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 Table of Contents  
Year : 2023  |  Volume : 15  |  Issue : 1  |  Page : 83-90

Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center

1 Department of Clinical Pharmacy, Faculty of Pharmacy, Andalas University, Padang; Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta, Indonesia
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta, Indonesia
3 Department of Clinical Pharmacy, Faculty of Pharmacy, Andalas University, Padang, Indonesia
4 Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Ha'il, Saudi Arabia

Date of Submission09-Jan-2023
Date of Decision01-Mar-2023
Date of Acceptance03-Mar-2023
Date of Web Publication31-Mar-2023

Correspondence Address:
Stefanus Lukas
Department of Clinical Pharmacy, Faculty of Pharmacy, Andalas University and Universitas 17 Agustus 1945 Jakarta
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_4_23

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Background: Vaccine is an essential tool to limit the health of the COVID-19 pandemic. AstraZeneca vaccine already provided promising effectiveness data. Still, the study must check the correlation between vaccination and antibody titer. Aim: This study aims to evaluate antibody titer after AstraZeneca vaccination based on the age group. Materials and Methods: This study used a prospective cross-sectional method with convenience sampling. Inclusion criteria were all Indonesian citizens above 18 years old who were vaccinated at UTA'45 Jakarta Vaccine Center with no history of COVID-19 before the vaccination and had filled up the informed consent. Results: This study's total sample was 102 females; 51.90%, residents of Java Island; 91.17% had comorbidities; 50,98%, smokers; 9,80%, alcohol drinker; 9,80%, exercise; 80,39%, blood pressure; 128/73, SpO2: 97,82. Most participants aged around 30 years had a body mass index of 23.33. Age, comorbidity, smoking, alcohol, and exercise habit significantly correlate with the increase of the participants' antibodies (P < 0.001). The age shows that the younger the participant, the higher the titer antibody 2 will be (P = 0.001, 95% confidence interval [CI], −1.935, −0.694). The exercise shows that the participant with the routine practice will have a higher titer antibody 2 (P = 0.002, 95% CI, 12.016, 51.791). Antibody titer for participants younger than 35 years old increased 5.7 times while for participants between 35 and 45 years old was 3.9 times. Another group (>45–55 years old) has shown an improvement in antibody titer at 1.7 times, but the last group (>55 years old) described an increase in antibody titer at 232.3 times. Conclusions: Age, comorbidity, smoking, alcohol, and exercise contributed to the increase in titer antibody 2 value of the AstraZeneca vaccine participants. Participants in the age group <35 years have an excellent immune system.

Keywords: Antibody titer, AstraZeneca, comorbidities, COVID-19, SpO2

How to cite this article:
Lukas S, Ramatillah DL, Aldi Y, Wahyuni FS, Khan K. Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center. Asian J Pharm Res Health Care 2023;15:83-90

How to cite this URL:
Lukas S, Ramatillah DL, Aldi Y, Wahyuni FS, Khan K. Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center. Asian J Pharm Res Health Care [serial online] 2023 [cited 2023 Jun 8];15:83-90. Available from: http://www.ajprhc.com/text.asp?2023/15/1/83/373373

  Introduction Top

Some patients were admitted to the hospital at the end of December 2019 with early pneumonia of unclear cause. The case involves the wholesale market and large animals in Wuhan, Hubei Province, China.[1],[2],[3] The advent of this coronavirus prototype was first noted in the study, which heightened expectations for universal reproduction for the 2019 coronavirus (COVID-19) released in February 2020.[2] There have been 2033 confirmed cases of 2019-nCoV infections in mainland China as of January 26, 2020, with 56 deaths.[4] On March 11, 2020, the World Health Organization (WHO) proclaimed COVID-19 a pandemic.[5] Clinically, the coronavirus is spreading among numerous hosts and causing a variety of symptoms, including the common to severe flu and, in some cases, fatal respiratory infections. The new virus, which is causing this outbreak, was initially known as “2019-nCoV” or “SARS-CoV-2.” SARS-CoV, the pathogen responsible for severe acute respiratory syndrome, is thought to be familiar with SARS-CoV-2.[1],[6] SARS-CoV-2 was recently discovered to be closely linked to SARS-CoV, with an RNA sequence that is 80% identical.[7] Coronavirus is divided into four groups: alpha, beta, gamma, and delta. They are all members of the Coronaviridae family. Human viruses are genetically related to the β-CoV genus, and alpha and beta coronaviruses can infect mammals. The β-CoVs are further divided into four groups (A, B, C, and D).[8],[9],[10] MERS-CoV is categorized as lineage C, which includes 500 viral sequences, while SARS-CoV and SARS-CoV-2 are classified as lineage B, with roughly 200 published virus sequences.[8]

When COVID-19 became an endemic by the end of 2019 and a pandemic by March 2020, the rush for vaccine development and the quest for new treatments began.[11],[12] The most effective strategy that considers ending the pandemic is vaccine.[13] Viral vector, mRNA vaccine, inactive virus vaccine, and protein subunit vaccination are the four forms of COVID-19 vaccine.[14],[15] AstraZeneca is one of the COVID-19 vaccines, a type of viral vector (adenovirus).[14],[16] The University of Oxford and AstraZeneca, a British-Swedish pharmaceutical corporation, collaborated to develop ChAdOx 1nCoV-19, a nonreplicating chimpanzee AstraZeneca vaccine known as AZD1222.[17] AstraZeneca developed a vaccine that uses a genetically engineered virus that does not cause disease but encodes coronavirus proteins to induce an immune response safely. This vaccine was first used in the United Kingdom (UK) and has been available in Italy and Poland since February 9, 2021.[14] The study showed that the vaccine's efficacy was around 62%, according to the data taken from Brazil, whereas it was around 90% in the UK.[14] Thus, with data from 12,000 participants from both investigations, the average efficacy value was 70%, with 131 positive cases and zero severe symptoms. The vaccine efficacy for the AstraZeneca/Oxford vaccine, ChAdOx 1-S (recombinant), was reported by the WHO as 63.09%.[14] Suppose we compare the Pfizer-BioNTech and Moderna vaccines which have 95% efficacy.[18],[19],[20],[21] The vaccine is suited for low- and middle-income nations due to its minimal storage needs.[14] Based on a study conducted in Poland, out of 509 people vaccinated with AstraZeneca, the most common side effects experienced were injection site pain, shoulder pain, reported muscle aches, headache, fever, chills, and weakness.[22]

One vaccine that has emergency use licensed for Indonesians by the Food and Drug Administration of Indonesia, called Badan Pengawas Obat dan Makanan, is the AstraZeneca vaccine.[23] The first batch of the AstraZeneca vaccine that arrived in Indonesia was on March 8, 2021.[24] One factor that proves the vaccine's high efficacy has been able to stimulate produced antibodies of the participant.[25] A positive vaccine response is mostly found in the younger age.[26]

Nucleic acid testing (NAT), RNA from a nose swab, screening antigens of viral proteins,[27],[28] and SARS-CoV-2 can be diagnosed by looking for viral particles. A positive NAT result, on the other hand, does not indicate whether or not an infected person is immune. Hence, serological analysis is needed.

The serological analysis is particularly essential since different types of antibodies in the blood might be identified for months or even years.[28],[29],[30] For the 1st several months after symptom onset, several recent studies have examined antibody levels in people who have recovered from SARS-CoV-2 infection.[31],[32],[33] Antibodies targeting the spike protein diminish several-fold over the first 3 months, according to the majority of these investigations, from a peak reached a few weeks after symptom onset.[31],[33],[34] Antibodies produced after vaccination can block the interaction between S protein and angiotensin-converting enzyme 2 (ACE2), effectively preventing the infection of SARS-CoV-2.[35]

The lack of further research on increasing antibody titers after prior vaccination with the AstraZeneca vaccine is the reason for conducting this research. Furthermore, the participants are from multi-cultured origins given from almost areas of Indonesia, and the antibody test used is electrochemiluminescence immunoassay (ECLIA) method.

  Materials and Methods Top

Study design and setting

This research was conducted at a vaccination center of UTA'45 Jakarta, Indonesia. This study used a prospective cross-sectional study with convenience sampling where 102 participants who were willing to do full-dose vaccination at Vaccine Center UTA'45 Jakarta. The inclusion criteria of this study (102 participants) were Indonesian citizens above 18 years old. These people were willing to fill in informed consent and willing to have their blood drawn for the first and second antibody tests. Those participants did not have any established COVID-19 infection or did not undergo a COVID-19 test before vaccination. Participants were included based on the polymerase chain reaction test before vaccination. Exclusion criteria were participants with an uncontrolled comorbid disease, an autoimmune disease, cancer, pregnant and breastfeeding women, and blood clot treatments.

Ethical approval

Before data collection, ethical approval was submitted, which was then issued by the Health Research Ethics Committee of the Esa Unggul University Jakarta with the ethical number 0153-21.153/DPKE-KEP/FINAL-EA/UEU/VI/2021.

Data collecting and handling

According to [Figure 1], ethical approval was submitted first. After getting ethical approval, the researcher agreed with the clinical laboratory. Before conducting the study (before the first dose of AstraZeneca vaccination), informed consent was obtained from all participants. Only participants who signed the informed consent were included in this study. Antibody titer 1 was collected before the patient was vaccinated. The medical team from the Bio-Medical Clinical Laboratory took the blood from participants 1 h before injecting the first dose and 1 month after injecting the second dose of AstraZeneca [Figure 1]. Then, the blood samples were sent to the BioMedical Clinical laboratory to be checked for immunoglobulin (Ig) G and IgM. ECLIA was the specific method for checking anti-SARS-CoV-2 antibodies. After 2 days, the researcher received the results of the antibody titer of COVID-19 of those participants. Three months after first-dose injection, those participants received the second dose of the AstraZeneca vaccine at the UTA'45 Jakarta Vaccine Center. Then, 1 month after the second dose, those participants attended the UTA'45 Jakarta Center to check their antibody titer of COVID-19 with the Bio-Medical Clinical Laboratory. Same as the first antibody titer, the researcher would receive the results of this second antibody titer after 2 days. Sociodemographic data were collected by conducting interviews with participants after participants signed the informed consent [Figure 1]. All data were fully anonymized. Then, the data were collected into the Collection Research Form, and data analysis was carried out by using the IBM ® SPSS version 26, (Jakarta, Indonesia). P < 0.05 is a sign of significant correlation. This study used Wilcoxon, Mann–Whitney, Kruskal–Wallis, and multivariable linear regression tests.
Figure 1: Research framework of the study

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  Results Top

Among 102 participants, 48% are male, and 52% are female. Titer antibody 1 was taken before the first dose of the vaccination, and titer antibody 2 after 1 month of the vaccination. There was a rise in titer antibodies after vaccination.

Age was associated with antibody titer 2 using Wilcoxon test [Table 1]. Around 52% of the participants were female who reside on Java Island. Most of these participants were without comorbidity, and only around 28% had anemia. More than 90% of them were nonsmokers and nonalcohol, with 82% always doing exercise. A very significant correlation was found between antibody titer 2 and exercise (P < 0.001).
Table 1: Correlation between antibody titer 2 and sociodemography

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Based on [Table 2], a significant correlation was shown between antibody titer 2 with body mass index (BMI), blood pressure, antibody titer 1, and SpO2. In terms of oxygen saturation, most of these participants had normal SpO2 (97.82). There is a very significant correlation between antibody titer 2 and antibody titer 1 (P < 0.05).
Table 2: Correlation between antibody titer 2 and clinical parameter

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According to the multivariable regression, age, comorbidity, smoking, alcohol, and exercise habit significantly correlate with the increase of the participants' antibodies (P < 0.001). The age shows that the younger the participant, the higher the titer antibody 2 will be (P = 0.001, 95% confidence interval [CI], −1.935, −0.694). The exercise shows that the participant with the routine practice will have a higher titer antibody 2 (P = 0.002, 95% CI, 12.016, 51.791) [Table 3].
Table 3: Multivariable linear regression with the antibody titer 2

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[Figure 2] shows the difference in titer antibodies based on the group of age before and after the AstraZeneca vaccination. Antibody titer for participants younger than 35 years old increased 5.7 times while for participants between 35 and 45 years old was 3.9 times. Another group (>45–55 years old) has shown an improvement in antibody titer at 1.7 times, but the last group (>55 years old) described an increase in antibody titer at 232.3 times.
Figure 2: Antibody titer 1 and antibody titer 2 based on the age group among participants

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  Discussion Top

To our knowledge, this is the first research about the evaluation of antibody titer relationship with sociodemographic and clinical parameters among participants who were receiving AstraZeneca Vaccination in Jakarta, Indonesia. One of the parameters that determine antibody titer is age. An antibody that increases is a response to humoral immunity.[36] Our study found that age influenced antibody titer 2 with a median of 37 years old. It can be seen that young people tend to have the highest antibody titer 2. The research found that antibody for Covid-19 decreases with age because T-cell decreases antibody production.[37] Where the previous studies discusses vaccine efficacy found that the elderly have the lowest immune responses to Covid-19 vaccination[38],[39], while increasing age decreases antibody response.[40]

In the current study, gender, smoker, or alcohol consumption has no significant correlation with the increase of the titer antibody after the second dose of vaccination. High consumption of tobacco was more likely consumed by the older man.[41],[42] A smoking habit was always associated with masculinity of Indonesian men.[43] Higher alcohol used during quarantine times was 9.5% (n = 436).[42] Most of the alcohol was consumed by the men regarding psychosocial factors.[44] Exercise is associated with antibody production by induced elevated plasma antibodies.[45]

In this study, we found BMI to be one of the factors in the development of antibodies after vaccination. The participants with a standard range of BMI tend to have the highest antibody response or high antibody postvaccination titer because CD8 cytotoxic T-cell, CD4 T-helper response, and memory T-cell response are insufficient antibody levels that decrease significantly after vaccination in obese participants.[46],[47]

A significant correlation between oxygen saturation and the count titer antibodies after the second dose has been found. A normal airflow in the blood is needed for immune response.[48] Adenosine triphosphate (ATP) is required to produce antibodies by B-cells; ATP is produced on mitochondria through glycolysis until electron transport requires oxygen for breaking glucose into the energy.[49],[50] This means that oxygen saturation in the blood below standard could lead to less effectiveness in produced antibodies.[51]

A study showed that individuals with preexisting comorbidities have a higher risk of dying from COVID-19,[23],[24] such as cardiovascular problems patients. Patients are usually treated with ACE-I and angiotensin receptor blocker as both can significantly increase the expression of ACE2,[39] and it is believed to be responsible for the high risk of COVID-19 complications in hypertensive patients.[52] Hence, our current study did not find a significant correlation between participants with comorbidities and antibody titer 2. However, blood pressure significantly correlates with antibody titer 2 with a median of 124/92. Evidence showed a correlation between elevated antibodies and pregnancy-related hypertension because most antibodies target receptors and ion channels involved the blood pressure.[53]

Java has an enormous population in Indonesia.[54] Based on the Nordström et al. study, in the primary cohort, the estimated vaccine effectiveness was more than 90% in the 1st month, with a progressive waning starting soon after that, ultimately resulting in nondetectable vaccine effectiveness after 7 months.[55] Only three patients had COVID-19 infection after the second dose.

Based on the Geller et al. study, before the third dose (median, 221 days [interquartile range, 218–225] after the first vaccination), 94 participants (97%) were seropositive.[55] In contrast, the median titer level increased significantly after the third dose, and all participants became seropositive.[56] This study has several limitations where the sample did not reflect all of the population, and the ratio between female and male participants was not equal.

A booster dose of mRNA-1273 might increase vaccine effectiveness against infection and disease caused by SARS-CoV-2.[57] Ozgocer et al. study reported that antibody titer was higher in older participants than in younger participants (P < 0.02),[58] and the study oppose our findings where there is decrease in antibody response with increasing age. The increase in age has been associated with the decrease of human body functions.[59] The rapid increase of titer antibody 1 to titer antibody 2 in the elderly age (55 years old) is 232.2 times; this can be caused by the slow response of the antibody production to deficiency of Vitamin D in the elderly.[60],[61] The lack of Vitamin D has been associated with a slow reaction to the vaccination.[62] Vitamin D has a benefit in determining antibody production.[63] The human body always has a regulation to fulfill the Vitamin that the body needs. Specific T-cells on COVID-19 vaccination can stay in our body for 3 until 6 months.[58] The dose length of AstraZeneca 1 and 2 is 3 months; when the second dose of the vaccine is injected into elderly participants' bodies, the Vitamin D is already in a steady state which causes the rapid increase of the titer antibodies in the elderly.[58]

  Conclusions Top

Age, comorbidity, smoking, alcohol, and exercise contributed to the increase in titer antibody 2 value of the AstraZeneca vaccine participants. Most had anemia at around 30 years old and a BMI of around 23.33. The eldest group (>55) had the highest increase in antibody titer compared to the younger groups. Still, the value of antibody titer 1 for this group is the lowest compared to others, only 0.81. Hence, participants in the age group <35 years have an excellent immune system due to an increase of antibody titer of 5.7 times, with the value of antibody titer 1, 42.75 U/ml and antibody titer 2, 244.05 U/ml.

Research approval institutional review and board statement

Before data collection, ethical approval was submitted, which was then issued received by the Health Research Ethics Committee of the Esa Unggul University Jakarta with the ethical number: 0153-21.153/DPKE-KEP/FINAL-EA/UEU/VI/2021.

Informed consent statement

All patients who fulfilled the inclusion criteria signed the informed consent before conducting the research.

Data availability statement



We would like to acknowledge UTA'45 Jakarta Vaccine Center for their support in this research.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]


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