ACIP unanimously approves preference for mRNA vaccines over J&J for all adults unless contraindicated in light of the new data update on Thrombosis with Thrombocytopenia Syndrome (TTS). The TTS risk appears to be heightened beyond young women.
If you can safely get mRNA vaccines, don't get J&J for your primary series or booster.
Big blow to J&J and AstraZeneca. The FDA believes this is a class-wide problem affecting all adenovirus vector vaccines. I hope this doesn't derail their global production as they are filling important gaps in vaccine supply in the developing world and some people will only get vaccinated if they can get J&J.
The new data indicates TTS is occurring at higher rates and among wider age groups and sexes than previous data. The main risk still is in women between 30-49, but it looks to be affecting all age groups and both sexes. For the main risk group, women 30-49, it is occurring at rates of ~1 in 100k doses. But women 18-29 and 50-64 and men 40-49 are also seeing it at rates of ~1 in 250k.
The cost benefit of J&J is still net positive, but compared to the mRNA vaccines the cost benefit is worse. Myocarditis associated with the mRNA vaccines fully resolves in over 90% of people at 3 month follow-up, 0 vaccine-associated myocarditis deaths reported, and the mRNA vaccines have higher effectiveness against hospitalization and death.
No data for J&J boosters and TTS rates yet.
J&J has niche use cases that are important with regard to transient/transitional settings like homeless shelters, prisons, and airports. And due to its ease of use, low cost, basic storage, and ease of manufacturing it is an important vaccine for the developing world.