Updated April 28, 2021
On April 23, the CDC’s ACIP voted to reaffirm its recommendation for the administration of the Janssen (Johnson & Johnson) vaccine under the FDA’s EUA for individuals aged 18 and older. The administration of the vaccine had been paused to allow for further analysis of cases of Thrombosis with Thrombocytopenia Syndrome (TTS) that were associated with individuals of the J&J vaccine. These events are rare with only 15 cases identified in almost 7 million doses of the vaccine.
The ACIP determined the potential benefits of vaccination to prevent morbidity and mortality from COVID-19 outweighed the potential risk of TTS. No cases have been reported among individuals who have received the Pfizer/BioNTech or Moderna vaccines. The CDC has updated its clinical considerations for the Janssen vaccine and the EUA fact sheets for clinicians and patients have been revised to include information on TTS. An MMWR was published with details on the identified cases of TTS, in addition to a benefit-risk analysis that informed the CDC in reaffirming the recommendation for use of the Janssen vaccine under the EUA. The AAFP has additional information on our Johnson & Johnson vaccine update web page, as well as a revised safety and efficiacy overview.
If Patients Have TTS Symptoms: While these events are infrequent, CDC is recommending individuals who receive the Janssen vaccine seek urgent medical care if they have symptoms including severe or persistent headache, blurred vision, severe abdominal pain, chest pain, shortness of breath, leg swelling, petechiae or bruising. Treatment with non-heparin products is recommended for individuals with TTS who received the vaccine. Detailed guidance for clinicians can be found in the CDC’s clinical considerations.
To date, no COVID-19 vaccine candidates have been approved (licensed) by the FDA. The FDA issued emergency use authorizations for three vaccines. EUAs were given for mRNA vaccines from Pfizer/BioNTech and Moderna in December 2020. The third EUA was issued on February 27, 2021 for the Janssen (Johnson & Johnson) COVID-19 vaccine, which uses a non-replicating adenovirus vector. Read more.
All three of the authorized COVID-19 vaccines have been recommended by the CDC’s Advisory Committee on Immunization Practices, which was reviewed and approved by the AAFP. All three vaccines are effective at preventing COVID-19 disease, hospitalizations and death. Encourage your patients to take the first vaccine available to them. Reference the updated efficacy and safety data overview, plus resources and patient education from the FDA and the CDC’s ACIP.
View the CDC's Interim Clinical Considerations for information on the different vaccines, including clinical considerations, preparation and storage.
Virus mutations are common, so it's not surprising that SARS-CoV-2 variants have been detected. The CDC is monitoring these variants and tracking their spread across the U.S., as well as the effect on infection and disease. Researchers are also rapidly checking vaccine effectiveness against the different variants.
It is important to note that all the variants appear to have increased efficiency in spreading from person to person so the use of mitigation measures like masks, ventilation, hand washing, physical distancing, and quarantine are paramount.
A Variant Classification scheme that defines three classes of SARS-CoV-2 variants has been developed and information for the different variants is provided at the links below:
The B.1.1.7, B.1.351, P.1, B.1.427, and B.1.429 variants circulating in the United States are classified as variants of concern. Use the CDC's map to see where the different variants are found in the U.S.
The CDC and other federal agencies are working to distribute vaccine doses to states and jurisdictions. At this time, limited vaccine quantities are available, so vaccine appointments may be difficult to find as more states open slots to all eligible individuals.
CDC has provided a vaccine finder to assist in finding locations with available vaccine at . Additionally, many jurisdictions have provided phone numbers to aid individuals without access to internet.
Interested in how we're advocating on vaccine distribution issues? The AAFP is working to ensure that family physicians are prioritized in federal and state vaccine strategies. Learn more about these efforts on our Vaccines and Immunizations Advocacy Hub.
Additionally, the CDC has issued updated guidance on quarantining after an exposure for vaccinated individuals. Note that while mRNA COVID-19 vaccines have demonstrated high efficacy at preventing severe and symptomatic COVID-19, there is currently limited information on how much the vaccines might reduce transmission and how long protection lasts. In addition, the efficacy of the vaccines against emerging SARS-CoV-2 variants is not known.
At this time, vaccinated persons should continue to wear a mask, practice physical distancing, practice hand hygiene and other public health measures. However, vaccinated persons with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet all of the following criteria:
Persons who do not meet all three should continue to follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19.
The FDA released guidance for manufacturers to request approval for EUA of a COVID-19 vaccine. The standards for EUA for the vaccine will be stricter than those for other products and vaccine candidates must meet prespecified efficacy and safety data with at least two months of follow up. Additionally, under an EUA, the FDA will continue to collect safety and efficacy data as the vaccine is made available to the public. All data will be reviewed by experts in vaccinology and the CDC’s Advisory Committee in Immunization Practices.
Find a list of other vaccine candidates and phase of development in a World Health Organization report.
AAFP member, Jennifer Middleton, MD, MPH, also wrote a blog on what's ahead with additional vaccines in "Here come the COVID vaccines".
The American Medical Association published the first set of COVID-19 vaccine and administration codes. Their unique structure allows for tracking and accommodating multiple COVID-19 vaccines.
Check out information on the CDC's COVID-19 site, including:
Expect updates to this site, plus CDC’s Vaccination and Immunization site, as more information is available. It's critical that jurisdictions and federal entities receiving vaccine have information to implement an effective COVID-19 vaccination program.