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What to know if you got Johnson & Johnson's COVID vaccine

J&J is still available, but people should opt for Pfizer or Moderna's COVID-19 vaccine instead, the CDC says, citing safety concerns. Here's what to know.

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For the most up-to-date news and information about the coronavirus pandemic, visit the WHO and CDC websites.

People should get Moderna's or Pfizer's vaccine instead of Johnson & Johnson's, the US Centers for Disease Control and Prevention recommended Thursday. However, shots of J&J will still be available for those who prefer it or can't take the other vaccines for whatever reason. 

The recommendation followed a meeting with a committee of scientists and doctors that advises the CDC discussing continued concerns of a rare but dangerous blood-clotting disorder associated with J&J that isn't linked to the other vaccines. Given the safety, effectiveness and wide availability of Moderna's and Pfizer's vaccines in the US, members of the committee decided to make the recommendation. Adults who originally got the one-dose shot should choose Pfizer or Moderna as a booster or as their second dose, the CDC says. 

Since its pause in April over the same disorder, which has been fatal in nine cases, additional information revealed that the blood clots, called thrombosis with thrombocytopenia syndrome (TTS), occur more frequently and in more age groups than previously understood (though it's still rare overall, women ages 30 to 49 are at highest risk). Countries such as Canada and the United Kingdom have made similar calls about AstraZeneca's vaccine, which is the same viral vector vaccine type as Johnson & Johnson and associated with the same side effect. 

In a statement Thursday, Johnson & Johnson said the company "remains confident in the overall positive benefit-risk profile of its COVID-19 vaccine." 

"The safety and well-being of those who use the Johnson & Johnson vaccine continues to be our number one priority," Dr. Mathai Mammen, the global head of research and development said in the statement. "We appreciate today's discussion and look forward to working with the CDC on next steps."

Although Johnson & Johnson is still available in the US and will keep its emergency use authorization from the US Food and Drug Administration, the CDC's decision to say officially that Moderna's and Pfizer's vaccines (both two-dose mRNA vaccines) are superior may reduce confidence in Johnson & Johnson's vaccine in other countries where it's either the only option or the most widely used vaccine. As the US rushes to boost its population for maximum protection against the omicron variant, as few as 7.6% of people in low-income countries have had a dose of a COVID-19 vaccine.

Fewer people in the US have received Johnson & Johnson's vaccine than an mRNA vaccine -- between 16 million and 17 million compared with the hundreds of millions of people that originally got Pfizer's or Moderna's vaccine. If you're one who got the J&J, here's what to know about the latest recommendation.

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The definition of "fully vaccinated" hasn't changed. You're considered fully vaccinated after two doses of Moderna's or Pfizer's vaccine, or one dose of Johnson & Johnson's.

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Should I be worried about blood clots if I got J&J? What are the symptoms? 

If you got your Johnson & Johnson shot more than four weeks ago, you are not at increased risk of side effects, CDC Director Dr. Rochelle Walensky tweeted. So, if you got your Johnson & Johnson shot months ago, there is no cause for concern. Symptoms of the blood-clotting disorder typically appear within one to two weeks after receiving the vaccine, according to a fact sheet by the FDA

Although cases of the blood-clotting disorder that occurs after vaccination with Johnson & Johnson's and AstraZeneca's vaccine are rare and have occurred in men and women (according to one of Thursday's CDC presentations, 54 cases in the US were reported through August out of millions of doses given), the risk is higher for women ages 30 to 49, occurring in one in 100,000 women. 

The vaccine-induced blood clots, TTS, also require different treatment and appear to be more fatal than other blood clots that can happen in people more at risk because they take birth control pills, for example. Cases of TTS after vaccination have been fatal in 15% of cases, the FDA says, or about one in seven people. All cases of TTS required hospitalization or ICU admission, nine people have died and some needed to be treated at a post-acute care facility after their hospitalization.  

If you received Johnson & Johnson within the last few weeks, know that TTS is a rare event, but symptoms of it include: blurred vision, intense headache, shortness of breath, changed mental status, chest pain, persistent abdominal pain, leg swelling, weakness on one side of the body and easy bruising or tiny blood spots away from the injection site, according to CDC information. If you experience symptoms, seek medical care immediately. Again, women under age 50 have a higher risk. 

Another side effect people might be at increased risk of following vaccination with Johnson & Johnson is Guillain-Barre syndrome, an autoimmune disorder that can also be triggered by viruses. According to a July presentation by a CDC committee, 98 cases of the syndrome were reported, and one person died. In general, Guillain-Barre is more common in men and adults over 50, according to the CDC. 

What booster should I choose if I got Johnson & Johnson? 

You should get a Pfizer or Moderna booster, the CDC says, at least two months after your Johnson & Johnson vaccine. This "mix and match" approach for COVID-19 boosters was authorized by the FDA after early studies from the US and other countries found it's safe and effective. In fact, some research shows that people who originally got J&J's shot have a better response to Moderna's and Pfizer's booster than to another shot of Johnson & Johnson. 

Boosters are recommended for everyone age 16 and up for maximum protection against the omicron variant, which appears to lower the effectiveness of all the COVID-19 vaccines, as well as protection from past COVID-19 infections. 

Preliminary research from a virologist in South Africa suggests that while Johnson & Johnson appears to lose its antibody protection against omicron, real-world evidence suggests it still provides protection against severe disease and death. (There are more measures to immunity than antibody response.) Johnson & Johnson said in late November the company is testing the vaccine against the new variant. 

However, you can still receive Johnson & Johnson's booster if you choose. The reason that the CDC is now recommending Pfizer and Moderna over Johnson & Johnson is because neither mRNA vaccine carries the rare but dangerous side effect, and both also appear to be more effective than J&J. What's more, vaccines are widely available in the US now, unlike earlier in the pandemic when the public health advice was to get whatever vaccine you could as soon as you could. (According to a Thursday CDC release, there are nearly 100 million doses of mRNA vaccines "in the field for immediate use.")

"Today's updated recommendation emphasizes CDC's commitment to provide real-time scientific information to the American public," Walensky said in a statement. "I continue to encourage all Americans to get vaccinated and boosted." To find a booster near you, text your ZIP code to 438829 and read this article

Unvaccinated Americans remain at high risk of severe COVID-19 and death. According to CDC data covering September, unvaccinated people were 14 times more likely to die from COVID-19 than fully vaccinated people. 

But don't we need J&J? 

Johnson & Johnson's vaccine is easier to store than Pfizer's and Moderna's vaccines. It's also the only one-dose COVID-19 vaccine authorized by the FDA, which has made it an attractive option to give out in places such as homeless shelters, prisons, airport vaccine clinics and to people living in "hard-to-reach" communities who may not be able to show up for a second dose. Also, it's an alternative to mRNA vaccines, which has contributed to vaccine hesitancy in some people (the new CDC guidance doesn't mean you can't get J&J now). 

However, some experts on the CDC panel questioned Johnson & Johnson's status as a one-doser as a reason to recommend the vaccine, given that everyone who received it is being told to get a COVID-19 booster sooner than those who got Moderna or Pfizer because of its lower effectiveness. If people living in communities that don't have as much access to health care continue to be given a vaccine scientists say isn't as good, it could worsen health care inequities in the country. 

"It's not all about ease," pediatrician and CDC committee member Dr. Pablo Sanchez said Thursday. "It is not a single-dose vaccine anymore." 

Even if the CDC's new guidance for Johnson & Johnson's vaccine levels the playing field in the US, it may contribute to problems abroad. CDC members also raised questions Thursday about how the US' recommendation on Johnson & Johnson will impact distribution around the world. 

"We are fortunate to have other vaccines available," said Lynn Bahta, a CDC committee member and immunization program clinical consultant.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.