A Comparative Analysis of Side Effects from the Third Dose of COVID-19 Vaccines in Palestine and Jordan

COVID-19, a virus that baffled scientists, disrupted the balance of nations and killed the young before the old in all countries worldwide. Moreover, it isolated the world from each other. From this standpoint, the World Health Organization (WHO) declared the coronavirus pandemic a global epidemic (W​o​r​l​d​ ​H​e​a​l​t​h​ ​O​r​g​a​n​i​z​a​t​i​o​n​,​ ​2​0​2​0​a). The highly transmissible respiratory disease outbreak in Wuhan, China in 2019 led to the discovery of a newly identified member of the human coronavirus family, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (P​a​l​ ​e​t​ ​a​l​.​,​ ​2​0​2​0). The coronavirus has spread to more than 27 countries through flights (D​u​ ​T​o​i​t​,​ ​2​0​2​0). This pandemic has affected two countries, Jordan and Palestine.

Most importantly, several proactive measures have been taken by Jordanian and Palestinian health officials to reduce the spread of the disease, such as receiving vaccinations, quarantine, and isolation, suspending flights, launching electronic platforms, and avoiding crowded gatherings and poorly ventilated indoor places (W​o​r​l​d​ ​H​e​a​l​t​h​ ​O​r​g​a​n​i​z​a​t​i​o​n​,​ ​2​0​2​0​b). This infectious disease has shaken the world and has become a dreaded disease for humans. On April 4, 2020, the total number of COVID-19 cases worldwide exceeded one million, including nearly 40,000 deaths (D​a​r​a​l​a​m​m​o​u​r​i​ ​e​t​ ​a​l​.​,​ ​2​0​2​0). Since the confirmation of the first case in Palestine and Jordan in early March 2020, the number of cases has exponentially increased, causing significant concern. This outbreak led to a health crisis and a decline in economic activity unprecedented in recent history (G​u​e​r​r​i​e​r​i​ ​e​t​ ​a​l​.​,​ ​2​0​2​2). In the twenty-first century, the COVID-19 pandemic is undeniably an unprecedented global public health threat. It has a wide range of socioeconomic, political, and public health implications worldwide.

Many countries, including Palestine and Jordan, are lamenting the impact of COVID-19, which has resulted in economic declines, travel disruptions, and fatalities (S​e​i​r​a​f​i​a​n​p​o​u​r​ ​e​t​ ​a​l​.​,​ ​2​0​2​2). Therefore, it is crucial to find vaccinations quickly to combat this virus; numerous companies have been racing to produce these vaccines, but they have resulted in side effects across all dosages (C​a​s​i​d​a​y​ ​e​t​ ​a​l​.​,​ ​2​0​0​6). Some studies dealt with side effects after the first and second doses of coronavirus. Still, according to the researcher’s limitations, no study dealt with side effects after the third dose of vaccines.

As with any medical intervention, the COVID-19 vaccine has potential side effects that individuals should be aware of. Common side effects include pain and swelling at the injection site, fatigue, headaches, muscle aches, chills, fever, and nausea (L​a​r​s​o​n​ ​e​t​ ​a​l​.​,​ ​2​0​1​8; A​l​-​A​n​s​i​,​ ​2​0​2​2). These side effects are generally mild to moderate in severity and typically subside within a few days (A​l​-​A​n​s​i​ ​&​ ​A​l​-​A​n​s​i​,​ ​2​0​2​0). It is important to note that these side effects are a sign that the vaccine is working to stimulate an immune response against the virus. Rare but more serious side effects may occur, such as allergic reactions or blood clotting disorders (G​a​r​a​d​ ​e​t​ ​a​l​.​,​ ​2​0​2​1; J​a​b​o​o​b​ ​e​t​ ​a​l​.​,​ ​2​0​2​4). However, the benefits of vaccination outweigh the risks of contracting COVID-19 which can lead to severe illness or death. Individuals should consult with their healthcare provider if they have concerns about potential side effects and report any adverse reactions through proper channels for monitoring and evaluation (J​a​b​o​o​b​ ​e​t​ ​a​l​.​,​ ​2​0​2​3).

The COVID-19 vaccine gap in the Arab region has emerged as a pressing concern, with disparities in access and distribution leading to uneven vaccination rates across countries. While some affluent states have made significant strides in securing doses and administering vaccinations, less-developed nations within the region have struggled to procure an adequate supply of vaccines (A​l​-​H​r​i​n​a​t​ ​e​t​ ​a​l​.​,​ ​2​0​2​4). This divide raised concerns about achieving widespread immunity and effectively combating the spread of the virus throughout the region (A​l​-​A​n​s​i​ ​e​t​ ​a​l​.​,​ ​2​0​2​3​a; A​w​a​i​n​ ​e​t​ ​a​l​.​,​ ​2​0​2​3). Addressing this gap required concerted efforts from both governments and international organizations to ensure equitable access to vaccines for all populations. Furthermore, collaboration among Arab nations was essential to streamline distribution channels and enhance vaccine deployment strategies. Failure to bridge this gap risks prolonging the pandemic’s impact on public health and socioeconomic stability within the region.

Clinical trials have shown that third-dose vaccines have been associated with various mild to moderate side effects, such as pain, redness or swelling at the injection site, fatigue, headache, chills, muscle and joint pain, and fever (W​o​r​l​d​ ​H​e​a​l​t​h​ ​O​r​g​a​n​i​z​a​t​i​o​n​,​ ​2​0​2​0​b). This study aims to compare the side effects of different COVID-19 vaccines after the third dose and evaluate the short-term side effects associated with the third dose among people in Jordan and Palestine. The other objectives include determining the food sensitivity, corona infection after eating, weight and drug sensitivity in addition to cardiovascular diseases, osteoporosis, and thyroid disorders. Other minor factors include immune diseases and cancer, followed by people who have arthritis and hypertension. By using data from both countries, the results of this study are expected to reveal the main differences between Jordan and Palestine regarding third dose side effects.

A simple randomized, cross-sectional online survey was performed from March 13 to May 11, 2022. Participants from Jordan and Palestine who received the third dose of a COVID-19 vaccine were invited to participate in this study by filling out a Question Pro Form-based questionnaire. The questionnaire was written in a smooth and easy-to-understand language and was designed‎for scientific purposes. A detailed and comprehensive description was provided, and the information was collected in the strictest confidence. The survey link was distributed via social media platforms (Telegram, Facebook, and WhatsApp) and email, along with sufficient information about the study.

The study used the questionnaire (an online survey) as the primary tool for obtaining data and ‎information, depending on many literature reviews using Google Scholar, ProQuest, Midline, ‎and Research Gate as it is considered an organized tool for collecting research data by ‎formulating a model for the questions directed to the individuals in the research sample. ‎The study tool was developed through a literature review, and experts in the scientific research field verified the questionnaire’s validity. Their comments were taken and modified upon their request. Also, the internal consistency method, Cronbacks Alpha, was used to verify the validity and reliability of the study.

According to data from “Our World in Data (OWID),” approximately 1,016,797 people in Jordan and Palestine had received a COVID-19 booster dose by August 21, 2022 (K​e​r​r​ ​e​t​ ​a​l​.​,​ ​2​0​2​1). The minimum representative sample size of 666 was determined using the calculator website for the calculated sample size (O​m​e​i​s​h​ ​e​t​ ​a​l​.​,​ ​2​0​2​2). The questionnaire was given to the participants in the study with a 99% confidence interval, a 50% response rate, and a 5% margin of error. The sample size is considered sufficient regarding the repeating of the same answers in the determined sample. The results of the research could be generalized to both countries, namely Jordan and Palestine. The exclusion criteria included that all questions should be answered and the answers should also be rational.

In conducting research, potential limitations and sources of bias were carefully addressed to uphold the credibility and validity of the study. Limitations of this research include small sample sizes, which may not accurately represent the larger population being studied, leading to biased or inconclusive results. Furthermore, the absence of randomization or convenience sampling methods can lead to selection bias, thereby distorting the findings. Additionally, reliance on self-report measures may introduce social desirability bias where participants provide responses, they believe are socially acceptable rather than truthful ones. To mitigate these limitations and biases, researchers strive for larger and more diverse samples, randomize participant selection processes, utilize objective measures whenever possible, and employ rigorous data analysis techniques to ensure the accuracy and reliability of their findings.

The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 28; frequencies and percentages were measured and used as descriptive statistics. A correlation test was performed to assess potential correlations between predisposing factors. The chi-square test investigated the statistical associations between predisposing factors and post-vaccination side effects. The association was considered statistically significant if the p-value was less than 0.05 to obtain the most significant associations.

The predisposing factors include educational level, gender, weight, suffering from chronic diseases, being a smoker, types of smoking, suffering from food and drug allergies, experiencing COVID-19 infection before receiving any vaccine dose, experiencing COVID-19 illness after receiving a third vaccine dose, the type of COVID-19 vaccine, a sense of protection increased by the third dose, and still wearing a mask after receiving the third dose. The post-vaccination side effects include fever, headache, fatigue, insomnia, joint pain, muscle pain, abdominal pain, anorexia, diarrhea, nausea, epistaxis, skin allergies, chills, hyperhidrosis, hair loss, poor memory, blurred vision or eye redness, hyperosmia.

This section covers demographic data from 800 people in Palestine and Jordan. Data was classified based on percentages for age, gender, educational level, and professional qualification. According to Table 1, most participants (55.3% and 65.8%) were men from Palestine and Jordan. The education level is high, as most participants in each country have a bachelor’s degree, accounting for approximately 53.9% and 51.8% of each country’s research sample, respectively. In Palestine, the 18-29 age group accounts for 52.5%, whereas in Jordan, the 30-39 age group accounts for 38.3%. The data also reveals that most participants in each country (76.1% and 68.5%) are of average weight.

Table 2 shows that the most popular vaccination type for the third dosage is Pfizer ‎BioNtech (67.8% and 62%), followed by Sinopharm (28.5% and 21.3%). In Palestine and Jordan, the percentage of participants infected with COVID-19 was 24.4% and 51.9% before receiving the vaccines, and it increased to 39.5% and 82.5% after the third dose vaccination. 39.0% and 60.8% of the participants started to wear masks after receiving the third dose. In addition, 54.8% and 52.0% of them showed symptoms after ‎‎receiving the third dose, which were less severe than those of the first and second doses, respectively. After receiving the third dose, 34.4% and 91.4% suffered from drug or food sensitivity. The majority of the participants do not smoke. 80.8% of the participants did not suffer ‎from allergies to ‎any food in ‎Palestine and the percentage is 5.8% in ‎Jordan. 90.8% and ‎6.25% of the participants are not allergic ‎to any ‎medication in Palestine or Jordan. It seems that most of the participants ‎did not ‎suffer from ‎chronic diseases.

Table 3 shows the correlation between the side effects from the third-dose vaccination and the predisposing factors in Palestine and Jordan. The x2 tests conducted in Palestine show significant correlations (α = 0.05) between fever and the following risk factors: educational level, sensitivity to food and medication, infection with corona before vaccination, and illness with symptoms following the third dose. In terms of headaches, there is a strong association between age, food sensitivity, corona infection before vaccination, and symptoms following the third dose. Regarding fatigue, a significant correlation exists between educational level, age, food sensitivity, a disease with corona before vaccination, and infection with symptoms following the third dose of the vaccination.

In terms of insomnia, there is a significant correlation between coronavirus infection before and after immunization and the development of symptoms after the third dose. Age, education level, food sensitivity, corona infection before immunization, and symptoms following the third vaccination dose are all associated with muscular pain. In addition, there is a significant correlation between joint pain and gender, age, education level, weight, sensitivity to food and medication, infection with corona before vaccination, and condition with symptoms following the third dose of immunization. Regarding abdominal pain, there is a strong association between disease with symptoms following the third immunization dosage, and sickness with a half before and after vaccination. As for anorexia, there is a significant association between Corona infection before and after immunization and infection with symptoms following the third dose of the vaccine. Regarding diarrhea, there is a strong link between disease with symptoms following the third dose of the vaccine and sickness with Corona before and after vaccination. Finally, in terms of nausea, there is a strong association between age, food sensitivity, corona disease before immunization, and infection with symptoms following the third dose of the vaccine.

Regarding epistaxis, there is a significant association between gender, age, educational level, food sensitivity, infection with the corona following immunization, and disease with symptoms following the third dose of the vaccine. Regarding skin allergies, there is a strong association between educational level, food sensitivity, corona illness following immunization, and infection with symptoms following the third dose of the vaccine. Chills, food sensitivity, corona status before immunization, and disease with symptoms following the third vaccination are all significantly correlated. With hyperhidrosis, there is a significant correlation between coronavirus infection following immunization and infection with symptoms following the third vaccine. In addition, age, education level, food sensitivity, a disease with corona following immunization, and an illness with symptoms following the third vaccine all significantly correlate with hair loss. In terms of poor memory, there is a direct link between corona disease before immunization and infection with symptoms following the third dose of the vaccine. Gender, age, educational level, corona following vaccination, and sickness with symptoms after the third immunization all significantly correlate with blurred vision. As for hyperosmia, there is a significant correlation between educational level, sensitivity to eating, infection with corona after the third vaccine, and illness with symptoms after the third vaccine.

In Jordan, there is a strong association between fever and the following predisposing factors: gender, age, level of education, and smoking. Age and weight significantly affect the frequency of headaches. Age and gender both significantly affect feelings of fatigue. Regarding insomnia, there is a significant correlation between smoking, gender, and educational level. In addition, age and smoking have a significant relationship with muscle pain. Food sensitivity and corona infection before immunization have been linked to joint pain. There is an essential link between smoking, food sensitivity, and corona disease before vaccination and abdominal pain. In addition, there is a strong link between food sensitivity and anorexia. In terms of diarrhea, there is no meaningful connection. There is a significant connection between food sensitivity and nausea. Regarding epistaxis, smoking, and corona infection following vaccination are significantly correlated. There is a strong link between food sensitivity and skin allergies. Chills don’t significantly correlate, either. In hyperhidrosis, there is a statistically significant relationship between gender and the frequency of symptoms following the third dose. There is a strong link between gender and hair loss. There is no apparent connection between hyperosmia and poor memory.

Table 4 shows the correlation between the side effects of those who received the third dosage and chronic diseases in Palestine and Jordan. In Palestine, the χ2 test reveals a significant (P<0.05) association between fever and diabetes mellitus. In terms of headaches, there is no significant correlation. There is a strong correlation between fatigue and diabetes. As for insomnia, there is no significant association with anything. When it comes to muscle pain, there is a considerable correlation with joint pain. In addition, there is a significant association with diabetes, hypertension, cardiovascular diseases, respiratory diseases, obesity, arthritis, osteoporosis, and autoimmune diseases. There is a significant correlation between thyroid disease and abdominal pain. There is no conclusive link between the following: nausea, diarrhea, or loss of appetite. Regarding epistaxis, there is a significant association between several conditions: osteoporosis, obesity, diabetes, and respiratory illnesses. As for skin sensitivity, there is a substantial correlation with diabetes, respiratory diseases, and thyroid disorders. There is a direct relationship between chills and cancer. Regarding hyperhidrosis, there is a significant link to cancer. Regarding hair loss, there is a strong correlation with obesity, autoimmune diseases, and thyroid disorders. There’s no statistically significant link between poor memory and anything. Regarding impaired vision, there is a strong correlation between diabetes and respiratory and cardiovascular disorders. There is a strong correlation between hyperosmia and osteoporosis, diabetes, cardiovascular disease, and many other conditions.

In Jordan, there is a sizable correlation between obesity, arthritis, fever, and headaches. In addition, there is a strong connection between respiratory illnesses and muscle pain. Thyroid conditions have a strong correlation with hyperhidrosis. There is a strong correlation between poor memory and arthritis. However, there is no correlational link between the other side effects and chronic diseases.