Infectious Disease

ACIP recommends mRNA vaccines over J&J vaccines

December 16, 2021

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The Advisory Committee on Immunization Practices voted 15-0 for a statement stating that mRNA COVID-19 vaccines are preferred over the Johnson & Johnson COVID-19 vaccine in people 18 years of age and older.

The CDC committee made the recommendation after considering new data. Specifically, they discussed a study of 54 cases of thrombosis with thrombocytopenia syndrome (TTS) after vaccination with the J&J syringe, which disproportionately affected women who received them.

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Current knowledge

Isaac Lake, MD, of the National Center for Emerging and Zoonotic Infectious Diseases, presented a study examining 54 cases of thrombosis with TTS following COVID-19 vaccination with a single dose of the J&J vaccine between March 2 and August 31, 2021.

A total of 3.83 TTS cases per million doses were reported. The mean age of those vaccinated was 44.5 years (range 18 to 70 years) for 37 men and 17 women. In addition, 26 (48%) women were younger than 50 years and 29 (54%) of the cases had cerebral venous sinus thrombosis (CVST).

The highest rates of TTS after J&J vaccination occurred in women aged 30 to 39 years (n = 11; 10.6 cases per million) and in women aged 40 to 49 years (n = 10; 9.02 Cases per million).

The median time from vaccination to onset of symptoms was 9 days (range, 0 to 18 days). All patients were hospitalized and the median time from onset of symptoms to admission was 5 days (range, 0 to 30 days).

In addition, 36 of the patients were admitted to the intensive care unit, with nine patients discharged into post-acute care facilities, 37 discharged home, and eight dying in the hospital.

The average age of the deceased was 45 years (range 28 to 62 years), of whom seven were women and two were men. The highest death rates included women aged 30 to 39 years (n = 2, 1.93 cases per million) and women aged 40 to 49 years (n = 2, 1.8 cases per million).

The underlying medical conditions included obesity (n = 7), hypertension (n = 3), diabetes (n = 2), iron deficiency anemia (n = 2), hypothyroidism (n = 4), and others (n = 4). All deaths had features of severe CVST and seven were confirmed with CVST.

Benefits and Risks

Sara Oliver, MD, who heads the ACIP COVID-19 Vaccine Working Group, presented a risk-benefit assessment and overview of the J&J vaccine. Its benefits include the flexibility and choice it offers patients, as well as its use in harder-to-reach populations.

The effectiveness against COVID-19 hospital admissions was also 73% in 18 to 49 year olds, 69% in 50 to 64 year olds and 76% in 65 year olds and older, Oliver reported.

In particular, the J&J vaccine prevented 3,729 COVID-19 hospitalizations per million doses in women ages 18 to 49, although it also resulted in nine hospitalizations for TTS and Guillain-Barre Syndrome (GBS).

However, when compared to mRNA COVID-19 vaccines, the J&J vaccine prevented fewer COVID-19 hospitalizations, intensive care stays, and deaths, and carries greater risks associated with TTS and GBS.

Oliver noted that discontinuing the J&J vaccine because of these risks would have a negative impact on supply, access to vaccines and confidence in vaccination, with a disproportionate impact on disadvantaged populations.

Education about these benefits and risks would help patients, Oliver said.

When alternative COVID-19 vaccines do not exist, or when mRNA vaccines are contraindicated, the benefits of the J&J vaccine outweigh its risks. But if mRNA vaccines are available, such vaccines would be preferable to the J&J vaccine, Oliver said.

After six cases of post-vaccination blood clots were reported on April 13, the CDC and FDA recommended suspending the launch of the J&J vaccine. They canceled the break on April 21st.

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