Alaska providers pause use of Johnson & Johnson vaccine while feds investigate rare risk of blood clots

Abput a dozen glass vials on trays
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Alaska providers say they’re following the federal recommendation to pause use of the single-dose Johnson & Johnson COVID-19 vaccine while they figure out the clotting risk.

About 6.8 million doses have been administered in the U.S., and there are reports of six people getting a rare blood clot afterward, according to the federal Centers for Disease Control and Prevention.

None of the cases were in Alaska, said the state Department of Health and Social Services.

Alaska health officials said Tuesday they’ll be talking to all of the providers in the state offering the Johnson & Johnson vaccine about what symptoms to look for and what to do with the doses they currently have.

Pharmacist Coleman Cutchins said this type of issue with new drugs happens often because clinical trials are performed on just a few thousand people. Then, when the drug or vaccine gets to market and millions of people start taking it — rare side effects become clear.

“I remind people that Ibuprofen has a similar bleeding risk to this and it’s in the black box warning on the packaging,” he said.

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Charlee Gribbon, infectious disease preventionist from Bartlett Regional Hospital, left, and Adam Crum, Alaska Department of Health and Social Services commissioner, center, answer questions about coronavirus on March 5, 2020. (Photo by Rashah McChesney/KTOO)

The specific type of clot that the CDC is investigating is called a “cerebral venous sinus thrombosis” or CVST. It’s essentially in an area of the brain where, when the blood clots off, it can cause a lot of pressure to build. The symptoms can vary, but Providence Alaska Medical Center’s Dr. Lisa Rabinowitz said when it’s severe, symptoms are similar to a stroke.

“So headache, visual changes, dizziness, syncope or passing out, decreases coordination or weakness on one side, one arm one leg, seizures and even a coma,” she said.

One issue is that the go-to medication for these clots can make people sicker because they’re being seen in combination with low levels of blood platelets.

Rabinowitz said doctors and medical providers in Alaska need to know the different treatment options.

“So we’ll be getting that information out to providers throughout the next few days,” she said.

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The CDC’s principal deputy director, Dr. Anne Schuchat, told NPR that people who got a Johnson & Johnson shot more than a month ago are at low risk for developing a clot. But people who got one within the last few weeks should be on the lookout for symptoms like headache, abdominal pain and shortness of breath, and should seek medical treatment if they develop them.

The data the CDC released indicates that there may be about a one-in-a-million risk of blood clots. The agency told NPR that it expects the pause to last for a “matter of days.”

Juneau’s Emergency Operations Manager Robert Barr and Rebecca Embler, a member of Bartlett Hospital quality team during Juneau’s COVID-19 vaccine clinic at Centennial Hall on Jan. 15, 2021, in Juneau. (Photo by Rashah McChesney/KTOO)

Alaska’s state health department was scheduled to meet with many of the providers using the Johnson & Johnson shot on Tuesday afternoon.

Some health care providers said in interviews that they didn’t expect the pause on the single-dose vaccine to pose much of an issue.

A spokesperson for the Alaska Native Tribal Health Consortium said the group is following the guidance to halt use of the vaccine. But, she said, the Johnson & Johnson vaccine isn’t a big part of the organization’s vaccination plans because they had just started ordering it.

At Juneau’s city-owned hospital, Bartlett Regional, infection preventionist Charlee Gribbon said they’d given out 10 vials of the vaccine by the end of March. That’s about 50 doses.

This month, the hospital got 20 more vials and has used five of them so far, Gribbon wrote in an email.

So far, there haven’t been any adverse reactions, she said. But, for now, they’re not using the rest of the doses, and waiting for further direction. 

Gribbon said Bartlett hospital had been relying on the Johnson & Johnson vaccine for people who don’t like needles, who only want one shot or who want a vaccine that seems a little less experimental. 

Unlike the two-dose Pfizer and Moderna vaccines, the Johnson & Johnson vaccine is a viral vector vaccine. That means it uses an inactivated cold virus to stimulate the body’s response to COVID-19. It doesn’t contain live virus, so you can’t get COVID-19 from it. 

“It’s definitely fair to say that it’s a more traditional vaccine,” said Juneau Emergency Manager Robert Barr. 

Barr said the pause will impact people who have been specifically interested in the Johnson & Johnson 

“The needle phobia thing is significant,” he said. “There are people who have a sort of automatic response to needles and it’s not necessarily something they control.”

But, it won’t affect the city’s planning too much, he said. 

“I think that we’ve only just scheduled our first Johnson and Johnson clinic,” he said. It’s supposed to be on Friday. They’ve decided to switch that clinic to the Pfizer vaccine.”

There are a number of providers in the state listed as using the Johnson & Johnson vaccine in upcoming clinics. 

In Juneau, Barr said individual providers can trade in their Johnson & Johnson doses to the city for a different kind of vaccine. 

In Anchorage, the city health department is also pausing the use of the vaccine at its clinics.

“This is an extremely rare, literally a one-in-a-million occurrence, but we are taking it seriously,” said the city’s epidemiologist, Dr. Janet Johnston. “Please note, this is not a concern with either the Pfizer or Moderna vaccines and we continue to encourage everyone to get vaccinated with either of the two dose vaccines.”

The state health department says any upcoming appointments with the Johnson & Johnson vaccine are being canceled in Alaska.

As of Monday, at least 11,178 Johnson & Johnson doses were administered in the state out of the 35,500 doses allocated to Alaska so far, according to state data. Those doses have been delivered to a combination of sites like outpatient clinics, pharmacies, federally-qualified health centers, local public health authorities and health systems.

The data doesn’t include the doses administered by the Veteran’s Administration or Department of Defense.  

One thing that state and local health officials in Juneau are questioning is whether the rare event of a blood clot outweighs the benefit of getting large numbers of people vaccinated against COVID-19. 

Gribbon wrote that there are other types of commonly-used medications that have much higher risks — like some types of birth control. She said it’s important to know about the risks of contracting COVID-19 and of adverse reactions to a vaccination to make informed choices. 

“Yes, there may be something that is happening in a rare group of people,” she wrote. “And people should know how to recognize a clot and get treatment. We can treat a clot, and we can treat (COVID-19). But making an informed choice about known risks and how to manage them is what this is all about.”

Another concern is that the Johnson & Johnson pause will cause people who are already hesitant to get vaccinated for COVID-19 to be even less inclined to do it. 

“In terms of how we counter that, I think the biggest thing is really relaying the information,” said Dr. Joe McLaughlin, the state’s chief epidemiologist. “It’s really important to be as transparent as we possibly can as quickly as we possibly can so that the public realizes that we’re not holding anything back.” 

The CDC will meet on Wednesday to review the cases and the Food and Drug Administration is also continuing to investigate.