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Covid Vaccine Update: Johnson & Johnson

For those that have not read my first blog postings on the Covid Vaccine in pregnancy and breastfeeding, I suggest you start there and then return to this one for updates.  Since the last blogs, over 30,000 pregnant women have self entered into the CDC’s v-safe program, which tracks outcomes including miscarriage, stillbirth, pregnancy complications, ICU admissions, birth complication, NICU admission, birth defects, neonatal death, and infant hospitalizations. There has been no concerning pregnancy outcomes, pregnancy complications, or neonatal outcomes over the baseline population.  This is excellent news for pregnant women who have or will receive the Pfizer or Moderna vaccines.

Recently, the Janssen Biotech vaccine (what we will call Johnson & Johnson or J&J) has been approved for emergency use by the FDA.  Let’s answer the important questions about this vaccine, as it is a different type of vaccine than Pfizer and Moderna.

How does the Johnson & Johnson vaccine work?

The J&J vaccine is a single dose vaccine (a big differentiator from the other two) and uses another type of virus, called adenovirus, to carry the gene for the coronavirus spike protein into tissue cells.  This adenovirus is not a live virus, does not contain preservatives and does not replicate in cells. Thus it is cleared from the human cells quickly after it tells them to make the coronavirus spike protein. Your body then has this spike protein on the cell surfaces which leads to an immune response by mimicking an infection by the coronavirus.  Use of adenovirus vectors has been used and studied in pregnancy for diseases such as ebola, HIV ,and RSV without any adverse pregnancy outcomes noted.

How effective is the J&J vaccine?

After 28 days post a single dose of this vaccine, it is 72% effective in preventing moderate to severe disease, 85% effective in preventing severe disease, and 100% effective in preventing hospitalization or death.

What are the side effects of the J&J vaccine?

Side effects from the vaccine include injection site reactions, fatigue, chills, muscle aches, joint pain, headache, and fever have been reported as mild and transient (first 1-2 days) after the vaccine.  Only 9% of those vaccinated reported a fever over 100.4 or higher. The CDC does not recommend taking fever-lowering medication (acetaminophen) prior to receiving the injection.  Instead, pregnant patients may take it if they notice fever after vaccination.  Remember, having side effects of the vaccine does NOT mean you have a Covid-19 infection, but rather your body is responding appropriately to a vaccine. There are no cases of anaphylaxis in the Johnson & Johnson Covid vaccine study.

Will the vaccine protect my baby?

Maternal vaccination during pregnancy can help protect a newborn from potentially deadly infections.  The mother forms the antibodies, that are then passed to the fetus through the placenta. This gives babies some protection.  Antibodies are also passed through the breast milk, continuing protection.

What about breastfeeding?

The ABM (Academy of Breastfeeding Medicine) and ACOG (the American College of OBGYN) both support Covid-19 vaccination in breastfeeding moms. Theoretical risks do not outweigh the potential benefits.  There is no need to avoid initiation of nursing, discontinue breastfeeding, or pump and dump if you receive a vaccine.

What if you are currently trying to get pregnant or will be trying soon?

The internet is full of disproven and nonscientific based claims that Covid vaccines cause infertility. ACOG recommends vaccination of all people who may consider future pregnancy. Adenovirus vaccines like J&J’s Covid vaccine cannot replicate in cells and are cleared from tissues following injection. Because it cannot replicate in cells, it cannot alter DNA and thus cannot affect fertility. It is not necessary to delay pregnancy after receiving the vaccine.

So what is MY opinion?

As of this moment, I am very comfortable saying that the benefits of the Johnson & Johnson vaccine for pregnant women, lactating women, or those planning on becoming pregnant outweigh the potential risks.  I would be very comfortable with my loved ones getting a vaccine.  I also understand the concerns about the unknowns that still exist and will be respectful of any woman that chooses not to get vaccinated.  You need to make the choice for yourself, based on your individual risk factors and infection risks.  I am confident the science will continue to support its use.

May 1, 2021 Update

On April 13, 2021 the CDC put a pause on the Johnson & Johnson Covid vaccine due to 6 cases of a blood clot in one of the brain’s venous systems. Ten days later this pause was stopped and the use of this vaccine continued. Since women of reproductive age seem to be those at highest risk of this very rare event, I was waiting on a statement from the American College of OBGYN to share with you. They feel the risk of this complication is very low (1 in a million) and the benefits of vaccination are high enough to warrant this risk. ACOG’s opinion is such that they are OK with reproductive aged and pregnant women getting it as long as they are aware that this risk exist and that they can consider getting the Pfizer or Moderna vaccines if they have access to it and want to mitigate said risk. In addition, women taking aspirin or anticoagulants as part of their care do not need to stop it before getting the Johnson & Johnson Covid vaccine.

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