Anthony writes:
Dr. Griffin,
I am a family physician in Rhode Island, and a weekly listener to your clinical updates. I have a patient in her 40s who suffers from advanced atopic dermatitis. She contracted COVID-19 in late september 2021. She was unvaccinated at the time, and we arranged MABs for her. Her illness was mild. Three months later, she agreed to her first COVID vaccine (Moderna). Unfortunately, she experienced a fairly severe flare of her eczema shortly after receiving her vaccine. After two ER visits and one with a colleague of mine, she was seen by a dermatologist who started her on methotrexate, which has helped tremendously.
She is understandably reluctant to receive any more vaccines, given her experience, but now she is immunosuppressed. I would like to arrange a second vaccine for her with close monitoring in the hours and days to follow, but doing so raises questions: What should I advise about her methotrexate, which has been helpful, surrounding her vaccine? Can I be reassured that her single vaccine is enough, given her prior infection? Is the three-month window between her infection and vaccine not long enough to generate an adequate long-term immune response? You have spoken frequently about the value of the 5-6 month window for the booster dose.
How would you counsel her?
Many thanks in advance!
David Anthony, MD, MSc
Director of Medical Student Education
Department of Family Medicine
Alpert Medical School of Brown University
Mary writes:
I occasionally use Fluticasone nasal spray. Was glad to hear in your last update that it’s use can be continued if I get Covid. But I was wondering if the nasal spray could in any way interfere with accurate results of an antigen test done the same day that one used the spray.
Thank you, Mary
David writes:
Good evening from Florida,
I have been avidly listening to the TWiV podcast and I have really been enjoying it. Especially your clinical updates. I sent this to Vincent already but I know all of you are super busy. Also I have added some clarifications that were missing before. I am not an expert in either virology or immunology but I have an immense interest in these subjects. I have not seen any data on this specifically and was wondering if there were any data on this somewhere I’m not privy to. I believe I was infected with the original strain of COVID twice. The first infection was simply a possible one as I had all of the symptoms but was unable to test in time and it was during the period where testing was possibly faulty when I finally was tested via pcr. The second infection was confirmed by pcr test and proximity to COVID positive individuals. Both injections were several months apart. I have since been triple vaccinated as have my wife and Mother-in-law who both live with me. My real concern is that my son, 6, has just gotten his second Pfizer dose. I wear a mask to work and in public (sometimes N95 others just a surgical mask) is this overkill? I don’t want to asymptomatically spread it to my son before his full vaccination nor to my unvaccinated coworkers. Is there data to justify my response or am I going overboard?
Thank you for keeping us all informed with science and good data,
-David
Lisa writes:
Hello, Dr. Griffin,
I wonder if you can speak on your opinion regarding the benefit vs. risk of boosting a 16- to 17-y/o male, who is in the highest-risk group for myocarditis as an adverse effect of vaccine.
Specifically, I just read the article you mentioned recently- “Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19-associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance.” I was concerned to read that VE against ED and UC once Omicron predominated was down to <40% by 6 mos post-second dose in adults, and VE against hospitalization only 57%.
The last data I saw on VE for adolescents was 4 or maybe 5 mos after vaccine, effectiveness in 12- to 15-y/o was very high with no change seen. I have not seen an update. This was pre-Omicron.
I have a now-16-y/o boy, thin, with no medical problems, who had his second vaccine dose 7 mos ago. He has never had Covid. I have been reassured by your reports, and those of other clinicians, that kids with Covid ending up in the hospital are overwhelmingly unvaccinated. But this data gives me pause. I don’t want my kid to need emergency care, either.
Do you have any data on the prevalence of teens with Covid showing up at EDs, and are you aware of any updated VE stats in adolescents, past 4-5 mos and ideally since Omicron?
What would be your recommendation for booster or not? At this point I’m weighing two small risks: risk of myocarditis (which, of course, causes hospitalization) vs. a low- but unknown to me- risk of ED/UC/hospitalization if he has a “breakthrough” Covid case.
Thank you!
Lisa