I love TWIV – and listen every week. And as an ID doc that does mostly research – I also appreciate the COVID clinical updates. So glad to help out Dr. Dan Griffin regarding one question that is in my wheelhouse – where he did not know the answer- immunogenicity of COVID vaccines in older subjects.
There are published data showing mRNA is similarly immunogenic across age groups – so good news.
John R. Mascola, M.D.
Director, Vaccine Research Center
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Hello Dr Griffin
Wonder if you are able to comment on the ongoing situation with the AstraZeneca vaccine.
Increasing numbers of counties seem to be stopping using it.
I have very little faith in the UK Government giving unbiased advice on this subject.
There are mentions in the media about clotting issues.
I’m due my first vaccination in three weeks’ time and will probably be getting the aforementioned.
I’ll be 58 with no underlying health issues, would you say taking aspirin around the time of vaccination would be a good idea?
Best Wishes, stay safe
University of Manchester
Dear Dr. Griffin:
My question is whether to administer the second Covid 19 vaccination to the following patient:
77-year-old WF with diabetes, hypertension, hyperlipidemia, obesity who received her first Covid 19 Pfizer vaccination on 3/6/2021. She was found unresponsive the morning of 3/8/2021 with a fixed gaze to the right. MRI determined that she had possible encephalitis and there was a question of a seizure. She was hospitalized at UNC Chapel Hill until her discharge on March 12. Her LP, labs did not reveal any other etiology for her symptoms. The repeat MRI showed abnormality consistent with encephalopathy/encephalitis. 48 hour EEG showed slowing in the left hemisphere. She has completely recovered but remains on Keppra 500 mg b.i.d. The working diagnosis is encephalopathy with possible seizure.
The family is quite apprehensive about the patient receiving the second vaccination. She has never had any allergic reactions to vaccinations. Her only medical intolerance is myalgias on statin therapy.
I’m inclined to have the patient receive the second vaccination but wondered if you had a different response.
I do enjoy listening to the TWIV podcast and have learned a lot. Thank you
I am a family physician in Pawtucket, RI. I have been listening to your thoughtful and measured guidance since last summer. This has been tremendously helpful as I work in a community that has been hard-hit by the virus.
I encountered a scenario this week that I was confused about, despite the benefit of your teaching. I was involved in the care of an elderly woman who lives in the community but is homebound and has home health aids on a daily basis. Unfortunately one of her aids tested positive for SARS-CoV2 last week on the day that this patient received her second mRNA vaccine. Four days later, the patient has now tested positive, though she remains asymptomatic.
She clearly meets the criteria for eligibility for monoclonal antibody therapy based on her age. The conundrum is that she also probably derives some protection from developing severe COVID from her nearly-completed vaccine series, AND there would be a theoretical concern about the passive immunization provided by the monoclonal antibody therapy blunting her own immune response to the vaccine she received just a few days ago.
We decided to get her treated, prioritizing short-term gains in a patient at risk. What would you say?
David Anthony, MD, MSc
Director of Medical Student Education
Department of Family Medicine
Alpert Medical School of Brown University