Comparison of physiological and clinical reactions to COVID-19 and influenza vaccination

Public reluctance to receive COVID-19 vaccination is associated with safety concerns. By contrast, the seasonal influenza vaccine has been administered for decades with a solid safety record and a high level of public acceptance. We compare the safety profile of the BNT162b2 COVID-19 booster vaccine to that of the seasonal influenza vaccine.

We study a prospective cohort of 5079 participants in Israel and a retrospective cohort of 250,000 members of MHS selected randomly. We examine reactions to BNT162b2 mRNA COVID-19 booster and to influenza vaccinations. All prospective cohort participants wore a smartwatch and completed a daily digital questionnaire. We compare pre-vaccination and post-vaccination smartwatch heart-rate data, and a stress measure based on heart-rate variability. We also examine adverse events from electronic health records.

In the prospective cohort, 1905 participants receive the COVID-19 booster vaccine; 899 receive influenza vaccination. Focusing on those who receive both vaccines yields a total of 689 participants in the prospective cohort and 31,297 members in the retrospective cohort. Individuals reporting a more severe reaction after influenza vaccination tend to likewise report a more severe reaction after COVID-19 vaccination. In paired analysis, the increase in both heart rate and stress measure for each participant is higher for COVID-19 than for influenza in the first 2 days after vaccination. No elevated risk of hospitalization due to adverse events is found following either vaccine. Except for Bell's palsy after influenza vaccination, no elevated risk of adverse events is found.

The more pronounced side effects after COVID-19 vaccination may explain the greater concern associated with it. Nevertheless, our comprehensive analysis supports the safety profile of both vaccines.