Your fall guide to COVID, RSV and flu vaccines

As temperatures cool, the risks of respiratory illness rise. This year, there are more vaccine options to consider that are designed to prevent serious illness from flu, COVID and RSV.

“All three are, in general, strongly recommended for the populations they’re intended for,” said Dr. Payal Patel, an infectious disease physician at Intermountain Health in Utah.

After last winter’s flu, COVID and RSV tripledemic threatened public health and the stability of the U.S. health care system, doctors are urging virtually everyone to get vaccinated against the flu and for people to talk to their health care providers about whether the newly available RSV vaccine or upcoming COVID booster is right for them.

The PBS NewsHour asked public health experts for advice on who should get which vaccine dose and when.

Influenza

Each year, the flu poses a deadly threat – preliminary federal data suggest the virus put as many as 650,000 people in the hospital and caused up to 58,000 deaths during the last flu season.

First developed during World War II for the U.S. military, an annual dose of the flu vaccine has been shown to be safe and effective for anyone who is 6 months or older, said Dr. Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia.

“The flu virus evolves so much from one year to the next that it really requires a yearly vaccine,” Offit said.

Infectious disease experts monitor the flu virus globally as it moves across seasons and hemispheres. In anticipation of the virus emerging, different flu strains are selected to make up the vaccine for the upcoming season. Over the last two decades, Offit said scientists and epidemiologists have rarely chosen the wrong combination of flu strains for a new season, but he added that “a miss is a mile,” leaving people’s immune systems ill-prepared for preventing severe outcomes.

Going into this fall and winter’s flu season, “We expect a good match,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “There’s no signal at this point that there’s going to be a mismatch.”

Chart by Megan McGrew/PBS NewsHour

Because the vaccine’s immunity-boosting protection can fade across the course of a few months, Adalja recommends that people get their flu shots in early October. However, it’s fine to receive a dose in late September if you’re facing scheduling demands or other health concerns, Adalja said.

People who are age 65 or older should request a higher dose tailored to offer them even more protection, he said.

Children age 8 or younger who have not yet received any flu vaccine will need to receive two doses, said Dr. William Schaffner of Vanderbilt University Medical Center.

Some patients complain about getting sick with the flu even after they have been vaccinated, Schaffner said, but he urges them not to worry too much, so long as they are able to stay home with their aches and sniffles.

“If you don’t expect perfection, you won’t be disappointed,” Schaffner said. “The flu vaccine is designed to keep you out of the hospital.”

COVID

In May, when the Biden administration ended the nation’s three-year-old public health emergency, some Americans may have felt like they no longer had to worry about COVID. While severe illness in the U.S. fell across the spring, hundreds have still died every week since then. In recent weeks, the Centers for Disease Control and Prevention have reported an uptick in COVID hospitalizations.

Although wastewater surveillance data suggests community transmission of the virus may already be tapering off again, COVID has not disappeared, Schaffner said.

COVID appears to mutate and evolve more rapidly than influenza, Schaffner said. That means public health officials and communities still need to remain vigilant, monitor the efficacy of vaccines and utilize boosters to shore up protections against this virus.

READ MORE: Biden says he will request more funding for a new COVID-19 vaccine

Pfizer, Moderna and Novavax have each developed a COVID vaccine updated to protect against the newer omicron subvariant XBB.1.5, and regulators at the Food and Drug Administration have vetted the changes. On Sept. 12, the CDC’s Advisory Committee on Immunization Practices will weigh evidence relating to the effectiveness of these boosters before voting on whether or not to recommend their use.

If the CDC approves these newest doses, they could be available by mid- to late September, Offit said.

However, the updated booster is not intended for everyone. It’s for people in high-risk groups – those who are age 75 or older, pregnant or immunocompromised, said Offit, who serves on the FDA’s expert panel that reviewed the vaccine companies’ data. Individuals in this group, he explained, stand to benefit the most in part because they account for a disproportionate number of COVID hospitalizations and deaths.

The general public should not expect to need to receive the latest COVID booster, Offit said.

RSV

Each year, respiratory syncytial virus, or RSV, tends to infect young children and seniors, and is particularly deadly in the latter group. As many as 10,000 older adults are estimated to die annually from this illness. It’s also the leading cause for hospitalization for kids under age 5.

“This is an underappreciated virus,” Schaffner said.

In 2022, the nation was hit with what some people called a tripledemic, in which RSV, COVID and the flu all surged at roughly the same time. It was a terrible coincidence that strained health care systems and sent a flood of patients to emergency departments for respiratory distress. That surge made developing and deploying a vaccine against RSV all the more urgent.

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Though RSV was discovered in the 1950s, vaccines to prevent this life-threatening illness had not been created and approved until this year. To prevent the worst outcomes, the FDA and CDC have approved RSV vaccines for individuals age 60 or older, infants and toddlers and pregnant people.

A single dose of Abrysvo is available between 32 and 36 weeks of pregnancy and protects both the parent and fetus. Clinical trial data showed it reduced the risk of severe complications for a newborn by more than 80 percent within three months of birth.

Because this vaccine is new, researchers and doctors are still figuring out how much durable protection it can offer to a person’s immune system. But early evidence suggests this vaccine may last beyond a single RSV season, which would be a relief for patients as well as the experts who try to keep us healthy.