A possible “one-in-a-million” risk of blood clots has prompted states, including Hawaii, to halt the administration of the Johnson & Johnson COVID-19 vaccine at the recommendation of federal health authorities.

The Centers for Disease Control and Prevention and the U.S. Food and Drug Administration issued a statement late Monday recommending states place Johnson & Johnson shots on hold, after finding six cases of a rare blood clotting disorder in women ages 18 to 48 who had received the shot a week to two weeks before.

Those six cases were among more than 6.8 million people who have received the Johnson & Johnson shot in the U.S. so far. One of the women died and another is still in critical condition, federal health officials said Tuesday.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said Johnson & Johnson vaccines are on hold in Hawaii following the recommendation of federal health authorities. Cory Lum/Civil Beat

“Unfortunately this takes one of the vaccines out of our toolkit right now,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, who is involved with overseeing the vaccine rollout to hospitals and clinics across the islands.

“It’s a very low incidence, approximately one in 1 million,” Raethel said. “The vaccine is still safe, but there is this potential risk and it is still too early to know if it is tied to the Johnson & Johnson vaccine. There is correlation right now. We just don’t know if it’s causation.”

Dr. Libby Char, director of the state Department of Health, said Hawaii remains on track to open vaccine eligibility to all residents by April 19. People 16 and older are eligible for the Pfizer vaccine. The Moderna and Johnson & Johnson vaccines were approved for people 18 and older.

Char said 17,000 Johnson & Johnson shots have been administered in Hawaii since the first shipment arrived March 3. The state had received a total of 47,000 doses and will keep the remaining 30,000 in stock awaiting further federal guidance, she said.

Shipments of the vaccine were already cut drastically across the country after an error at a Baltimore manufacturing plant ruined 15 million doses. Hawaii was scheduled to receive 2,600 more doses from federal authorities this week, a much smaller allotment than in previous weeks.

“This will be a little bit of a setback but we weren’t receiving that much Johnson & Johnson,” she told reporters Tuesday afternoon. “It’s not going to affect us greatly.”

The Johnson & Johnson vaccine has been offered at various clinics across the state, including some held specifically for the Department of Education and correctional centers, she said.

The state had also planned to provide Johnson & Johnson vaccines to new residents of long-term care facilities, but that is now on hold, according to Raethel.

Both Char and Raethel said no Hawaii patients have reported any of the symptoms associated with the rare blood clots.

The blood clot disorder is called cerebral venous sinus thrombosis and requires special treatment. A typical medication for blood clots could be harmful. It occurred among women who also had low blood platelet counts, which has various causes, such as a weakened immune system or certain medications.

“When we saw this pattern and were aware that treatment needed to be individualized for this condition, it was the utmost importance for us to get the word out,” Dr. Anne Schuchat, principal deputy director of the CDC, said in a media briefing held Tuesday.

The symptoms the women experienced included severe headache, abdominal pain, leg pain or shortness of breath after they got the shot, Raethel said.

“If someone did get the Johnson & Johnson vaccine, male or female, and they are experiencing symptoms, they should contact their healthcare provider immediately,” Raethel said. “There is treatment for anyone who does have these symptoms.”

Vaccination clinics that were scheduled to administer the Johnson & Johnson COVID-19 vaccine will either offer an alternative or reschedule, according to the Department of Health.

Many vaccine appointments are still open at local pharmacies including Longs, Walgreens and Safeway, which have been contracted by the federal government and have received an increased supply in recent weeks.

Demand will likely continue to exceed supply, Raethel said, so even as eligibility widens, people will likely not get an appointment until after April 19.

On Monday, Oahu residents 50 years old and older were added to the eligibility pool for COVID-19 vaccines. All other Hawaii counties have opened eligibility to people 16 years and older.

A list of vaccine distribution clinics is available online.

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