further investigations are recommended to uncover mechanisms influencing varied responses to SARSCoV-2 vaccination [2, 3].

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1

Last Page

154

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