Editor’s note: The CDC on Dec. 16 embraced the ACIP’s referral “expressing a clinical choice for individuals to receive an mRNA COVID-19 vaccine end Johnson & Johnson’s COVID-19 vaccine. ACIP’s unanimous recommendation adhered to a robust discussion of the latest evidence on vaccine effectiveness, vaccine safety and also rare disadvantage events, and consideration of the U.S. Vaccine supply.”

ACIP’s deliberations came after the FDA amendment the fact sheets because that J&J COVID-19 vaccine providers and also recipients, i m sorry now encompass a contraindication for people with a history of thrombosis with thrombocytopenia (TTS) adhering to the J&J vaccine. Women 30–49 year old room at highest risk, v one in 100,000 emerging TTS ~ J&J vaccination. About one in seven instances has to be fatal.

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ACIP reaffirmed the “receiving any kind of vaccine is better than being unvaccinated. People who room unable or unwilling to get an mRNA vaccine will proceed to have access to Johnson & Johnson’s COVID-19 vaccine,” says the CDC statement.

After receiving emergency use authorization native the Food and Drug administration (FDA) and also recommendation indigenous the Centers for disease Control and Prevention (CDC), Johnson & Johnson-owned Janssen Pharmaceuticals ended up being the third company to do its coronavirus vaccine accessible in the country. The Johnson & Johnson (J&J) SARS-CoV-2 viral vector vaccine join mRNA vaccines made by Pfizer-BioNTech and Moderna to assist prevent an ext severe COVID-19 outcomes, consisting of hospitalizations and death.


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J&J’s one-shot vaccine for adults was another major step towards vaccinating countless people throughout the country. While its single-dose, easy-to-store logistical benefits make the an attractive option, it’s necessary to know what to intend with the Johnson & Johnson COVID-19 vaccine and the require for a booster shot.

The AMA’s What physicians Wish patient Knew™ series provides physicians with a platform to re-publishing what they want patients come understand around today’s health care headlines, particularly throughout the COVID-19 pandemic.

In this installment, 2 physician specialists took time come share what patients should know around the J&J vaccine. Castle are:

Mira Irons, MD, president and also CEO that the university of doctors of Philadelphia. In a front role, Dr. Irons served as cook health and also science officer at the AMA.
One dose is a full vaccine series

One sheep is a complete vaccine series


The J&J vaccine “is the very first authorized vaccine to need one dose instead of two,” said Dr. Irons throughout an illustration of the “AMA COVID-19 Update” around the Janssen COVID-19 vaccine.

“A Janssen vaccine collection is tho a solitary dose the vaccine it is designated in Janssen’s emergency use authorization native FDA,” said Dr. Fryhofer, a member that the AMA board of Trustees. “One dose is still thought about a full dose series for public health and wellness purposes, however now a booster is encourage at least two months later on for anyone 18 and older who has actually received a single Janssen dose.


associated Coverage Moderna and also J&J COVID-19 vaccine boosters: What doctors must understand

“Some experts say Janssen should have been a two-dose vaccine from the beginning,” she added. “When and also if Janssen receives full FDA approval, the one dose reference could change and possibly end up being two, however that has actually not happened yet and it might not. It will certainly be exciting to view what happens.”

Additionally, the J&J Janssen vaccine “can be stored at regular refrigerator temperatures and does not require dilution, which renders storage and administration easier,” Dr. Fryhofer explained. “Many clinicians had actually high really hopes of making use of this vaccine in difficult to with geographical areas. We require this vaccine as an option.”


There are three for sure vaccines

There space three for sure vaccines


“Don’t get captured up necessarily on the numbers game, due to the fact that it’s a safe and effective vaccine and what we require is to have as plenty of effective vaccines together possible,” stated Dr. Irons. Quite than focusing on efficacy rates, “accept the truth that now you have actually three highly effective vaccines.”

“We do have actually three safe and also highly effective COVID vaccines. COVID vaccines continue to maintain high protection against severe disease, hospitalization and also death,” said Dr. Fryhofer. “However, we are seeing breakthrough infections. It’s all around waning immunity—with time and also with the Delta variant, along with concern about vaccine effectiveness versus future variants the concern.

“Studies gift to FDA and also others the evaluation by ACIP display some waning of immunity with time,” she added. “For example, a recent study published in Sept. 28 MMWR looked in ~ COVID vaccine effectiveness versus hospitalization native mid-March through mid-August. VE—vaccine effectiveness—was higher for Moderna vaccine at 93% as compared to Pfizer-BioNTech vaccine in ~ 88%.”

“Pfizer vaccine effectiveness declined substantially from 91% down to 77%—at an ext than four months ~ the second vaccine dose. Moderna vaccine performance did no wane as much as Pfizer,” Dr. Fryhofer explained. “VE for both mRNA vaccines was greater than Janssen. Janssen’s solitary dose vaccine had the lowest vaccine effectiveness at 71%.

“Janssen protection is nice stable—it doesn’t wane together much, yet its vaccine effectiveness has never ever been approximately par with mRNA vaccines,” she added. “Janssen never ever made it approximately mRNA vaccine standards as soon as it concerned vaccine effectiveness, for this reason the booster reference for anyone who obtained Janssen should assist enhance that is protection.”

Read around what come tell her patients as soon as they ask which vaccine come get.


Everyone should get a booster shot

Everyone should get a booster shot


“For adults who obtain the Janssen vaccine, the time frame"s different” than booster shots for Pfizer-BioNTech and Moderna mRNA vaccines, defined Dr. Fryhofer during an illustration of the “AMA COVID-19 Update” about the brand-new mix and also match strategy because that boosters. “A booster is encourage at least two months after a single Janssen dose primary series. This applies to anyone 18 and also older who received it.

“This wide eligibility is as result of Janssen"s lower vaccine effectiveness as contrasted to mRNA vaccines. The an increase can assist increase Janssen vaccine effectiveness,” she added. “And to obtain a booster, it"s quiet the honor system. If people say they"re eligible, they can get it.”

For side impacts from the booster shot, “people must expect much more of the same—pain in ~ the injection site, headache, fatigue, muscle aches, fever, chills,” stated Dr. Fryhofer, adding that side effects “probably won"t be worse through one exception, tender swollen lymph nodes under the vaccinated arm.”

Additionally, “risk the vaccine-specific disadvantage reactions in specific age groups, as well as sex-based differences might be considered,” she said. “For example, Janssen vaccine has actually been linked to TTS—thrombosis through thrombocytopenia syndrome—in which rare types of blood coagulation in inexplicable places in addition to really low platelets.

“The TTS risk is greater in females under 50 and this is why some ACIP members to be concerned about young females receiving a 2nd Janssen vaccine dose and also push for the nonspecific language because that the type of booster allowed,” Dr. Fryhofer added, additionally noting that “Guillain Barré Syndrome, GBS, threat is greatest in males 50-64, in the 42-day window after the very first dose.”

Discover what doctors have to know around Moderna and J&J COVID-19 vaccine boosters.


Mixing and also matching is OK

Mixing and matching is OK


“The language CDC provides in the reference for the type of booster to provide is neutral and also vague. … the doesn"t point out what sort of booster come give, and also this is no an oversight,” stated Dr. Fryhofer. “The bottom line: girlfriend can rise with any type of authorized COVID vaccine.

“The booster doesn’t have to enhance the primary vaccine series type. This is called heterologous boosting,” she added. “On the various other hand, raising with the same type of vaccine as the one you originally received is referred to as homologous boosting. Either strategy is permitted.”


The “CDC and FDA acted quickly and also issued a joint statement recommending the pause,” Dr. Fryhofer said during a recent “AMA COVID-19 Update” episode about the J&J Janssen COVID-19 vaccine pause. The CDC also “released additional information v its health Alert Network,” i m sorry “could lead to more cases being reported as a an outcome of boosted awareness.”

Additionally, the CDC warned “that in this cases, heparin, a standard therapy for blood clots, could cause tremendous harm,” Dr. Fryhofer added, noting the the “CDC advises checking for platelet activating antibodies by act a platelet aspect four (PL4) antibody test.”

The “CDC advises versus heparin therapy if platelet factor four antibody test is positive,” she said. “If PL4 test is positive, usage of non-heparin anticoagulants and high dose intravenous immune globulin need to be considered. Hematology consultation is additionally advised.”

After a thorough review, ACIP lifted the J&J Janssen vaccine pause April 23.

AMA president Susan R. Bailey, MD, commended ACIP because that “reaffirming its reference on the usage of the Janssen COVID-19 vaccine” because that those 18 or older under the FDA’s emergency use authorization. “The population-level data presented during ACIP’s meeting … plainly demonstrates that the services of this strategy outweigh the risks,” she said.

“The pause on the Janssen COVID-19 vaccine has actually demonstrated the strength of our nation’s vaccine security monitoring system and also the transparent and also careful deliberations by the ACIP must raise confidence in FDA-authorized and also CDC-recommended COVID-19 vaccines,” Dr. Bailey added. “The AMA proceeds to encourage everyone who is eligible for COVID-19 vaccines to acquire vaccinated as shortly as possible.”

Discover what physicians should know around the J&J vaccine and brain blood clots.


Which symptoms to look for

Which symptoms to look at for


“After COVID vaccination, patients should expect flu-like symptoms, a mild to moderate headache, fatigue, fever, muscle aches,” Dr. Fryhofer said, noting the “these symptoms room expected and usually resolve within one to two days.”

There is additionally risk that a rare mind blood clot merged with low platelets—cerebral venous sinus thrombosis v thrombocytopenia, or TTS. These adverse events were identified through the Vaccine Adverse event Reporting System, i m sorry is jointly managed by the CDC and FDA. The highest reporting price is in 30–39-year-old females in ~ 21 work of vaccination and also occurs in ~ a price of 10 instances per million sheep administered.

“The hazard of this concerning combination of blood clots and also low platelets is rare however serious,” she said. “Patients who’ve had the Janssen vaccine need to seek prompt medical attention if they develop shortness of breath, chest pain, foot swelling, persistent abdominal pain, neurological symptoms including severe or persistent headache or blurred vision, or petechiae past the website of vaccination.

“Patients through these symptoms should contact their physician and seek medical evaluation,” Dr. Fryhofer added.

Additionally, the FDA update the fact sheet (PDF) for the J&J COVID-19 vaccine and added Guillain Barré Syndrome—a rarely disorder the occurs when a who immune mechanism damages nerve cells and also causes muscle weakness or paralysis—as a danger of the vaccine. The possibility of having this occur is really low and also the benefits of the vaccine outweigh the risks. Many cases emerged in males 50 and older about two weeks ~ J&J vaccination with raised risk during the 42-day window after vaccination.

Patients need to seek medical treatment if they construct weakness or study abroad sensations in the foot or arms that worsens and spreads to various other parts the the body. Various other symptoms come be responsibility of are challenge with walking, facial movements and bladder regulate or bowel duty as well as twin vision or i can not qualify to move their eyes.


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You have other vaccine choices

You have actually other vaccine choices


The FDA updated the J&J Janssen vaccine EUA (PDF) with an additional warning, noting the “women under 50 must be made aware of a rare risk of blood clots and low platelets complying with vaccination,” claimed Dr. Fryhofer. “They also need to understand there are various other COVID vaccines the end there that don’t posture this small risk.

“That empowers patient choice. That also method vaccination clinics have to make clear which vaccine or vaccines space being offered and when,” she added.

With the J&J Janssen vaccine, the benefits of the one-dose regimen far outweigh the risks. But, if civilization are worried, lock can accessibility Pfizer or Moderna COVID-19 vaccines. There have actually been much more than 180 million doses of mRNA vaccines through Pfizer and Moderna administered through no reports that cerebral venous sinus thrombosis with thrombocytopenia.

Discover what to tell her patients when they ask i m sorry COVID-19 vaccine they should get.


Adenovirus vector vaccines no new

Adenovirus vector vaccines aren’t new


“Janssen’s phase 3 clinical attempt included an ext than 40,000 participants. In addition, Janssen’s viral vector platform is supported by an even larger body of evidence, including an Ebola vaccine that"s already been tested in pregnant women and also children and also approved in Europe,” claimed Dr. Fryhofer. “More than 193,000 people—including patient of various ages and conditions—have to be vaccinated with miscellaneous investigational vaccines making use of this adenovirus platform.”

“The adenovirus vector vaccine offers a amendment cold virus—an adenovirus called Ad26—as the viral vector and also several genes have been gotten rid of from this virus,” she explained. “It’s replication deficient, so it can not multiply in the body.”

This way that “it cannot offer someone COVID-19,” said Dr. Fryhofer. “The agency says this safety and security sign imbalance—blood clots and low platelets—did not display up in the phase three trial or v their research study on other Ad26 based viral vector vaccines.

“However, in the phase 3 trial, one patient, a 25-year-old male, did suffer CVST, had low platelets and additionally had PF4 antibodies,” she added.


Expect the very same side effects

Expect the same side effects


Aside native the extremely rare blood clots and also risk of GBS questioned above, “the side effects for the J&J vaccine are very similar to those for the mRNA vaccines, consisting of injection-site pain, headache, fatigue, fever, chills and also muscle aches,” stated Dr. Fryhofer.

With many of the next effects arising within one to two days adhering to vaccination, Dr. Fryhofer recommends selecting a work or two once “you don’t have actually a lot of important stuff walking on, because you can not feel well.”

Learn much more from the AMA around what medical professionals wish patients knew about COVID-19 vaccination.


There is easier access

There is simpler access


Since the J&J vaccine no require chillier temperatures because that storage as the Moderna and also Pfizer vaccines do, “it’s an ext mobile, so it’s perfect for world who room homebound, that can’t—or won’t—go come a second appointment,” stated Dr. Fryhofer. “It’s also an excellent for world who move approximately a lot.”

“As i have talked to other physicians around this vaccine, one physician who gives health treatment for those in jails and also prisons said, ‘We have human being constantly comes in and also out that the system, it’s tough keeping track,’” she said. “So, this is one means we might give castle this vaccine and also feel good that castle now fully vaccinated. CDC’s mix and also match booster strategy enhances the versatility of keeping people protected.”


Tested in large, varied groups

Tested in large, diverse groups


As with the Moderna and Pfizer COVID-19 vaccine trials, the J&J vaccine to be tested v in big and varied populations the patients. Practically 44,000 world in south Africa, certain countries in southern America, Mexico and also the U.S. Took part in the J&J testing.

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“These vaccine manufacturers, once they’ve recruited participants, castle thinking about diversity,” stated Dr. Fryhofer. “They’re including civilization with different ethnicities and also different geographies. They additionally include both older and also younger people and also those v underlying medical conditions.”

The AMA has arisen frequently-asked-questions files on COVID-19 vaccination covering safety, allocation and also distribution, administration and more. There are two FAQs, one designed to answer patients’ questions (PDF), and another to deal with physicians’ COVID-19 vaccine questions (PDF).


Table of Contents


Table of components One sheep is a full vaccine series There are three safe vaccines everyone should obtain a booster shot Mixing and matching is yes Vaccine pause showed system’s strength Which symptom to look for You have other vaccine options Adenovirus vector vaccines aren’t new Expect the very same side effects There is easier accessibility Tested in large, varied groups