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This article has been reviewed and updated as of April 24, 2021.
COVID-19 Vaccine Immunocompromised Medical Organizations

On April 13, 2021, the U.S. Food and Drug Administration (FDA) and U.S. Centers for Disease Control and Prevention (CDC) asked states to temporarily halt using the Johnson & Johnson’s COVID-19 vaccine “out of an abundance of caution” after receiving six reports of a rare and severe type of blood clot forming in individuals after receiving the vaccine. On April 23, following a through safety review, the FDA and CDC lifted the pause after determining “the vaccine’s known and potential benefits outweigh its known and potential risks in individuals 18 years of age and older.”

If you have an autoimmune or inflammatory condition — such as rheumatoid arthritis, psoriasis, lupus, or inflammatory bowel disease — or you take medication that hampers your immune system function, you likely have a host of questions about which COVID-19 vaccine is “best” to get.

Here’s the bottom line: Doctors and public health experts strongly encourage patients with autoimmune disease and those who take immunosuppressant medications to get vaccinated at the first available chance.

That means getting whichever vaccine is offered to you first.

You shouldn’t get hung up on comparing the clinical trial efficacy rate of the Johnson & Johnson vaccine (66 percent) to those of the Moderna and Pfizer vaccines (about 95 percent). It’s comparing apples to oranges since these weren’t head-to-head clinical trials. They were conducted at different times, in different places, and while different virus variants were circulating. Even the definitions of symptomatic infection varied between trials.

Right now, the most important thing to consider is that all authorized vaccines are very effective at preventing severe cases of COVID-19, which could prevent hospitalization and death.

Here, we’ll share further updates from professional medical and public health organizations on the Johnson & Johnson vaccine specifically.

We also encourage you to check out these articles about COVID-19 vaccines in people who are immunocompromised or who have autoimmune conditions for further information:

Can You Get a COVID-19 Vaccine If You’re Immunocompromised?  

Yes. People with autoimmune conditions or who are immunocompromised are not excluded from getting the vaccine, and in fact, are encouraged to get a COVID-19 vaccine. There isn’t much data on this group and the vaccine yet, so they may require additional consideration.

Typical of vaccine development, these groups were not included in the clinical trials that led to the vaccine getting emergency use authorization. Most vaccine clinical trials do not include these patient groups because the goal of these studies is to make sure the vaccine is safe and effective in a large group of healthy adults

Immunocompromised patients and other populations are typically studied in phase 4 (post-marketing) studies. These take place after the vaccine has been approved and more data is available on its safety and effectiveness.

All of the rheumatologists and other autoimmune disease specialists, infectious disease, and public health experts CreakyJoints and the Global Healthy Living Foundation have spoken with so far recommend that their immunocompromised patients get any authorized vaccine as soon as it is available to them, whether that’s the Johnson & Johnson, Moderna, or Pfizer vaccine.

The general consensus for most immunosuppressed patients — based on what is known about how COVID-19 vaccines work — is that COVID-19 vaccines should be safe for people on immunosuppressant therapy but may be some degree less effective.

However, even a slightly less effective vaccine may still help prevent severe disease that requires hospitalization (or worse). Think of it this way: If you had a choice between being in a snowstorm wearing a winter coat, hat, gloves, and scarf (fully effective vaccine) versus a just a winter coat (less effective vaccine) versus just a T-shirt (no vaccine), of course you’d prefer having all the winter attire. But having the coat is way better than just the T-shirt.

Recommendations About the Johnson & Johnson Vaccine from Medical and Public Health Organizations for Immunocompromised Patients

There’s plenty of inaccurate or misleading rumors floating around about COVID-19 vaccines, so it’s important to get your information straight from the most reliable sources. We are closely following what trusted medical experts and professional medical organizations are saying about the viral vector vaccines (like the Johnson & Johnson vaccine) in people who are immunocompromised.

We will be updating this list as more information emerges.

U.S. Centers for Disease Control and Prevention

From Vaccine Considerations for People With Underlying Medical Conditions:

COVID-19 vaccines, including the Johnson & Johnson vaccine, can be administered to most people with underlying medical conditions once it’s available to them. The below information can help you make an informed decision about receiving a COVID-19 vaccine.

People who have weakened immune systems

You may receive a COVID-19 vaccine, including the Johnson & Johnson vaccine, if you have HIV or a weakened immune system due to other illnesses or medication (which may put you at a higher risk for severe COVID-19).

However you should be aware of the limited safety data:

  • Information about the COVID-19 vaccine safety for people who have weakened immune systems in this group is not yet available.
  • People living with HIV were included in clinical trials, but safety data specific to this group are not available at this time.

You should be aware that you may have a reduced immune response to the vaccine if you have a weakened immune system, and may need to continue following current guidance to protect yourself against COVID-19.

People who have autoimmune conditions

You may receive any COVID-19 vaccine if you have an autoimmune condition. However, keep in mind that no data are currently available on the safety of COVID-19 vaccines for people with autoimmune conditions.

People who have previously had Guillain-Barre syndrome (GBS) may also receive the COVID-19 vaccine. One case of GBS was reported in a vaccinated participant in the Johnson & Johnson COVID-19 vaccine clinical trial, compared to one case among those who received the placebo. No cases of GBS were reported following vaccination in participants in the mRNA COVID-19 [Pfizer and Moderna] vaccine clinical trials.

With few exceptions, the independent Advisory Committee on Immunization Practices general best practice guidelines for immunization do not consider a history of GBS as a precaution to vaccination for other vaccines.

Advisory Committee on Immunization Practices (ACIP) from the U.S. Centers for Disease Control and Prevention

From Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States: 

People who have weakened immune systems

All currently authorized COVID-19 vaccines — including the Johnson & Johnson vaccine — are not live vaccines and therefore can be safely given to immunocompromised people. The Johnson & Johnson vaccine is a viral vector vaccine, and is not a live virus, and therefore can be safely administered to those with weakened immune systems.

Ideally, COVID-19 vaccination should take place at least two weeks before initiation of immunosuppressive therapies based on general best practices for vaccination in immunocompromised people. However, when it’s not possible to receive the single dose Johnson & Johnson COVID-19 vaccine in advance, those on immunosuppressive therapy can still receive the vaccine.

Any decisions to delay immunosuppressive therapy to get the COVID-19 vaccine should be made with your doctor, who will consider your risks related to your underlying condition.

People with autoimmune conditions

No data is currently available on the safety and efficacy of COVID-19 vaccines in people who have autoimmune conditions. That said, no imbalances were observed in the occurrence of symptoms consistent with autoimmune conditions or inflammatory disorders in clinical trial participants who received a COVID-19 vaccine compared to a placebo.

People with autoimmune conditions can receive any authorized COVID-19 vaccine, including the Johnson & Johnson vaccine.

The Johnson & Johnson COVID-19 vaccine is highly effective against COVID-19 hospitalization and death, per a report from the ACIP in the CDC’s Morbidity and Mortality Weekly Report. For this reason, people are encouraged to receive the earliest vaccine available to them.

The use of all Emergency Use Authorization COVID-19 vaccines is a critical key to controlling the pandemic.

National Psoriasis Foundation (NPF)

From NPF COVID-19 Task Force Updates Guidance Statements Regarding COVID-19 Vaccines:

The NPF Task Force views the Johnson & Johnson vaccine as a major advance in protecting individuals and an important tool for ending the COVID-19 pandemic. Just one dose of the vaccine is highly effective in preventing the most serious COVID-19 cases.

Patients with psoriatic disease should receive the first COVID-19 vaccine offered to them, because all three of the currently available vaccines (including the Johnson & Johnson vaccine) are extremely effective in preventing serious COVID-19 outcomes like hospitalization or death.

“Delaying vaccination to receive a particular vaccine puts individuals at unnecessary risk of death from COVID-19,” Joel M. Gelfand, MD, MSCE, Professor of Dermatology and Epidemiology at the University of Pennsylvania Perelman School of Medicine and Co-Chair of the NPF COVID-19 Task Force, said in the guidance statement.

On high-risk patients

The NPF Task Force notes that patients age 60 or older with at least one comorbidity associated with a higher risk for poor COVID-19 outcomes and who are also taking methotrexate with well-controlled psoriatic disease may — in consultation with their doctor — consider holding methotrexate for two weeks after receiving the Johnson & Johnson vaccine to potentially improve vaccine response.

This guidance is influenced by data that suggests patients with rheumatoid arthritis who hold methotrexate for two weeks after receiving the flu shot achieve a marginally better antibody response of unknown clinical significance. It is still unknown if holding methotrexate for two weeks after getting the Johnson & Johnson vaccine will result in clinically meaningful benefits for vaccine efficacy.

American College of Allergy, Asthma, and Immunology

From ACAAI Updates to Guidance on Risk of Allergic Reactions to COVID-19 Vaccines:

On immunocompromised patients

Like the mRNA vaccines, the viral vector COVID-19 vaccines like the Johnson & Johnson vaccine are not live vaccines and can be administered to immunocompromised patients. That said, physicians and other providers should inform these patients of the possibility of a diminished immune response to the vaccine.

On patients with a history of allergies 

  1. Anyone receiving the vaccine should be screened to determine the potential risk of an allergic reaction to the Johnson & Johnson vaccine. If you have had a history of a severe allergic reaction to any prior vaccine, you should be referred to a board-certified allergist or immunologist for further evaluation prior to receiving the vaccine. The anaphylaxis rate for the Johnson & Johnson COVID-19 vaccine has not been reported.
  2. The COVID-19 vaccines should be administered in a health care setting where anaphylaxis can be treated. All individuals must be observed for at least 15 to 30 minutes after injection to monitor for adverse reactions. All anaphylactic reactions should be managed immediately with epinephrine as a first line treatment.
  3. The Johnson & Johnson vaccine should not be administered to individuals with a known history of a severe allergic reaction to any component of the vaccine. Polysorbate 80 is an ingredient in the Johnson & Johnson vaccine which may cause anaphylaxis and may cross-react with polyethylene glycol (PEG) (one of the ingredients in the mRNA vaccines known that has been known to cause anaphylaxis). While patients with allergic reactions to PEG should not be immunized with the mRNA COVID-19 vaccines, consideration may be given to vaccination with viral vector COVID-19 vaccine such as Johnson & Johnson.
  4. A viral vector vaccine like the Johnson & Johnson vaccine may be an option instead of a second dose of an mRNA vaccine for those patients who had an adverse reaction to the mRNA vaccine. People who have received one mRNA COVID-19 vaccine dose but have a contraindication for the second dose should wait at least 28 days after the first mRNA vaccine dose to receive the viral vector COVID-19 vaccine. These patients should be observed for at least 30 minutes after the injection.
  5. In patients who have a contraindication to a viral vector COVID-19 vaccine (including a known polysorbate allergy), there should be consideration of administering the mRNA COVID-19 vaccination. Polysorbate allergy is no longer a contraindication to mRNA COVID-19 vaccination.

British Society for Immunology

From the British Society for Immunology’s Immunity & COVID-19 report:

 We know so far that at least five vaccines reduce the number of people becoming sick from COVID-19, and also seem to prevent both mild/moderate and severe COVID-19 symptoms:

  • Johnson & Johnson
  • Pfizer vaccine
  • Moderna vaccine
  • AstraZeneca
  • Novavax

On immunocompromised patients

Similar to how immunocompromised people and older people might not make as good an immune response to SARS-CoV-2 infection, they may also be less likely to make as strong an immune response to a vaccine compared with a young healthy person.

On autoimmune patients

People whose immune systems are compromised by immunodeficiency diseases, autoimmune diseases, or by taking certain medications will not be able to make as good an immune response as young healthy people.

We may eventually learn whether or not some vaccines are more effective for some people than others. In this case, experts could modify vaccination strategies accordingly: for example, for people of different age groups, with immunodeficiencies, autoimmune disease, cancers, and so forth.

International Organization for the Study of Inflammatory Bowel Disease

From SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting:

Patients with irritable bowel disease (IBD) should be vaccinated against SARSCoV-2, and the best time to administer vaccination in patients with IBD is at the earliest opportunity to do so. This includes mRNA vaccines (like Pfizer and Moderna) and vector vaccines (like Johnson & Johnson).

On immunocompromised patients

Although vaccine studies have excluded immunocompromised adults, children, and pregnant women at present (though some women became pregnant during the trials), it is expected that patients with IBD will develop protective immunity from any of the vaccine strategies in spite of immune-modifying medications.

Lupus Foundation of America

From Lupus Foundation of America’s National Resource Center on Lupus:

 Although it’s unlikely that many people with lupus were included in vaccine clinical trials, there is no evidence that people with lupus should not receive the vaccine. While there still isn’t much information on the Johnson & Johnson vaccine and people with lupus, there’s no reason to think that it will not be safe for people with lupus to receive it.

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Janssen Pharmaceuticals, Inc., which is owned by Johnson & Johnson, is a corporate sponsor of the Global Healthy Living Foundation.

ACAAI Updates to Guidance on Risk of Allergic Reactions to COVID-19 Vaccines. American College of Allergy, Asthma and Immunology. March 11, 2021. https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines.

COVID-19 vaccine and lupus. Lupus Foundation of America. March 8, 2021. https://www.lupus.org/resources/covid19-vaccine-and-lupus.

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. Vaccines & Immunizations. U.S. Centers for Disease Control and Prevention. March 5, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html.

Immunity & COVID-19. British Society for Immunology. February 3, 2021. https://www.immunology.org/sites/default/files/BSI_Briefing_Note_2021_immunity_COVID19.pdf.

NPF COVID-19 Task Force Updates Guidance Statements Regarding COVID-19 Vaccines. National Psoriasis Foundation. March 5, 2021. https://www.psoriasis.org/guidance-statements-covid-19-vaccines.

Oliver SE, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Janssen COVID-19 Vaccine — United States, February 2021. Morbidity and Mortality Weekly Report. March 5, 2021. doi: http://dx.doi.org/10.15585/mmwr.mm7009e4.

Vaccine Considerations for People with Underlying Medical Conditions. COVID-19. U.S. Centers for Disease Control and Prevention. March 5, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/underlying-conditions.html.

Siegel CA, et al. SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting. Gut 2021. doi: http://dx.doi.org/10.1136/gutjnl-2020-324000.

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