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Pause ordered on Johnson and Johnson vaccine

QUESTIONS — A nurse fills a syringe with a dose of the Johnson & Johnson's one-dose COVID-19 vaccine at the Vaxmobile, at the Uniondale Hempstead Senior Center, March 31 in Uniondale, N.Y. — Associated Press

WASHINGTON — Ohio Gov. Mike DeWine and W.Va. Gov. Jim Juctice have called for a pause in all Johnson & Johnson vaccine administration according to the recommendation Tuesday by the Centers for Disease Control and Prevention and the Food and Drug Administration.

DeWine, Ohio Department of Health Director Stephanie McCloud and Ohio Department of Health Chief Medical Officer Dr. Bruce Vanderhoff are advising all Ohio vaccine providers to temporarily pause using the Johnson and Johnson (Janssen) vaccine.

Justice said the action was needed to ensure the safety of those who were seeking to be vaccinated.

“This pause will not impact our ability to continue vaccinating West Virginians, and is exactly the reason why we stood up our Joint Interagency Task Force led by our West Virginia National Guard. They were absolutely ready for this scenario,” Justice said.

The U.S. is recommending a “pause” in administration of the single-dose Johnson & Johnson COVID-19 vaccine while an investigattion is completed into reports of potentially dangerous blood clots.

In a joint statement Tuesday, the Centers for Disease Control and Prevention and the Food and Drug Administration said they were investigating unusual clots in six women that occurred 6 to 13 days after vaccination. The clots occurred in veins that drain blood from the brain and occurred together with low platelets. All six cases were in women between the ages of 18 and 48.

The reports appear similar to a rare, unusual type of clotting disorder that European authorities say is possibly linked to another COVID-19 vaccine not yet cleared in the U.S., from AstraZeneca.

More than 6.8 million doses of the J&J vaccine have been administered in the U.S., the vast majority with no or mild side effects.

U.S. federal distribution channels, including mass vaccination sites, will pause the use of the J&J shot, and states and other providers are expected to follow. The other two authorized vaccines, from Moderna and Pfizer, make up the vast share of COVID-19 shots administered in the U.S. and are not affected by the pause.

CDC’s Advisory Committee on Immunization Practices will meet Wednesday to discuss the cases and the FDA has also launched an investigation into the cause of the clots and low platelet counts.

“Until that process is complete, we are recommending a pause in the use of this vaccine out of an abundance of caution,” Dr. Anne Schuchat, principal deputy director of the CDC, and Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a joint statement.

They are recommending that people who were given the J&J vaccine who are experiencing severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after receiving the shot contact their health care provider.

U.S. health authorities cautioned doctors against using a typical clot treatment, the blood-thinner heparin. “In this setting, administration of heparin may be dangerous and alternative treatments need to be given,” the FDA and CDC said.

Also Tuesday, Johnson & Johnson said it would delay the rollout of its coronavirus vaccine in Europe as a result of the recommended paue in the United States.

“We have been reviewing these cases with European health authorities,” the company said. “We have made the decision to proactively delay the rollout of our vaccine in Europe.”

Hundreds of thousands of doses of the vaccine were due to be shipped to Europe in the coming weeks.

The European Medicines Agency, the EU’s equivalent to the FDA, said it had already started reviewing the Johnson & Johnson vaccine to assess reports of blood clots in people who received the shot.

“These reports point to a ‘safety signal,’ but it is currently not clear whether there is a causal association between vaccination” with the Johnson & Johnson shot, it said. Experts were “investigating these cases and will decide whether regulatory action may be necessary,” it added.

Johnson & Johnson said it was aware of the reports of “thromboembolic events,” or blood clots, but that no link to its vaccine had been established.

“We are aware that thromboembolic events including those with thrombocytopenia have been reported with Covid-19 vaccines,” said Johnson & Johnson in a statement. “At present, no clear causal relationship has been established between these rare events and the Janssen Covid-19 vaccine.”

States swiftly moved Tuesday morning to implement the pause. New York state health commissioner Dr. Howard Zucker said the state will follow the recommendation and pause the use of the Johnson & Johnson vaccine at state-run sites. People with Tuesday appointments for Johnson & Johnson vaccines at state-run mass vaccination sites will instead get the Pfizer vaccine, he said.

The city of Dallas had planned to begin an in-home vaccination program Tuesday using the Johnson & Johnson vaccine for homebound or elderly people. The city, citing the FDA announcement, said it will pause the program until more guidance is released.

In Mississippi, state health officer Dr. Thomas Dobbs, said Tuesday on Twitter that the state health department is “instructing all physicians, clinics and hospitals to refrain from using Johnson and Johnson until additional guidance (is) available from CDC/FDA.”

The J&J vaccine received emergency use authorization from the FDA in late February with great fanfare, with hopes that its single-dose and relatively simple storage requirements would speed vaccinations across the country. Yet the shot only makes up a small fraction of the doses administered in the U.S. as J&J has been plagued by production delays and manufacturing errors at the Baltimore plant of a contractor.

Last week the drugmaker took over the facility to scale up production in hopes of meeting its commitment to the U.S. government of providing about 100 million doses by the end of May.

Only about 9 million of the company’s doses have been delivered to states and are awaiting administration, according to CDC data.

Until now concern about the unusual blood clots has centered on the vaccine from AstraZeneca, which has not yet received authorization in the U.S. Last week, European regulators said they found a possible link between the shots and a very rare type of blood clot that occurs together with low blood platelets, one that seems to occur more in younger people.

The European Medicines Agency stressed that the benefits of receiving the vaccine outweigh the risks for most people. But several countries have imposed limits on who can receive the vaccine; Britain recommended that people under 30 be offered alternatives.

But the J&J and AstraZeneca vaccines are made with the same technology. Leading COVID-19 vaccines train the body to recognize the spike protein that coats the outer surface of the coronavirus. But the J&J and AstraZeneca vaccines use a cold virus, called an adenovirus, to carry the spike gene into the body. J&J uses a human adenovirus to create its vaccine while AstraZeneca uses a chimpanzee version.

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