How to time COVID, RSV and flu vaccines to avoid ‘tripledemic’


Americans will have more reasons to roll up their sleeves this fall as vaccines are available for three respiratory viruses that typically overwhelm hospitals and kill thousands of people annually. Hoping to avoid another “tripledemic” of COVID-19, influenza and the respiratory syncytial virus, public health officials are urging everyone to consider what shots are right for them ahead of a potential surge of illnesses. 

“There will be a lot of virus this winter,” said Dr. Mandy Cohen, director of the U.S. Centers for Disease Control and Prevention. “That’s why we want to get ahead of it.”

Here’s what to know.

Table of Contents

COVID-19

New COVID-19 vaccines from Moderna and Pfizer have been authorized by the CDC and Food and Drug Administration for everyone 6 months of age and older, regardless of their vaccination status. Cohen signed off on the recommendation on Tuesday night, making the mRNA vaccines available to the public by the end of the week.

“We have more tools than ever to prevent the worst outcomes from COVID-19,” she said in a statement. 

Novavax, a third vaccine manufacturer, is awaiting FDA review for its updated protein-based vaccine.

Eligibility: The fall round of COVID-19 vaccinations is available to adults and children age 6 months and older, with most individuals from age 5 able to receive a single dose, even if they haven’t previously been vaccinated against COVID-19. This approach is in line with making COVID-19 vaccinations routine like annual flu shots. Younger children may need additional doses depending on their vaccination and infection history. 

Timing: Vaccinations are expected to start this week. Those with upcoming travel plans or visits to high-risk individuals may choose to get vaccinated immediately, as it takes around two weeks after vaccination for the body to build immunity. Others may prefer to wait until mid-October for increased protection against potential winter outbreaks. It is safe to get the COVID-19 vaccine at the same time as getting vaccinated against the flu and RSV. The CDC says there is no difference in effectiveness or side effects if people get those vaccines simultaneously, although one in each arm might be more comfortable.

Reasons to get vaccinated: COVID-19 hospitalizations have been increasing since late summer, albeit not to the same extent as the previous year, thanks to prior immunity from vaccinations and infections. However, immunity diminishes over time, and the virus produces new variants. About 21% of Californians are up-to-date on their shots. The FDA refers to this round as a vaccine updated to better match the currently circulating virus, targeting the omicron variant XBB.1.5, rather than a “booster.” While this variant is no longer dominant, the shot provides substantial cross-protection against newer strains like EG.5 and BA.2.86, primarily guarding against severe COVID-19 cases.

“Although hospitalization rates are currently low, we have seen rates increase in recent weeks and anticipate further increases as we enter respiratory virus season,” said Megan Wallace, an epidemiologist at the CDC.

Vaccination may also cut the risk of suffering the effects of long COVID, which can develop following acute infection and last for months or years. “The best protection against COVID-19 and the possibility of serious illness remains staying up to date with vaccinations, including the latest vaccine,” said Carlos del Rio, president of the Infectious Diseases Society of America. “Having vaccines approved is not enough—getting vaccinated is necessary for protection.” 

Cost: Most Americans can access the shots for free through private insurance or Medicare. However, uninsured or underinsured individuals can obtain free shots through health departments, clinics, and select pharmacies. Locations will be listed on the government’s website, www.vaccines.gov. California residents can schedule an appointment by visiting MyTurn.ca.gov. Commercially available shots are $115-$130 per dose. 

Influenza

This year’s flu vaccine is expected to be a relatively good match against the circulating strains of the virus, which could signal a more predictable, less severe winter respiratory season. The forecast is based on the southern hemisphere’s flu season, which is nearing its end. U.S. infectious disease experts look to Australia’s influenza season to gain clues for how the flu will play out here.

Eligibility: Influenza vaccines are available for all individuals aged 6 months and older, with additional formulations for older adults. 

Timing: California’s flu season typically lags behind other parts of the country, often peaking in February instead of December or January, making late October the ideal time for vaccination. However, specific recommendations exist for various groups, including older adults, pregnant individuals and young children who may require two doses four weeks apart. Children under 8 who are getting the flu shot for the first time will need to get two shots four weeks apart; they should get the first in September and the second in October.

“I think that the timing of flu is always an interesting thing,” said Dr. George Rutherford, an infectious diseases expert with UCSF. “It’s a Goldilocks problem. You want it to be just right. You want to have your immunity peaking as the disease peaks, but that’s all about foretelling the future. I always get it in October.”

Reasons to get vaccinated: Influenza leads to tens of thousands of deaths and hundreds of thousands of hospitalizations each year, according to the CDC. Between 2010 and 2020, an average of 35,000 people died from the flu annually, and 420,000 were hospitalized annually. Flu vaccines typically reduce the risk of hospitalization or emergency department visits by 40%-60%. 



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