"The groundwork of all happiness is health." - Leigh Hunt

When and why it is best to get vaccinated against COVID, RSV and flu this fall

September 13, 2023 – We are initially of the autumn respiratory season, and already this week the main target is on the FDA’s approval and CDC’s support of the brand new COVID-19 booster shot.

But it's not nearly COVID. This can be the primary fall that a vaccine against respiratory syncytial virus (RSV) is accessible, which is advisable for people over 60 and pregnant women. And there are the ever-present worries in regards to the flu.

Who needs to be most concerned? What is the optimal timing for a number of of those vaccines? And how long do you have to wait to get the brand new booster shot when you had COVID this summer?

These and other practical questions were discussed by two experts at a press conference sponsored by the Infectious Diseases Society of America.

Higher risk means higher urgency

Even though the CDC now recommends the brand new COVID vaccine for each American over 6 months of age, people at higher risk — those over 65, individuals with underlying medical conditions — should get the vaccine as soon as possible, said Jeffrey Duchin, MD, health officer for Public Health-Seattle & King County in Seattle.

“I want to emphasize that people of all ages can benefit from COVID-19 vaccination, but the greatest benefit is for people at increased risk for severe COVID-19 in terms of hospitalization and death,” Duchin said. People at higher risk “should get the vaccine as soon as it is available, and that will be in the next few weeks.”

As for the timing of the flu and RSV vaccines, they might be combined. Additionally, people “who have the luxury of visiting their doctor or pharmacy multiple times” can opened up the vaccinations. “You might want to schedule your flu vaccine a little earlier to coincide with the time when flu activity is increasing in your community,” Duchin said, “because we know that the effectiveness of the flu vaccine varies even over several months.”

As for RSV, “I wouldn't say there's an urgent need for everyone to run out and get vaccinated today,” he added, adding that folks should confer with their doctor about eligibility and timing.

So why is the vaccine being offered to just about the complete U.S. population? An evaluation presented this week at a gathering of CDC advisers found that making the vaccine available to just about everyone — a so-called “universal recommendation” — could prevent about 200,000 hospitalizations and 15,000 deaths from COVID over the following two years, compared with vaccinating only people age 65 and older.

Young, healthy people who find themselves truly at low risk “need to consider their willingness to become infected and to take the risk of disease that can be severe even in a small proportion of young, healthy people,” Duchin said. They must also consider their home and work environments and whether or not they could infect another person at higher risk.

Not a sure-fire success for everybody

Sometimes the next risk for COVID is more obvious, comparable to in older age, and for that group vaccination is strongly advisable, Duchin said. “It's a no-brainer.”

Others might not be aware that they’re at high risk, including some with underlying health conditions, he said. “Why should people [at] low risk to consider getting vaccinated? One reason is that many people who think they are at low risk actually aren't.”

The CDC lists many underlying conditions and factors which will put an individual at higher risk for severe outcomes from COVID. Below are the principal categories in alphabetical order. There could also be other rare conditions that increase the chance, so people should check with their doctor.

  • Cancer
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic lung diseases
  • Cystic fibrosis
  • Dementia or other neurological diseases
  • Diabetes (type 1 or type 2)
  • Disabilities
  • Heart Conditions
  • HIV infection
  • Immunodeficiency or weakened immune system
  • Mental illness
  • Overweight and obesity
  • Physical inactivity
  • pregnancy
  • Sickle cell anemia or thalassemia
  • Smoking, current or former
  • Transplantation of solid organs or blood stem cells
  • Stroke or cerebrovascular disease
  • Substance use disorders
  • tuberculosis

What if I had COVID this summer?

The CDC's official advice is to attend a minimum of two months after your last vaccination to get a booster shot, and three months when you recently had a COVID virus infection.

“That said, everyone has to look at their own personal situation,” Duchin said. Someone at very high risk, for instance, might wish to get their COVID booster shot earlier of their eligibility period, he said.

On the opposite hand, someone who’s at lower risk of infection and takes many precautions “may want to wait a little longer and see if they can extend their protection a little longer after a natural infection.”

It can be flu and RSV season

As essential as protection against COVID is, “we need to think about other vaccines that we can use to protect people from other respiratory viruses that are going to be circulating,” including influenza and RSV, says Tina Q. Tan, MD, a pediatrician within the division of infectious diseases at Ann & Robert H. Lurie Children's Hospital of Chicago and vp of the board of directors of the Infectious Diseases Society of America.

“We know that millions of children get the flu every year,” Tan said. Children under 5, and particularly under 2, are at increased risk for flu complications.

It is advisable that every one children aged 6 months and older be vaccinated against influenza. “This is really an important way to protect people from severe flu and its complications. It is also important to vaccinate not just the child, but everyone, especially if there are infants under 6 months in the household.”

As for RSV, greater than 2 million doctor visits by children under 5 are as a consequence of RSV annually, with most visits being for otherwise full-term, healthy infants. Although there is no such thing as a approved RSV vaccine for young children, the CDC in August advisable a recent monoclonal antibody for all infants under 8 months of age and a few older babies, Tan said. This preventive treatment is essential because “RSV can cause serious illness and complications in this very young infant population.” RSV is related to as much as 80,000 hospitalizations and 300 deaths in young children annually.

Older individuals are also at higher risk for severe RSV disease. “Many of us know how important the annual flu shot is, but most don't realize what a big problem RSV can be for older people,” Duchin said.

The CDC estimates that RSV is chargeable for about 160,000 hospitalizations and between 6,000 and 10,000 deaths amongst older adults. Those at highest risk are older Americans with chronic heart or lung disease, weakened immune systems, and adults living in nursing homes or long-term care facilities. Duchin added that folks ages 60 and older should confer with their doctor or the person administering their vaccines to find out if RSV vaccination would profit them.