Marcia writes:


Thanks for your clinical updates through the TWIV podcasts I’ve been following since the SARS CoV-2 pandemic became prevalent in the US in March 2020.

My 38-year-old son has a condition called sero-negative spondyloarthropy, which is related to psoriatic arthritis (though he doesn’t have skin symptoms). His rheumatologist has recently recommended that he begin taking Humira (adalibumab), an immunosuppressant drug, to help relieve the pain and limitation of mobility he experiences in multiple joints. His feet are especially affected currently, causing pain and difficulty walking.

He received 2 doses of the Moderna vaccine at the recommended interval between doses, and reached the milestone of 2 weeks beyond the second dose on June 1, 2021.

2 Questions:

1.  BEFORE  beginning to take Humira, should he/could he get an antibody test (quantitative, if possible) to determine his existing level of immunity to SARS CoV-2 from his 2-dose COVID-19 vaccination?

2.  BEFORE beginning to take Humira, should he have a 3rd dose of vaccine to boost his existing immunity and wait 2 more weeks BEFORE starting Humira?

I would expect him to need to continue taking Humira indefinitely.

Thank you for any advice you can give.


Moraga, California

Douglas writes:

I really thank you for the Covid clinical updates. Very useful in my family medicine practice.

I noticed that you usually talk about the importance of infections after vaccination being classified as either just a positive test or the more important hospitalization or death.

However, when you’ve compared the rate of reinfection after natural infection versus the rate of infection after vaccination, you only compared positive tests, and did not mention if there’s a difference in hospitalization or death. Is that data available?

Thank you,

Douglas R. Morrissey MD

Chris writes:

Hi Dr. Griffin —  

The Times is reporting that Pfizer could be given full approval on Monday ( I have seen a lot of discussion on Twitter with conflicting information from people who all have MD in their bio about whether or not it could then be prescribed off-label for children (see this thread: Can you clarify the facts here, and, if it is possible to use it off-label, how a pediatrician for, or parent of, a kid <12 should think about the risks. I do not have kids but a number of my friends do and they are all worried sick (so to speak) about the fall and going back to school. 

—  Chris in Cambridge 

Abby writes:

Hi Daniel,

  Thank you so much for all the work you do to spread accurate information about covid! I have 2 children, aged 4 and 18 months. Their pediatrician told me that it would be March before they could be vaccinated. I learned that there’s a phase 2/3 local trial of the moderna vaccine in ages 6 months-11 years. With community transmission increasing in our area I feel that the risk of contracting covid is higher than the risk of the vaccine causing a very negative reaction, but it’s hard to tell. How safe are phase 2/3 trials? I understand that they may get the placebo, but other than that, do you have a sense of the likelihood of severe reactions? As a parent, would you enroll your child in one?

Thank you,