Health providers should offer the Moderna and Pfizer COVID-19 vaccines rather than Johnson & Johnson’s because of an increased risk of blood clots in young and middle-aged women, the Centers for Disease Control and Prevention (CDC) said Thursday.

CDC Director Rochelle Walensky adopted the unanimous recommendation from the agency’s Advisory Committee on Immunization Practices. The panel voted 15-0 that the mRNA vaccines are preferred to the J&J vaccine, but many members wanted stronger language.

The so-called “preferential” recommendation from the panel does not necessarily put any limitations or restrictions on the Johnson & Johnson vaccine. Instead, it gives individuals the ability to make a decision for themselves.

Panelists said the recommendation was not based on the efficacy of the vaccine, but instead on safety. Johnson & Johnson’s shot will still be recommended in cases where people cannot access a different brand or if people want it despite the risk.

The vaccine has been linked to a rare but severe type of blood clot — Thrombosis with Thrombocytopenia Syndrome (TTS) — which led to the product’s pause for 10 days last April. Health officials examined the cases, which were found in just six women out of more than 7 million doses administered. 

On Thursday, CDC officials presented new data that showed higher incidences of the clotting disorder. Through Aug. 31, 54 people who received a single dose of the Johnson & Johnson shot were diagnosed with the condition, out of about 14 million shots administered.  Overall, the rate of the condition was 3.8 cases per 1 million people; still rare, but more common than previously thought.

Of all the people recipients diagnosed with the condition, CDC said 36 were admitted to an intensive care unit. Eight of them died. Since September, a ninth person has died. Seven of the patients were women, and the average age was 45 years old.

The CDC’s recommendation is another blow to J&J, which has struggled to gain a foothold in the U.S. and is much more popular overseas. Usage dropped considerably after the 10-day pause was lifted, and reports about lower effectiveness also served to tamp down usage.

The company’s single-dose vaccine was initially heralded as a game changer, especially for hard-to-reach populations like migrant workers, prisoners, the homebound and people experiencing homelessness. Health officials encouraged people to take whichever vaccine was available to them, especially as initial supplies of all three vaccines were scarce and all three have strong protection against severe disease.

But the situation is different now, and the U.S. has more than enough supply of both Pfizer’s vaccine and Moderna’s. Still, the CDC panel acknowledged the decision could have an impact on overall vaccine confidence.

Penny Heaton, global head of vaccines for Janssen, J&J’s vaccines division, told the panel that the clotting risks are small, and the company’s vaccine is still effective at preventing severe disease and death. Studies have shown two doses of the vaccine may even offer more lasting protection than the mRNA vaccines.

“Efficacy against severe disease matters. Durability matters,” Heaton said. “TTS continues to be a rare event, but, unfortunately, cases of COVID-19 are not – in fact, they are surging in the U.S. and around the world.”

Isaac See, a CDC doctor on the agency’s vaccine safety team, told the panel the rate at which the clotting condition would normally be expected in the general population is not known.

The recommendation is only aimed at people who have not yet been vaccinated. About 16 million people have received a single dose of the Johnson & Johnson vaccine so far, and none of the cases were found in people who have received a booster dose.

However, See noted the number of people who’ve received a booster dose of J&J is very small— only about 1.5 percent of the boosted population. The CDC in October recommended that anyone who received the J&J vaccine should get a second dose of any vaccine they want. 

Updated: 8:45 p.m.

Tags CDC Coronavirus Johnson & Johnson COVID-19 vaccine Rochelle Walensky

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