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Johnson & Johnson COVID-19 Vaccine: Care for Migrant Women Requires Adjusted Approach

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A woman receives the COVID-19 vaccine

After nearly two weeks of looking comprehensively at all the data on vaccines and their potential side effects, scientists made the decision to reinstate the use of the Johnson & Johnson/Janssen (J&J) single-dose vaccine in Europe and the US. Other countries are expected to do the same in the coming days.

For migrant women ages 18 to 60, who may struggle to complete the two-shot vaccine because of migration, MCN recommends the following:

  1. Build in flexibility, if possible, around the variety of vaccines that the clinic offers, to accommodate migrant patients’ specific health needs and barriers.

  2. Provide education to patients so they can make an informed choice.

  3. Recommend the Pfizer or Moderna vaccines as an alternative.

  4. Enroll the patient in Health Network to help the patient access their second shot in their new location.

  5. Watch closely among patients for symptoms of TTS and know what to do.


Here's a more detailed look into each of these steps:

1. Choice of Vaccine

Some health departments, clinics, and health centers have a choice in which vaccines they receive for their communities. For those who exclusively see men, for example, small mobile clinics that serve farmworker camps that are populated only by men, the J&J is still recommended. For clinics and health centers who serve men and women, MCN recommends having an alternative vaccination, either the Pfizer or Moderna, available for women who may wish to avoid J&J. Please consider a patient's access to care when determining which vaccines will be available. Many migrant women lack access to emergency services, should they have symptoms of thrombosis with thrombocytopenia syndrome (TTS). However, many migrant women may struggle to make and attend a second vaccine appointment if they are moving before their second shot -- and the risk of contracting COVID-19 remains significantly higher than the risk of TTS. We recognize these decisions are difficult and the choices may be different for each community.

 

1. Choice of Vaccine
Clinics and health centers receiving funding from the Health Resources and Services Administration (HRSA) have a choice in which vaccines they receive for their communities. For those who exclusively see men, for example, small mobile clinics that serve farmworker camps that are populated only by men, the J&J is still recommended. For clinics and health centers who serve men and women, MCN recommends having an alternative vaccination, either the Pfizer or Moderna, available for women who may wish to avoid J&J. Please consider a patient's access to care when determining which vaccines will be available. Many migrant women lack access to emergency services, should they have symptoms of thrombosis with thrombocytopenia syndrome (TTS). However, many migrant women may struggle to make and attend a second vaccine appointment if they are moving before their second shot -- and the risk of contracting COVID-19 remains significantly higher than the risk of TTS. We recognize these decisions are difficult and the choices may be different for each community.

2. Education

As clinicians serving highly mobile patients, it is important to explain to younger women about the risks associated with this vaccine.

  • J&J may cause thrombosis with thrombocytopenia syndrome (TTS). TTS is not a common blood clot, but a combination of blood clots with thrombocytopenia, or low blood platelets. It is very rare.

  • The risk for women between the ages of 18 and 49 are about 1 in 80,000. This risk is still lower than the risk of contracting COVID-19, but is still a serious risk to consider.

  • The risk for women 50 and older is estimated to be 1 in 500,000 – a significantly lower risk than for younger women.

  • The risk for men of any age is unknown, but is estimated to be extremely low. During J&J clinical trials, one man had symptoms in line with TTS. Since the release of the vaccine, no men have been found to have TTS after J&J vaccination.

  • Symptoms do not appear immediately, but occur roughly four to 30 days after receiving the vaccine. Common vaccine reactions in the day or two following the vaccine (headache, fever, aches, chills, etc.) do not indicate TTS.

  • Symptoms of TTS include:
    • Severe headache
    • Visual changes
    • Abdominal pain
    • Nausea and vomiting
    • Back pain
    • Shortness of breath
    • Leg pain or swelling
    • Petechiae, easy bruising, or bleeding

  • Pfizer and Moderna do not have a risk of TTS. AstraZeneca, not yet approved in the US but widely in use worldwide, does share the same risk of TTS.


3. Recommendations

MCN recommends that migrant women between 18 and 60 avoid the J&J if an alternative (Pfizer or Moderna) is available. This eliminates the risk of TTS, as both Pfizer and Moderna, as mRNA vaccines, do not share the same vaccine mechanisms as the J&J or AstraZeneca  that have the TTS risk. Migrant women in particular have serious barriers to access health care, including transportation, language barriers, work limitations, rural and isolated locations, and limited integration into their new communities to understand health care options. These barriers may make access to emergency care needed for TTS even more difficult. 

Most cases of TTS have been seen in women between 18 and 49, with a small number in women between ages 50 and 58. In an abundance of caution, MCN is recommending the avoidance of J&J for migrant women up to age 60.

If a migrant woman prefers the J&J or if the J&J is the only vaccine available, make sure the patient knows the signs and symptoms of TTS and typical window of onset of symptoms.

For women 58 and over and for men of any age, MCN recommends to get vaccinated with the vaccine that is available in their area, whenever they first have the opportunity to do so. Do not delay vaccination.


4. Enrollment

For any migrating patient who opts to take a two-shot vaccine (Pfizer or Moderna), clinicians are encouraged to enroll their patients in Health Network. A Health Network Associate can follow up with patients, determine which vaccine they received and to where they are migrating, and find an appointment for the second shot on behalf of the patient. Of course, clinicians may also sign up migrant patients with any ongoing health condition that will need follow-up after the patient has moved. This is an essential service for migrants who may struggle in their new community to access the health services they need. Learn more at https://www.migrantclinician.org/services/network.html.


5. Care of Patients with TTS

It is important for clinicians to understand what to do if a patient presents with symptoms in line with TTS. Do NOT use heparin, as this blood thinner may worsen TTS symptoms. Read the American Society of Hematology's diagnosis and treatment information here. Read the FDA's updated fact sheet on the J&J here

 

Resources:

J&J Vaccine: An Educational Resource for Women Fliers in Multiple Languages

 

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