Most Americans have had one or more flu and covid vaccines. New this year are the first injections to protect older adults against respiratory syncytial virus, a lesser-known threat whose toll in hospitalizations and deaths rivals that of the flu.
Federal health officials hope that the widespread use of these three vaccines will prevent a new “triple illness” of respiratory disease, like the one that occurred last winter. For people with insurance, all vaccines should be available free of charge.
“This is an embarrassment of riches,” said Dr. Ofer Levy, director of the precision vaccine program at Boston Children’s Hospital and an advisor to the Food and Drug Administration.
Here’s what he and other experts say about who should get which vaccines, and when.
Which respiratory diseases come our way?
The coronavirus, flu and RSV are all likely to resurface this fall, but exactly when and how much damage they will cause is unknown. That’s partly because the restrictions in place during the pandemic changed the seasonal patterns of the viruses.
Last winter, the flu peaked in December instead of February, as usual. The virus may have caused as many as 58,000 deaths, a higher than usual number. Covid caused a consistent number of infections and deaths for most of the season, peaking in January.
Compared to the pre-pandemic pattern, last year RSV peaked several weeks earlier and circulated longer than normal.
RSV is increasingly recognized as a major respiratory threat, particularly for older adults, the immunocompromised, and young children. “RSV has a disease burden similar to the flu in older adults — it can make you very, very sick,” says Dr. Helen Chu, a physician and immunologist at the University of Washington.
Scientists expect respiratory viruses to eventually return to their prepandemic patterns, but “it’s going to be unpredictable over the next two years,” said Dr. Chu.
Which Vaccines Should I Look For?
Everyone should at least have the flu and covid shot this fall, experts said.
The annual flu vaccine is recommended for everyone 6 months and older, but it’s especially important for adults 65 and older, children under 5, and people with weak immune systems.
Updated Covid shots are coming this fall from Pfizer, Moderna and Novavax, and all are designed to target XBB.1.5, the Omicron variant that currently accounts for about 27 percent of cases. The full recommendations won’t be available until the FDA approves the injections and the CDC reviews new data.
Federal health officials are not talking about an initial round of shots followed by boosters. (Officials aren’t even calling the shots “boosters” anymore.) Instead, they’re trying to steer Americans toward the idea of a single annual immunization with the latest version of the vaccine.
“Like a seat belt in a car, it’s a good idea to keep using it,” said Dr. Camille Kotton, a Massachusetts General Hospital physician and consultant to the Centers for Disease Control and Prevention, on the Covid vaccine.
RSV is a frequent cause of respiratory disease in older adults, particularly those age 75 or older who have other conditions, such as cardiovascular disease, chronic lung disease, or diabetes.
The new RSV vaccine is not approved for Americans under age 60. The CDC recommends that people age 60 and older sign up for the shot after speaking with their doctor.
While it’s true that the risks of any of the three viruses increase with age, remember that “65 isn’t a magical cutoff point,” said Dr. Chu.
“Even those with no pre-existing conditions can become quite ill from all three of these viruses,” she said.
When should I get the vaccines?
No one knows when these viruses will resurface, so you need to get the injections early enough in the fall to build up immunity against the pathogens. Most people won’t or won’t be able to go to a clinic or pharmacy multiple times to tell the injections apart.
That probably means September or October. Most Americans may want to consider getting flu and covid shots at the same time so they are prepared for both viruses. Older adults in poor health — those who have heart or lung disease, for example, or who have oxygen at home — should get all three injections, some experts said.
They need to “get them as soon as possible and certainly before the season, and do it all at once,” said Dr. Chu.
Adults age 50 and older should also get the shingles vaccine, if they haven’t already, and those age 65 and older should sign up for the pneumococcal vaccine. But those vaccines don’t have to be given in the fall and should be scheduled at a different time, Dr. Chu said.
Is it safe to get these vaccines at once?
The flu shot and Covid shot were often given together last fall and seemed to work well. However, because the RSV vaccine is new, there is little information on how it might interact with the other two vaccines.
“The available data regarding the co-administration of flu and Covid-19 vaccines do not indicate safety concerns,” the Department of Health and Human Services said in a statement to DailyExpertNews.
“FDA and CDC systems monitor vaccine safety year-round and will remain in effect,” the department said. “If new potential safety signals are identified, the FDA and CDC will conduct further review and inform the public.”
Some research suggests that the RSV and flu vaccines produce lower levels of antibodies when given together than when given one at a time. But those levels are probably still high enough to protect people from the viruses, experts said.
There is also limited data on the safety of the two RSV vaccines. Clinical trials recorded six cases of neurological problems, including Guillain-Barré syndrome, compared to none in the placebo groups.
But the numbers were too small to determine whether the cases were due to the vaccinations. There will be more clarity through oversight as the vaccines are widely administered, said Dr. Chu.
The CDC is expected to jointly make recommendations on the administration of the vaccines in the coming weeks.
