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Johnson & Johnson for men only?

How quickly things are changed...

We were supposed to receive J&J vaccine and help in the effort to vaccinate more Mainers. As most of you know, this vaccine was put on pause on April 13th after multiple cases of thrombosis with thrombocytopenia (TTS, blood clots in the setting of low platelets that increased risk of bleeding). Specifically, there is concern for cerebral venous sinus thrombosis (CVST) in young women. The original estimate was 6 cases in 6.8 million or 1 in a million. This may not sound significant. As with most new findings, it spurs more cases to be reported. The CDC is evaluating the risk of all blood clots with low platelets or thrombosis with thrombocytopenia. Out of 8 million doses given in the US, 15 cases were identified.

- 13/15 were less than 50 years old with an average age of 37

- 2/15 were on birth control pills (which is an increased risk for blood clots)

- 3/15 have died

- 7/15 remain hospitalized, 4 in critical condition

These numbers make you think the risk is 2 in 1 million. More importantly, the risk of TTS in women less than 50 years old is 1 in 80,000 patients. This is not insignificant. Now the vaccine will be resumed. Should women be wary? My answer is yes.

For all of you that received it already, you will most likely be fine. Almost all of these diagnoses occurred within 2 weeks of vaccine administration.

What is CVST?

- Cerebral vein sinus thrombosis is a blood clot in the cerebral vein that prevents proper drainage of blood from the brain. It is treated with anticoagulants. The scary part is most women are found to have low platelets (that help them clot) and this can increase risk of bleeding. Even with this, we still treat with anticoagulants and this leads to the increased severity of this condition. CVST should not be compared to deep vein thrombosis.

What are the symptoms of CVST?

- Headache, blurred vision, dizziness, N/V

- Severe: Stroke symptoms - abnormal speech, loss of control of limbs

The CDC estimated that for every 1 million doses of this vaccine given in the under-50 female group, it would prevent 657 hospitalizations and 12 deaths. In women over 50, a million doses would prevent 4,794 hospitalizations and 593 deaths (Washington Post).

In medicine, we must consider risks and benefits of all treatments. For older Americans and all males, J&J appears safe and the benefits are worth the risks. For women under 50, who already have a low risk of developing severe COVID, these risks are too great to recommend this vaccine when there are 2 other vaccines that do not impose that risk.

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