COVID-19 vaccine, viral vector-Janssen (Investigational)

Brand and Other Names:Ad26.COV2.S (Johnson & Johnson)
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injection, suspension

  • 5x1010 virus particles/0.5mL (5 doses per vial)

COVID-19 Disease Prevention

February 27, 2021: Emergency use authorization (EUA) issued by FDA for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals aged ≥18 years

0.5 mL IM as a single dose

Dosing Considerations

Limitations of effectiveness: May not protect all vaccine recipients

Data unavailable on use of the Janssen COVID-19 vaccine to complete a vaccination series initiated with another COVID-19 vaccine

Efficacy against moderate-to-severe/critical COVID-19

  • No overall differences in safety or efficacy were observed between individuals aged ≥65 yr and younger individuals
  • Aged 18-59 years
    • 14 days post vaccination: 63.7%
    • 28 days post vaccination: 66.1%
  • Aged ≥60 years
    • 14 days post vaccination: 76.3%
    • 28 days post vaccination: 66.2%

Efficacy against confirmed severe/critical COVID-19

  • Aged ≥18 years
    • 14 days post vaccination: 76.7%
    • 28 days post vaccination: 85.4%

Efficacy against severe/critical COVID-19 by variant

Data as of February 12, 2021

  • United States
    • 96.4% of strains identified as the Wuhan-H1 variant D614G during the trial
    • 28 days post vaccination: 85.9%
  • Brazil
    • 69.4% of strains identified as a variant of the P.2 lineage and 30.6% of strains identified as the Wuhan-H1 variant D614G
    • 28 days post vaccination: 87.6%
  • South Africa
    • 94.5% of strains identified as the 20H/501Y.V2 variant (B.1.351 lineage)
    • 28 days post vaccination: 81.7%

<18 years: Safety and efficacy not established

COVID-19 Disease Prevention

February 27, 2021: Emergency use authorization (EUA) issued by FDA for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals aged ≥18 years

0.5 mL IM as a single dose

Dosing Considerations

Limitations of effectiveness: May not protect all vaccine recipients

Data unavailable on use of the Janssen COVID-19 vaccine to complete a vaccination series initiated with another COVID-19 vaccine

Efficacy against moderate-to-severe/critical COVID-19

  • No overall differences in safety or efficacy were observed between individuals aged ≥65 yr and younger individuals
  • Aged 18-59 years
    • 14 days post vaccination: 63.7%
    • 28 days post vaccination: 66.1%
  • Aged ≥60 years
    • 14 days post vaccination: 76.3%
    • 28 days post vaccination: 66.2%

Efficacy against confirmed severe/critical COVID-19

  • Aged ≥18 years
    • 14 days post vaccination: 76.7%
    • 28 days post vaccination: 85.4%
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Adverse Effects

VAERS Reporting

Mandatory for vaccination providers to report to the vaccine adverse events reporting system (VAERS) all vaccine administration errors, serious adverse events, multisystem inflammatory syndrome in adults and children, and hospitalized or fatal cases of COVID-19 following vaccination

May submit report online or fax it to VAERS at 1-877-721-0366

>10%

7 days post vaccination; aged 18-59 yr

  • Injection site pain (58.6%)
  • Headache (44.4%)
  • Fatigue (43.8%)
  • Myalgia (39.1%)
  • Use of antipyretic or pain medication (26.4%)
  • Nausea (15.5%)
  • Fever (12.8%)

7 days post vaccination; aged ≥60 yr

  • Injection site pain (33.3%)
  • Headache (30.4%)
  • Fatigue (29.7%)
  • Myalgia (24%)
  • Nausea (12.3%)

1-10%

7 days post vaccination; aged 18-59 yr

  • Injection site erythema (9%)
  • Injection site swelling (7%)
  • Myalgia, Grade 3 (1.4%)
  • Fatigue, Grade 3 (1.2%)

7 days post vaccination; aged ≥60 yr

  • Use of antipyretic or pain medication (9.8%)
  • Injection site erythema (4.6%)
  • Fever (3.1%)
  • Injection site swelling (2.7%)

<1%

7 days post vaccination; aged 18-59 yr

  • Grade 3
    • Headache (0.9%)
    • Injection site pain (0.4%)
    • Injection site erythema (0.3%)
    • Fever (0.3%)
    • Injection site swelling (0.2%)
    • Nausea (0.1%)

7 days post vaccination; aged ≥60 yr

  • Grade 3
    • Fatigue (0.8%)
    • Headache (0.4%)
    • Injection site pain (0.2%)
    • Injection site swelling (0.2%)
    • Myalgia (0.2%)
    • Injection site erythema (0.1%)
    • Fever (0.1%)

Post Authorization Experience

Blood and lymphatic system disorders: Thrombosis with thrombocytopenia

Immune system disorders: Allergic reactions, including anaphylaxis

Nervous system disorders: Guillain-Barré syndrome

Vascular disorders: Capillary leak syndrome, thrombosis with thrombocytopenia

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Warnings

Contraindications

Known history of severe allergic reaction (eg, anaphylaxis) to any component in vaccine

Cautions

Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have diminished immune response to the vaccine

Post authorization reports suggest an increased risk of Guillain-Barré syndrome during the 42 days following vaccination

Vaccine may not protect all vaccine recipients

Allergic reactions

  • Appropriate medical treatment used to manage immediate allergic reactions must be immediately available following vaccination
  • Individuals with histories of severe allergic reaction to vaccines should consult their doctors about the COVID-19 vaccine
  • Monitor vaccine recipients for immediate adverse reactions according to the Centers for Disease Control and Prevention guidelines

Thrombosis and thrombocytopenia

  • Extremely rare cases reported of thrombosis involving the cerebral venous sinuses and other sites (including but not limited to the large blood vessels of the abdomen and the veins of the lower extremities) combined with thrombocytopenia
  • Onset of symptoms ~1-2 weeks after vaccination
  • Reporting rate of thrombosis and thrombocytopenia has been highest in females aged 18-49 years; some have been fatal
  • Specific risk factors for thrombosis with thrombocytopenia and the level of potential excess risk owing to vaccination continue to be investigated
  • Based on available evidence in April 2021, a causal relationship between thrombosis with thrombocytopenia and the vaccine is plausible
  • Healthcare professionals should be alert to the signs and symptoms of thrombosis with thrombocytopenia in individuals who received the Ad26.COV2-2 vaccine
  • Clinical course
    • The clinical course shares features with autoimmune heparin-induced thrombocytopenia
    • Use of heparin may be harmful in individuals with suspected thrombosis with thrombocytopenia following vaccination; alternant treatments may be needed
    • Diagnosis must include the following 4 criteria: 1) Ad26.COV2-2 vaccine 4-30 days previously; 2) thrombosis (often cerebral or abdominal); 3) thrombocytopenia; 4) positive PF4 “HIT” (heparin-induced thrombocytopenia) ELISA
    • NOTE: If patient presents with thrombosis and a normal platelet count post-vaccination, they might be in an early stage of VITT; continued assessment for development of thrombocytopenia/VITT required
  • Hematology consultation
    • Consultation with hematology specialists is strongly recommended
    • American Society of Hematology has published considerations relevant to the diagnosis and treatment of thrombosis with thrombocytopenia following vaccination
    • Urgent medical evaluation for vaccine-induced immune thrombotic thrombocytopenia (VITT) indicated if any of the following develops: severe headache, visual changes, abdominal pain, nausea/vomiting, backache, shortness of breath, leg pain/swelling, or petechiae/easy bruising

Drug interaction overview

  • Data are not available to assess concomitant administration with other vaccines
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Pregnancy & Lactation

Pregnancy

Data are insufficient to inform of vaccine-associated risks in pregnancy

Women vaccinated with Janssen COVID-19 vaccine are encouraged to enroll in the pregnancy exposure registry

A smartphone app, v-safe, is also available to report adverse effects to the CDC following vaccination with a COVID-19 vaccine

CDC guidelines for vaccination of pregnant or lactating women

Lactation

Data are not available to assess effects on breastfed infants or on milk production/excretion

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

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Pharmacology

Mechanism of Action

Vaccine is composed of a recombinant, replication-incompetent human adenovirus type 26 vector that after entering human cells, expresses the SARS-CoV-2 spike (S) antigen without virus propagation

An immune response elicited to the S antigen protects against COVID-19

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Administration

IM Preparation

Suspension is a colorless to slightly yellow, clear to very opalescent suspension

Visually inspect for particulate matter and discoloration; if either of these conditions exists, do not administer

Carefully mix vial contents by swirling gently in an upright position for 10 seconds; do NOT shake

Each dose is 0.5 mL; each vial contains 5 doses; do not pool excess vaccine from multiple vials

IM Administration

For IM injection only

Storage

Receiving shipment

  • Once received, do not freeze
  • Initially stored frozen by the manufacturer, then shipped at 2-8ºC (36-46ºF)
  • If vaccine is still frozen upon receipt, thaw in refrigerator at 2-8ºC (36-46ºF)
  • If needed immediately, thaw at room temperature (maximally 25ºC/77ºF)
  • At room temperature, a carton of 10 vials takes ~4 hr to thaw, and an individual vial takes ~1 hour to thaw
  • Do not refreeze once thawed

Unopened vials

  • Refrigerated: 2-8ºC (36-46ºF) and protect form light; do not freeze
  • Room temperature: 9-25ºC (47-77ºF) for up to 12 hr

Opened vials

  • Refrigerated: 2-8ºC (36-46ºF) for up to 6 hr, OR
  • Room temperature: Maximally 25ºC (77ºF) for up to 2 hr
  • Discard if vaccine is not used within these times
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Images

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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.