The Washington State Department of Health is recommending people 18 and older choose to receive an mRNA COVID-19 vaccine such as Pfizer-BioNTech or Moderna, instead of the single-shot Johnson & Johnson vaccine.

This update follows guidance and recommendations from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the Western States Scientific Safety Review Workgroup. Individuals who wish to receive the J&J vaccine are encouraged to reach out to their health care provider to discuss their options as J&J will still be available across the state.

The recommendation follows new data presented to the ACIP about thrombosis and thrombocytopenia syndrome, or TTS. TTS is a rare but serious condition involving blood clots and a low blood platelet count seen in some people who received the J&J vaccine. However, the risk is rare.

Nationwide, 54 cases of TTS, including nine confirmed deaths, have been reported, which is a fraction of a percent of the 14 million doses of J&J given overall. While TTS has been seen in both men and women, the most at-risk group is women 30 through 49. People who received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.

Of the more than 11.4 million doses of COVID-19 vaccine given out across Washington, about 436,000 doses have been the J&J vaccine, which equals about 4%. According to data reported to the Vaccine Adverse Event Reporting System through Nov. 30, there have been six possible cases of TTS following J&J vaccinations in Washington, including one death.