by Dr. Debbie-Ann Shirley, Division Head of Pediatric Infectious Disease
COVID-19 vaccines and TTS. Thrombosis with thrombocytopenia syndrome, or TTS, is a rare syndrome characterized by thrombosis (often cerebral or abdominal) with thrombocytopenia that has been observed within 3 weeks of receipt of the Johnson & Johnson (J&J) COVID-19 vaccine. The J&J COVID-19 vaccine was first authorized for use in the US at the end of February 2021. Here is a brief recap of the remarkable events that rapidly unfolded shortly after in April:
- April 13th: following initial reports of rare thromboembolic events among J&J vaccine recipients, the CDC recommended a pause in the use of the J&J COVID-19. Similar reports had emerged internationally following receipt of the similar adenovirus-vector Astra-Zeneca vaccine
- April 21st: of 7.98 million J&J vaccine doses administered, there were 15 confirmed cases of TTS reported. All were females, mostly in the third decade of life (age range 18 -59 years), many without known underlying risk factors for thrombosis and all with positive PF4 heparin-induced thrombocytopenia ELISA when tested. In depth review of these cases indicated that risk of death and serious outcome of COVID-19, including thrombosis, overall far outweigh risk of TTS possibly associated with vaccination
- April 23rd: the CDC Advisory Committee on Immunization Practices recommended resumption of the use of the J&J vaccine with a new warning on the patient fact sheet. In addition to providing highly efficacious protection against COVID-19, the single dose J&J COVID-19 vaccine offers advantages of flexibility, choice, improved patient access for vulnerable populations and efficiency for mobile vaccination clinics, Emergency Departments and Student Health centers
All healthcare professionals should be alert to the signs and symptoms of TTS in individuals who received the J&J COVID-19 vaccine, which include severe headache, visual changes, abdominal pain, emesis, back pain, difficulty breathing, leg pain/swelling or petechiae. Evaluation in includes obtaining complete blood count with platelets and imaging for thrombosis based on symptoms, with urgent consultation by a hematologist since the outcome is significantly improved with rapid identification and management. Heparin should be avoided until TTS has been excluded. Education for patients, nursing, and providers at UVA is under development. In the meantime, the American Society for Hematology has helpful information here.
As a reminder, anyone who is ≥ 16 years living in Virginia is now eligible for COVID-19 vaccination. The Moderna and J&J COVID-19 vaccines are currently authorized for use in those ≥ 18 years of age and the Pfzier/ BioNTech vaccine for those ≥ 16 years of age. Vaccine makers have expanded age eligibility in vaccine trials down to 6 months of age. Based on interim results, Moderna and Pfizer/ BioNTech have already submitted to the FDA to expand authorization to ≥ 12 years and planning is underway at UVA to offer vaccination to middle school children in anticipation of a decision soon. Patients eligible for vaccination can call the UVA COVID-19 vaccine call center at 434-2977-4829 (4VAX) to schedule an appointment.
For more information: Updated Recommendations from the Advisory Committee on Immunization Practices for Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine After Reports of Thrombosis with Thrombocytopenia Syndrome Among Vaccine Recipients — United States, April 2021 | MMWR (cdc.gov)
In case you missed it, here are links to some other recent COVID-19 updates at UVA:
Filed Under: Features