BISMARCK — The North Dakota Department of Health urged a pause on the use of the Johnson & Johnson vaccine Tuesday, April 13, following the recommendation of federal officials in response to rare blood-clotting cases.

The Food and Drug Administration and Centers for Disease Control and Prevention reported six instances of severe blood clotting among people who received a Johnson & Johnson dose, and recommended a pause on using the vaccine. The reports of the clotting issue have been extremely rare, and North Dakota immunization program director Molly Howell said in a press conference Tuesday that the state is recommending that its health care providers observe the pause "out of an abundance of caution."

All six instances of severe blood clotting occurred in women ages 18 to 48 within three weeks of receiving the vaccine. One woman died and another is hospitalized in critical condition. There have been no blood-clotting reports linked to the Johnson & Johnson vaccine in North Dakota, Howell said.

The immunization director noted that the frequency of the blood-clotting reports is "one in more than a million," and stressed that vaccination continues to be safer than contracting COVID-19. Howell said North Dakotans looking to get vaccinated should seek out appointments for the Pfizer and Moderna shots during the pause.

“I’m hoping that the pause in administering the Johnson & Johnson COVID vaccine gives the public more confidence in vaccine safety in the United States,” Howell said. “It shows that the federal government is very transparent and putting out information when there are safety concerns about vaccines.”

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North Dakota has been a national leader in the administration of COVID-19 vaccines, and Howell said a temporary pause on Johnson & Johnson injections would not hinder the logistics of the state's rollout. Johnson & Johnson has so far accounted for less than 5% of the administered doses in North Dakota, and all scheduled vaccine clinics that were planning to use Johnson & Johnson doses this week were able to be completely substituted with Pfizer or Moderna shots, Howell said.

So far, North Dakota has administered more than 21,000 doses of the Johnson & Johnson vaccine of over 25,000 doses received.

Still, Howell said the national and state pause on the Johnson & Johnson product could exacerbate issues of vaccine skepticism around Johnson & Johnson, which has been in high demand among North Dakotans looking to take advantage of the single shot vaccine.

An advisory panel in the Centers for Disease Control and Prevention is scheduled to meet on Wednesday to determine further guidance on the Johnson & Johnson product.

"They’re going to have to likely weigh the severity of the COVID-19 disease with having a vaccine that has a very rare — right now, one case in over a million people vaccinated — adverse event,” Howell said.

The federal guidance on the Johnson & Johnson vaccine comes as North Dakota has lately seen a bump in its virus numbers.

The state reported 234 new cases on Tuesday, and Department of Health Disease Control Director Kirby Kruger noted that the recent upward trend in virus levels seems to be driven in part by the presence of more contagious variants. The state has identified 79 cases of variants of the coronavirus, among them 50 cases of what’s known as the U.K. strain and 28 of the California strain, both thought to be more transmissible than the strain that drove North Dakota’s surge last fall.

“I think the tool that we have in front of us that will help prevent the spread of variants is the vaccine,” Kruger said. “I can’t emphasize it enough.”

Readers can reach Forum reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.