Laurie writes:

Hello Dr. Griffin,

I have recently been treated with oral budenoside for an ulcerative colitis flare, currently I am tapering off usage of the drug and if all goes well I should be finished with it in two weeks (for a total of 1 month of treatment).  I understand that steroids weaken the immune system so my question is how long after my last dose of budenoside will it take for my immune system to return to it’s normal level of immunity? And is it ok to receive a flu vaccine and a covid booster after steroid treatment?

I have been listening to TWIV and the clinical updates since the pandemic started, thank you so much for providing understandable and honest information about SARS CoV2 and other viruses. It is greatly appreciated.



Virginia writes:


I retired from ID practice about a year ago so lived through much of the COVID pandemic. I wanted to thank you for educating me throughout COVID.  I had little time to read and keep up especially early on and I was so grateful you shared your expertise with all of us.

I chuckled a few months ago when you and Vincent were joking about surgeons reading only titles of articles and I thought how I as a retired ID doc don’t read the entire article nor do I read just the title but I listen to your podcast to stay up to date.  I still return periodically to the hospital to help out and am also involved in public health so I need to stay current.

I was interested in the discussion last week about having Paxlovid available when one travels abroad.  This has been referred to as “prophylactic”.  To me, a medicine taken “prophylactically” is meant to prevent disease. In the case that Cathy mentioned, she wanted to have medication available should she develop symptomatic COVID.  In that case the medication is not “prophylactic” but rather “treatment” and thus would be used as intended by the FDA.  I don’t understand the reluctance of physicians and other providers to prescribe Paxlovid for patients to have when they travel. This is of concern to me as I am an avid traveler in retirement.

Again, thank you so much for keeping me and my fellow ID docs up to date on COVID and other emerging infectious diseases.  Please do not mention my name on the air as I like to remain under the radar.


Laurie writes:

Once again, thank you for being available to support those of us on the front lines of vaccinating kids and young adults.  We now have 5 (!) vaccines that we will have to decide upon in short order and I am having a hard time finding the data.

Fortunately the RSV decision is easy.  Hallelujah, I can’t believe we are finally here!

COVID booster 2023:  There seems to be no data available except for neutralizing antibody responses which I have learned from you all may or may not be relevant, but that is what we have.   We have to order ASAP and we definitely will want Moderna for the littles but for the bigs?  Flip a coin?

PCV 15 vs 18:  The Merck 15 claims to have superior coverage for serotype 3 but of course the Pfizer 20 covers more serotypes.  Any thoughts?

We the pediatricians of San Francisco and the greater Bay Area would love to hear your thoughts – many of us listen to you and Vincent and your words of wisdom are frequently referenced.

Thank you,

Laurie Schultz MD, MPH

Golden Gate Pediatrics

San Francisco

Kate writes:

Hi Daniel,

Have you seen any COVID studies relating vaccination to a drop in blood platelets?

My 83 year old mother is loving in a nursing home (cared for by my sibling, in another state).  She has been advised to decline a booster because the doctor “suspects” the cause of her low blood platelets has been a vaccine reaction.  After a recent visit, when COVID was active in a few patients on her floor, I’m seriously concerned.

Please point me to any studies that might alleviate my concerns and that I can potentially share with my mother and sibling.

Thank you for your podcast (I’ve learned so much!).



Bill writes:

Do you recommend using a high dose flu vaccine in a 40yo female with systemic lupus erythematosus?


Bill Hardman, MD

Ellen writes:

Dear Daniel,

My husband and I are in our upper 70’s, one has mild COPD, the other well-controlled diabetes. It seems that the Pfizer vaccine is somewhat less durable for the second year, while the GSK had more serious adverse effects. Should we have a preference for one or the other?

Again, grazie molto,