Booster Vaccination May Determine COVID-19 Symptoms and Severity: Study


Boosted individuals were more likely to get nasal congestion and/or a sore throat and less likely to experience body and muscle aches.

Getting a COVID-19 booster shot and its timing may affect the frequency and type of symptoms in breakthrough SARS-CoV-2 infections.

A recently published study in Vaccines found that boosted individuals were significantly more likely to get nasal congestion and/or a sore throat but considerably less likely to experience body and muscle aches, compared with those who were vaccinated but had not received a booster dose during the Omicron surge.

Additionally, the frequency of fever and cough symptoms was directly associated with increased time between vaccine doses. With each booster vaccination, the likelihood of having a fever and cough increased by 4.4 percent and 4.8 percent, respectively.

Study Details

Researchers evaluated the number, type, and duration of symptoms among 476 students and employees with SARS-CoV-2 infections at New York Medical College (NYMC) from Dec. 1, 2021, to June 30, 2022. They also tracked the days between their last vaccination and COVID-19 diagnosis.

All students and employees at NYMC during this time were mandated to receive a two-dose primary series of an mRNA COVID-19 vaccine or a single dose of Janssen’s Johnson & Johnson vaccine by Sept. 30, 2021, unless they had a vaccine exemption. In February 2022, the school began requiring a booster dose.

In addition to vaccine requirements, the school implemented testing requirements for symptomatic and asymptomatic individuals exposed to COVID-19. Individuals with confirmed SARS-COV-2 infection had to fill out a symptom log for 10 primary symptom categories, including fever, cough, shortness of breath, nasal congestion, sore throat, headache, fatigue, body/muscle aches, gastrointestinal issues, and a loss of taste or smell.

According to the study, 2,443 of the 2,456 (99.4 percent) students and employees received a primary series COVID-19 vaccine, and 13 individuals were unvaccinated. Yet COVID-19 cases in December 2021 increased tenfold over each of the previous three months.

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Between December 1, 2021, and June 30, 2022, the proportion of infections among vaccinated individuals was significantly greater than the proportion of cases among the unvaccinated—46.2 percent versus 19.5 percent.

Of the 476 vaccinated individuals, 433 were symptomatic, but only 393 cases had sufficient data to assess symptoms. Of the 393 cases, 285 individuals were boosted, and 108 were vaccinated but non-boosted. The study found that cough, nasal congestion, and fever were the most common SARS-CoV-2 symptoms reported, followed by sore throat, headache, body and muscle aches, and fatigue. Only 13 cases reported a change or loss in taste or smell.

Among vaccinated individuals who were not boosted, 44 percent reported nasal congestion only, 62 percent reported nasal congestion, sore throat, or both, and 32 percent reported body/muscle aches. In contrast, among boosted individuals, 58 percent reported nasal congestion only, 77 percent reported having nasal congestion, sore throat, or both, and 22 percent reported body/muscle aches.

“These data suggest that having had a booster vaccination, as well the timing of receiving it, impacts the clinical manifestations of breakthrough SARS-CoV-2 infections,” the authors wrote.

Other Study Data

Other data suggests that the number of COVID-19 vaccinations a person receives could influence which symptoms they’re most likely to experience if they become infected with SARS-CoV-2. According to data from the ZOE Health Study, a collaborative data project between health science company ZOE and researchers from King’s College London, Massachusetts General Hospital, Harvard T.H. Chan School of Public Health, and Stanford Medicine, the most frequently reported symptoms by individuals with positive COVID-19 tests include the following:

  • Sore throat
  • Runny nose
  • Blocked nose
  • Sneezing
  • Cough without phlegm
  • Headache
  • Cough with phlegm
  • Hoarse voice
  • Muscle aches and pains
  • Altered sense of smell

Among those who received one vaccine dose, a two-dose primary series, or were unvaccinated, four of the five most frequently reported COVID-19 symptoms appeared in all three groups, such as sore throat, runny nose, persistent cough, and headache, but their prevalence varied. For example, unvaccinated people were more likely to report experiencing a fever, whereas “fever” did not appear in the other groups’ top-five symptoms.

Those who had received two vaccine doses reported experiencing a sore throat as their top symptom, whereas those who received only one dose or no doses experienced a headache as their top symptom. Only those who received two vaccine doses reported experiencing a “blocked nose.” The ZOE health study data showed that sneezing more than usual could be a sign of COVID-19, but only in those vaccinated.
Research suggests that symptoms from an infectious disease result from the immune system’s efforts to eliminate the infection from the body. As a person’s immune systems changes through vaccination, the symptoms they experience could also change.


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