Does BNT Vaccine Affect ESR Levels in Patients with Inflammation?

Will the ESR value increase after receiving the BNT vaccine?

Hello Doctor! My son is 18 years old and has stiffness.
Over the past year, his CRP/ESR levels have been as follows:
- 2021/03/31: CRP - 9.6 / ESR - 36
- 2020/12/22: CRP - 11.8 / ESR - 36
- 2020/11/24: CRP - 16.2 / ESR - 38
- 2020/10/30: CRP - 17.1 / ESR - 37
- 2020/09/15: CRP - 17.8 / ESR - 36
However, he received the BNT vaccine 1.5 months ago (on 2021/09/28), and during his follow-up appointment for stiffness on 2021/11/17, his CRP was 6.7 and ESR was 45.
While the CRP has improved, the ESR has increased.
Could this be related to the BNT vaccination? How should we interpret the improvement in CRP alongside the increase in ESR? Does this indicate that inflammation has worsened, or is it unrelated? Thank you for your assistance.

Xiao Zhen, 40~49 year old female. Ask Date: 2021/11/19

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Firstly, it is recommended not to monitor CRP and ESR too frequently; generally, checking them every three months is sufficient.
These two values naturally fluctuate, and frequent monitoring can lead to difficulties in interpretation and unnecessary anxiety.
Furthermore, both CRP and ESR are inflammatory markers.
Compared to ESR, CRP directly measures a specific protein in the blood that reflects the current inflammatory state of the body; ESR, on the other hand, can be influenced by external factors, which may not accurately represent the patient's current inflammatory status, leading to occasional discrepancies between the two.
Additionally, the interpretation of CRP and ESR should be considered alongside the patient's symptoms and should not be used as the sole basis for assessment.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2021/11/19

More Info

The relationship between the BNT vaccine (Pfizer-BioNTech COVID-19 vaccine) and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) is a complex topic that requires careful consideration of various factors. In your case, it appears that your son, who has ankylosing spondylitis, experienced a decrease in CRP levels but an increase in ESR after receiving the BNT vaccine.
CRP and ESR are both markers of inflammation in the body, but they reflect different aspects of the inflammatory process. CRP is a protein produced by the liver in response to inflammation, and its levels can rise quickly in response to acute inflammation. ESR, on the other hand, measures how quickly red blood cells settle at the bottom of a test tube; it can be influenced by various factors, including the presence of certain proteins in the blood, and may not always correlate directly with CRP levels.

In your son's case, the decrease in CRP levels suggests that there may have been a reduction in acute inflammation, which is a positive sign. However, the increase in ESR could indicate that there are still underlying inflammatory processes at play, or it could be a result of other factors unrelated to the vaccine. For instance, ESR can remain elevated for some time after an inflammatory episode has resolved, or it can be influenced by other conditions, such as anemia or chronic diseases.

Regarding the potential impact of the BNT vaccine on ESR levels, current evidence does not strongly support a direct correlation between COVID-19 vaccination and significant changes in ESR. Vaccines can elicit an immune response, which may temporarily affect inflammatory markers, but these changes are typically transient and should not be interpreted as a worsening of the underlying condition.
In the context of your son's health, it is essential to consider the overall clinical picture. The improvement in CRP is encouraging, and it may indicate that the vaccine has had a beneficial effect on his inflammatory status. However, the elevated ESR should be monitored, and it may warrant further investigation to rule out any other underlying issues.

It is advisable to discuss these results with your son's healthcare provider, who can provide a more comprehensive assessment based on his medical history and current condition. They may recommend additional tests or adjustments to his treatment plan if necessary.
In summary, while the BNT vaccine may have some effects on inflammatory markers, the changes in CRP and ESR should be interpreted in the context of your son's overall health and disease management. Continuous monitoring and open communication with his healthcare team will be crucial in managing his condition effectively.

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