September 13, 2023 – We are at the start of the fall respiratory season, and this week there is already a lot of attention on FDA authorization and CDC support for the new COVID-19 booster shot.
But it’s not just COVID. This is also the first fall in which a vaccine is available against respiratory syncytial virus (RSV), which is recommended for people over 60 and pregnant women. Plus, there are the evergreen concerns about the flu.
Who should be most concerned? What is the optimal time to take one or more of these shots? And how long do you have to wait to get the new booster if you had COVID this summer?
Two experts addressed these and other practical questions at a news briefing sponsored by the Infectious Diseases Society of America.
Higher risk means higher urgency
Although the CDC now recommends the new COVID vaccine for every American over six months of age, people at higher risk — over age 65, those with underlying 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 while people of all ages can benefit from the COVID-19 vaccination, the greatest benefit is among people at increased risk for severe COVID-19 in terms of hospitalizations and deaths,” Duchin said. People at higher risk “should take the vaccine as soon as it becomes available, which will happen in the coming weeks.”
As for the timing of the flu and RSV vaccines, they can be combined. Also for people “who have the luxury of making multiple visits” to their doctor or pharmacy, the shots can be spaced out. “Maybe it’s time to back off your flu a bit toward when flu activity is increasing in your community,” Duchin said, “because we know the effectiveness of the flu vaccine also varies over several months.”
As for RSV, “I wouldn’t say there’s an urgent need for everyone to go out and get that vaccine today,” he added. People should talk to their doctors about eligibility and timing.
So why offer the vaccine to almost the entire US population? An analysis presented this week at a meeting of CDC advisors found that having the vaccine available to almost everyone, known as a “universal recommendation,” would save about 200,000 hospitalizations and 15,000 deaths from COVID over the next two years will save, compared to just vaccinating individuals. 65 and older.
Young, healthy people who are truly at low risk “should look at their willingness to get infected and take their chances with the disease, which can be serious even in a small proportion of young, healthy people,” Duchin said. They should also consider their home and work environments and whether they may expose someone else at higher risk.
No ‘Slam Dunk’ for everyone
Sometimes a higher risk of COVID is more apparent, such as in older age, and for this group the vaccine is strongly recommended, Duchin said. “It’s a slam dunk.”
Others may not realize they are at high risk, including some with underlying conditions, he said. “Why would people [at] low risk, consider vaccination? One reason is that many people who think they are at low risk actually are not.”
The CDC lists many underlying conditions and factors putting an individual at greater risk of severe outcomes from COVID. Below are the main categories, in alphabetical order. There may be other rare conditions that increase the risk, so people should contact their healthcare providers.
- Cancer
- Chronic kidney disease
- Chronic liver disease
- Chronic lung diseases
- Cystic fibrosis
- Dementia or other neurological disorders
- Diabetes (type 1 or type 2)
- Physical disability
- Heart condition
- HIV infection
- Immunocompromised condition or weakened immune system
- Mental health problems
- Overweight and obesity
- Physical inactivity
- Pregnancy
- Sickle cell disease 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 official CDC recommendation is to wait for a booster at least 2 months after your last immunization and 3 months if you have recently had a COVID virus infection.
“That said, everyone needs to look at their own personal situation,” Duchin said. For example, someone at very high risk might want to get their COVID booster earlier in their eligibility period, he said.
On the other hand, someone with a lower exposure risk who takes a lot of precautions “may want to wait a little longer and see if they can extend that protection a little bit further after a natural infection.”
It’s also flu and RSV season
As important as protection against COVID is, “we need to think about other vaccines that we can use to protect individuals from these other respiratory viruses that will be circulating,” including influenza and RSV, said Tina Q. Tan, MD, a pediatrician at the Division of Infectious Diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago and vice president of the board of directors of the Infectious Diseases Society of America.
“We know that millions of children get the flu every year,” says Tan. Children under 5 years of age, and especially children under 2 years of age, are at increased risk of flu complications.
The advice is to vaccinate all children aged 6 months and older against the flu. “It really is a critical tool to protect individuals from severe influenza and its complications. It is also important to immunize not only the child, but everyone, especially if there are babies in the household who are under six months old.”
Regarding RSV, more than 2 million medical visits for children under 5 years of age are related to RSV each year, with most visits occurring in otherwise full-term, healthy infants. Although no RSV vaccine has been approved for young children, the CDC recommended a new monoclonal antibody in August for all babies under 8 months and some older babies, Tan said. This preventive treatment is important because “RSV can cause serious illness and complications in this very young infant population.” RSV is associated with as many as 80,000 hospitalizations and 300 deaths in young children annually.
Older adults are also at greater risk for severe RSV disease. “Many of us know how important it is to get the annual flu vaccine, but most don’t know what a major problem RSV can be for older adults,” Duchin said.
The CDC estimates that RSV is responsible for approximately 160,000 hospitalizations and between 6,000 and 10,000 deaths among older adults. The risk is greatest for 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 people age 60 and older should have a conversation with their doctor, or whoever is administering their vaccines, to determine whether RSV vaccination will be beneficial for them.