CDC Staff: One mRNA Dose Better Than J&J, Even Among Elusive Patients

Clinicians should not automatically give the Johnson & Johnson COVID-19 vaccine even if they suspect patients will not return for a second dose of mRNA vaccine, CDC staff said on a call with clinicians on Friday.

CDC’s Advisory Committee on Immunization Practices (ACIP) voted for a preferential recommendation for mRNA vaccines on Thursday due to the risk of thrombosis with thrombocytopenia syndrome (TTS) with the Johnson & Johnson vaccine.

However, there are exceptions, CDC staff noted, including for individuals with a contraindication to mRNA vaccines or severe allergic reactions to mRNA vaccines, individuals who would otherwise remain unvaccinated due to limited access to mRNA vaccines, and those who would prefer to receive the Johnson & Johnson vaccine.

“Being vaccinated is better than not being vaccinated,” Agam Rao, MD, of the CDC, told clinicians.

CDC staff also noted FDA’s change to its emergency use authorization (EUA) for the Johnson & Johnson vaccine, which states that the vaccine is contraindicated for any individual with a history of TTS following either the Johnson & Johnson vaccine or other adenovirus vector-based vaccines, such as AstraZeneca’s vaccine.

However, simply believing a patient will not return for a second dose of Pfizer or Moderna is not a good enough reason to give them the Johnson & Johnson vaccine. Sara Oliver, MD, of the CDC, explained that, many times, providers would give Johnson & Johnson vaccines to individuals who they suspected would not return for a second dose.

“I would give the first dose of mRNA vaccine … but we wouldn’t ever want someone to be offered the [Johnson & Johnson] vaccine strictly because there was a chance they wouldn’t come back,” she said.

Oliver suggested coming up with “creative ways” to get people to return, such as second dose reminders, and stressed the need for an “informed discussion” about the Johnson & Johnson vaccine.

Indeed, CDC staff emphasized that individuals who opt for a Johnson & Johnson vaccine should receive “pre-vaccination counseling,” in which they are informed about the risk and symptoms of TTS, especially symptoms in the first 2 weeks after vaccination, and are advised to seek immediate medical care if symptoms do develop.

CDC staff also clarified that those who received the Johnson & Johnson vaccine as a primary series should receive a booster dose at least 2 months later, and that should likely be with an mRNA vaccine, unless the patient requests otherwise.

However, they added that those vaccinated with the one-dose Johnson & Johnson vaccine are still considered “fully vaccinated.”

Given the CDC’s new recommendation, a few clinicians wondered what they were supposed to do with their stockpile of unused, but unexpired, Johnson & Johnson shots: get rid of them, donate them, or try to return them?

One member of the CDC staff advised clinicians that if they no longer want to use the vaccine, “keep it at an appropriate temperature, mark ‘do not use,’ and contact your local jurisdiction. We do not have a return program, so as we approach expiration, we will send out information on proper disposal.”