Three fall vaccines: what you need to know

Most Americans have had one or more flu and Covid shots. New this year are the first vaccines to protect older adults from respiratory syncytial virus, a lesser-known threat that could cause hospitalizations and deaths comparable to the flu.

Federal health officials are hoping that widespread use of these three vaccines will prevent another “triple pandemic” of respiratory illnesses like last winter. All vaccines should be available free of charge for insured persons.

“It’s an embarrassment of wealth,” said Dr. Ofer Levy, director of the precision immunization program at Boston Children’s Hospital and consultant to the Food and Drug Administration.

Here’s what he and other experts say about who should get which vaccines and when.

It is likely that the coronavirus, flu and RSV will flare up again 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 have changed the viruses’ seasonal patterns.

Last winter, the flu peaked in December, rather than February as usual. The virus could have caused as many as 58,000 deaths, a higher number than usual. Covid maintained a constant number of infections and deaths for most of the season, peaking in January.

Compared to the pre-pandemic pattern, RSV peaked several weeks earlier last year and circulated longer than usual.

RSV is increasingly recognized as a major respiratory threat, particularly to older adults, immunocompromised individuals, and young children. “RSV has a similar burden of disease to the flu in older adults — it can be very, very ill,” said Dr. Helen Chu, physician and immunologist at the University of Washington.

Scientists anticipate that respiratory viruses will eventually return to their prepandemic pattern, but “that’s going to be unpredictable over the next two years,” said Dr. Chu.

Everyone should at least be vaccinated against the flu and Covid this fall, experts said.

Annual influenza vaccination is recommended for everyone aged 6 months and over, but it is most important for adults aged 65 and over, children under 5 and people with weakened immune systems.

Updated Covid vaccines from Pfizer, Moderna and Novavax are coming this fall, and all target XBB.1.5, the Omicron variant, which currently accounts for about 27 percent of cases. The full recommendations will not be available until the FDA approves the shots and the CDC reviews new data.

Federal health officials do not speak of an initial series of vaccinations followed by booster shots. (Officials don’t even call it a “booster” anymore.) Instead, they’re trying to get Americans to think of a single yearly shot 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 advisor to the Centers for Disease Control and Prevention, on the Covid vaccine.

RSV is a common cause of respiratory disease in older adults, particularly those aged 75 and older who have other conditions, such as cardiovascular disease, chronic lung disease, or diabetes.

The new RSV vaccine isn’t approved for Americans under the age of 60. The CDC recommends that people age 60 and older register for the vaccine after consulting their doctor.

While it’s true that the risks from each of the three viruses increase with age, remember, “65 isn’t a magic threshold,” said Dr. Chu.

“Even people without previous illnesses can contract all three of these viruses,” she said.

No one knows when these viruses will reappear. Therefore, you should get vaccinated early enough in the fall to build up immunity to the pathogens. Most people will not be able or willing to make multiple trips to a clinic or pharmacy to separate vaccinations.

That probably means September or October. Most Americans might want to consider getting vaccinated against the flu and Covid at the same time so they are prepared for both viruses. Older adults who are in poor health — those who have heart or lung disease, for example, or who need oxygen at home — should get all three shots, some experts said.

They should “get them as soon as possible and definitely before the season and do it all at once,” said Dr. Chu.

Adults age 50 and older should also get the shingles vaccine if they haven’t already, and those age 65 and older should sign up for the pneumococcal vaccine. But those shots don’t have to be given in the fall and should be scheduled at a different time, said Dr. Chu.

The flu and Covid shots were often given together last fall and seemed to be working well. However, because the RSV vaccine is new, there is little information on how it might interact with the other two vaccines.

“The available data on co-administration of flu and Covid-19 vaccines do not indicate safety concerns,” the Department of Health and Human Services said in a statement to The New York Times.

“The systems of the FDA and CDC monitor vaccine safety year-round and remain in place,” the department said. “As new potential safety signals are identified, the FDA and CDC will conduct further evaluation and update the public.”

Some research suggests that the RSV and flu vaccines produce lower levels of antibodies when given together than when given individually. But these levels are likely still high enough to protect people from the virus, experts said.

There is also limited data on the safety of the two RSV vaccines. Clinical studies recorded six cases of neurological problems, including Guillain-Barré syndrome, compared to none in the placebo group.

However, the numbers were too small to determine whether the cases were due to the vaccinations. Surveillance will bring more clarity while vaccines are widely administered, said Dr. Chu.

The CDC is expected to make recommendations on co-administration of the vaccines in the coming weeks.

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