Johnson & Johnson’s Covid-19 vaccine worked better than it gets the credit for and may play an important role in the future
Johnson & Johnson’s Covid-19 vaccine worked better than it gets the credit for and may play an important role in the future

Johnson & Johnson’s Covid-19 vaccine worked better than it gets the credit for and may play an important role in the future

And a CNN analysis of information collected by the U.S. Centers for Disease Control and Prevention showed that the J&J vaccine had the lowest breakthrough infection rate of all the vaccines since the week ending December 25, the last five weeks of available data.

In January, during the Omicron rise, breakthrough infections were highest among those receiving the Pfizer / BioNTech vaccine, followed by those receiving Moderna. Those vaccinated with the Johnson & Johnson shot had the lowest incidence of breakthrough infections.

From the week ending January 22, there were 650 infections per week. 100,000 people with the J&J vaccine. At Moderna there were 757 pr. 100,000, and at Pfizer the price was 862 pr. 100,000.

Unvaccinated people were particularly vulnerable to becoming ill during the Omicron and Delta climbs, as were the original version of coronavirus. They were 3.2 times as likely to get sick as people who received the J&J vaccine. The unvaccinated were 2.8 times more likely to be infected than those who received Moderna and 2.4 times as likely as those who received Pfizer.

“What we saw in the summer and fall during the Delta rise is that all three vaccines protected very, very well. But the breakthrough rates in August, September last year with the Janssen vaccine were slightly higher than Pfizer, and Moderna was slightly lower. . But these differences were relatively small, “said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. He helped develop and study the J&J vaccine.

“But what we saw over time is that these differences were then narrowed,” he said. “And in the first week of December, what we saw in the data was that the lines cross each other,” with incidence rates for the J & J / Janssen vaccine being lower than the others.

‘Consoling’ data for J&J recipients

In March 2021, the J&J vaccine was the third to be approved by the US Food and Drug Administration, and the initial response was more subdued than the milestone approvals of the mRNA vaccines from Pfizer / BioNTech and Moderna.

The vaccines work differently. The mRNA vaccines essentially provide drawings that train your body to fight that infection and any similar infection along the way. Adenovirus vector vaccines, such as J & Js, use a virus that can act like a Trojan horse. But instead of soldiers jumping out, the adenovirus releases genes that encode the coronavirus’ nail protein.

The J&J vaccine also stood out for other reasons: It came as a convenient single dose and did not require special refrigeration, whereas the mRNA vaccines required two doses and Pfizer needed special refrigerated storage. The flexibility was appealing to people who were afraid of shots or did not have time to get two shots. It was also better for countries without a solid health infrastructure.

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But its performance dampened some of the enthusiasm around it, especially from the public.

Whereas the mRNA vaccines were praised for “astonishing” efficacy of more than 90%, the news that J&J was 65% effective in preventing symptomatic Covid-19 among volunteers in clinical trials overwhelmed some.

From the beginning, the supply of J&J vaccines was more limited. After the vaccine was approved, the federal government briefly suspended use due to safety issues surrounding rare blood clots. Even when vaccinations were resumed, the pace of J&J vaccinations was never restored.

In December, the CDC changed its recommendations to say that images made by Moderna and Pfizer / BioNTech are preferred over J & J’s. It also encourages people who received the J&J syringe to get a booster of one of the mRNA vaccines two months later.

The protection offered by the Covid-19 vaccines has diminished over time, and none of them work as well against the variants that have emerged since the original coronavirus appeared. But science is beginning to show that people who received the J&J Covid-19 vaccine may have some benefit.

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Barouch told CNN he was “not at all surprised” to see that the shelf life of the Johnson & Johnson vaccine appears to last longer than that of the mRNA vaccines – Pfizer / BioNTech and Moderna – based on the incidence of breakthroughs. infections.

It has been shown that mRNA vaccine technology rapidly elicits a potent and robust immune response after vaccination, but this may diminish over time. The Johnson & Johnson virus vector platform may not trigger such a strong immune response in the short term, but it is known to have a strong shelf life.

“Over time, the effectiveness of the Pfizer and Moderna vaccines decreases, the effectiveness of the J&J vaccines remains stable, and it is exactly as you would predict: that they will converge and they will then cross,” Barouch said.

The J&J vaccine may also have “a particular benefit,” he said.

“The immune system is actually made up of two arms: the antibody side and the T cells. And the type of T cells that are essential for the prevention of serious disease are called CD8 T cells,” Barouch said. “The J&J vaccine produces better CD8-T cells than Pfizer and other mRNA vaccines, so the J&J vaccine may have a particular benefit for variants like Omicron, which largely escaped antibody responses.”

In general, Barouch called these data “very reassuring” for recipients of the J&J vaccine.

“They should be assured that they have received a vaccine that provides very good protection for a long time,” Barouch said. “And I think the second message is that I think people should also learn about this new data when it comes to considering booster shots.”

Prospects like a booster?

David Montefiori, a virologist at Duke University Medical Center, said: “The J&J vaccine has somehow gotten a bad rap because of its effectiveness, but the stability of the response is exciting.”

The antibody level dropped with each vaccine during the Omicron rise, and this may mean that people need an extra booster. More research is needed to find out.

An as yet unpublished study from the National Institutes of Health that looked at a mix-and-match vaccine strategy saw good results when J&J was included, Montefiori said.

“In people who got the Pfizer vaccine initially and then boosted with the J&J vaccine, these people made quite high levels of neutralizing antibodies to Omicron: 10 times higher than people who got two shots with the J&J vaccine alone,” he said. . “So the J&J vaccine can be a good booster for people who got an mRNA vaccine in the beginning.”

The Johnson & Johnson vaccine can be used for primary doses or as a booster, but the CDC says that the Pfizer and Moderna vaccines are recommended in most situations due to the risk of serious side effects with the Johnson & Johnson vaccine.

The J&J vaccine has been linked to rare cases of low-platelet thrombosis, known as thrombosis with thrombocytopenia syndrome or TTS. “It occurs at a rate of about 3.83 cases per million Janssen doses and has resulted in deaths,” the CDC said.

Dr. Angela Branche, an infectious disease specialist and associate professor of medicine at the University of Rochester, said the side effect profile of the J&J vaccine “remains something of concern to some high-risk groups.” Women between the ages of 30 and 49 have an increased risk of this rare side effect, the CDC says.

But if that research succeeds, the J&J vaccine can only be useful as a booster for certain populations.

“For some groups, where the risk of developing severe blood clots is not very high, such as older adults, this may be a good strategy,” Branche said.

Montefiori said the vaccine deserves more study.

“I think there may still be a place for the J&J vaccine in the long-term picture of this pandemic,” Montefiori said.

CNN’s Jacqueline Howard and Tasnim Ahmed contributed to this report.

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