Most Americans have received one or more flu and Covid vaccines. New this year are the first shots to protect older adults against respiratory syncytial virus, a lesser-known threat whose number in hospitalizations and deaths can rival that of the flu.
Federal health officials hope that widespread use of these three vaccines will eliminate another “triple epidemic” of respiratory illnesses, like the one seen 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 vaccines program at Boston Children’s Hospital and an adviser to the Food and Drug Administration.
Here’s what he and other experts say about who should get which vaccines, and when.
What respiratory diseases come to us?
The coronaviruses, influenza and RSV are all likely to re-emerge this fall, but exactly when and how much damage they will do is unknown. That’s partly because the restrictions in place during the pandemic changed the seasonal patterns of the viruses.
This past winter, the flu peaked in December instead of February, as it usually does. The virus may have caused up to 58,000 deaths, a higher number than usual. Covid has kept a constant number of infections and deaths most of the season, with a peak in January.
Compared to its pattern before the pandemic, RSV peaked several weeks earlier last year, and it circulated longer than usual.
RSV is increasingly recognized as a serious respiratory threat, especially to older adults, immunocompromised people and young children. “RSV has a disease burden similar to the flu in older adults — it can make you very, very sick,” said Dr. Helen Chu, a physician and immunologist at the University of Washington.
Scientists expect respiratory viruses to return to their pre-pandemic patterns eventually, but “it will be unpredictable for the next two years,” Dr. Chu said.
What vaccines should I look for?
Everyone should have at least the flu and Covid shots this fall, experts said.
The annual flu vaccine is recommended for everyone 6 months and older, but it’s most important for adults age 65 and older, children under 5 and people with weakened 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 is currently responsible for approximately 27 percent of cases. The full recommendations won’t be available until the FDA authorizes the shots and the CDC reviews new data.
Federal health officials are not talking about a primary series of shots followed by boosters. (Officials don’t even call the shots “boosters” anymore.) Instead, they are 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 physician at Massachusetts General Hospital and an adviser to the Centers for Disease Control and Prevention, about the Covid vaccine.
RSV is a common cause of respiratory disease among older adults, especially those 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 younger than 60. The CDC recommends that people age 60 and older sign up for the shot after consulting with their doctors.
While it’s true that risks posed by any of the three viruses increase with age, remember that “65 is not a magic cutoff,” Dr. Chu said.
“Even those with no pre-existing conditions can become quite sick with all three of these viruses,” she said.
When should I get the vaccines?
No one knows when these viruses will reappear, so you should get the shots early enough in the fall to build immunity against the pathogens. Most people won’t be willing or able to make multiple trips to a clinic or pharmacy to split the shots.
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 to face both viruses. Older adults who are in poor health — who have heart or lung disease, for example, or are on home oxygen — should get all three shots, some experts said.
They should “get them as quickly and definitively as possible before the season, and do everything at once,” Dr. Chu said.
Adults 50 and older should also get the shingles vaccine if they haven’t already, and those 65 and older should sign up for the pneumococcal vaccine. But those vaccines do not need to be given in the fall and should be scheduled for another time, Dr. Chu said.
Is it safe to get these vaccines right away?
The flu and Covid shots were often given together last fall and seemed to work well. Because the RSV vaccine is new, however, there is little information about how it might interact with the other two vaccines.
“The available data on the administration of influenza and Covid-19 vaccines at the same time do not indicate safety concerns,” the Department of Health and Human Services said in a statement to The New York Times.
“FDA and CDC systems monitor vaccine safety throughout the year and will remain in place,” the department said. “If any new potential safety signals are identified, the FDA and CDC will conduct further evaluation and notify the public.”
Some research suggests that the RSV and flu vaccines produce lower levels of antibodies when they are given together than when they are given individually. But those levels are probably still high enough to protect people from the viruses, experts said.
There are 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 a result of the inoculations. More clarity will come from surveillance as the vaccines are administered on a large scale, Dr. Chu said.
The CDC is expected to make recommendations about administering the vaccines together in the coming weeks.