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September 04, 2023

When to get your flu shot, COVID-19 booster and RSV vaccine this fall

Doctors explain who is eligible for the new RSV immunizations, and why its best to get inoculated against influenza by early October

Fall may be the season of pumpkin patches and hayrides, but it's also the time when cases of influenza, COVID-19 and respiratory syncytial virus typically climb.

The start of the school season and drop in temperature tend to drive larger groups of people indoors, making it easier to spread respiratory infections. Last year, as cases of all three viruses overwhelmed hospitals, the confluence of illness was dubbed the "tripledemic." At the time, there were no vaccines even available for RSV, which can cause serious lung infections in small children and older adults.

That's no longer the case, and medical professionals say the best way to avoid another tripledemic — or at least soften its impact — is to get vaccinated. But does everyone need all three shots, and when should they get them? Here are the answers to those and other common questions about fall vaccines, with insight from local doctors:

What RSV vaccines are available?

There are two RSV vaccines, designed to protect the groups at highest risk of severe illness: the elderly and infants.

Earlier this year, the FDA approved Arexvy, a single-dose shot from GSK designed to protect adults 60 years and older from respiratory illness. It also approved Abrysvo, a single vaccine for patients 60 and older or expectant mothers at 32-36 weeks gestation. In pregnant women, the shot spurs the production of antibodies and transfers them to the placenta, protecting babies for their first 6 months of life.

While not a vaccine, a preventive RSV shot is also now available for infants and toddlers.

Are they effective?

For people 60 and older, Arexvy is 82.6% effective at preventing infection while Abrysvo has an efficacy of 88.9%. In clinical trials, both vaccines waned in protection during subsequent RSV seasons. Abrysvo reduced the risk of severe illness by 69-82% in infants whose mothers received the immunization.

Beyfortus, the preventative drug, was found to be 70-75% effective in studies.

Do they have side effects?

According to Dr. Delana Wardlaw, a family medicine physician with Temple Health, the side effects associated with the new RSV vaccines are minimal. 

"As far as the side effects that people can potentially have, it's basically the side effects that we typically see with vaccines," she said. "We see some soreness at the site. You may have some low-grade fevers and some redness at the site. Outside of that, we have not seen any significant side effects from the vaccine itself."

When should people get the RSV vaccine?

Fall may not technically begin until Sept. 22, but with school resuming, the season is more or less upon us — and if you're pregnant or older than 60, you may want to get an RSV shot sooner rather than later. Last year, the virus showed up early, catching pediatricians by surprise with its April arrival and surge in September and October.

"This is really the crux of the problem right now," said Dr. Martin Topiel, head of infectious diseases at Virtua Health. "It does vary year by year. We're also having issues because there was a gap in RSV infections because everybody stayed home a couple years ago. So we still don't know if there's going to be a larger bump for people who've never been exposed to it in the past or recently. And that could bring a more significant season of RSV or an earlier season of RSV."

Is there a new COVID-19 booster?

Yes, but it's not available yet. Updated vaccines designed to fight the XBB variants descended from the omicron variant are expected this fall. 

Dr. Mandy Cohen, director of the U.S. Centers for Disease Control and Prevention, said last week that while she expected new boosters to be available by "the middle of September," they were still going through the FDA approval process.

When should you get a COVID-19 vaccine?

If you had COVID-19 or got your latest booster within the last 90 days, you're not due for another shot yet. But if you are, talk to your doctor about the best choice for your health. Those without any risk factors for severe infection, like diabetes or a weakened immune system, may want to wait for the updated booster. With cases already rising, medical experts recommend staying on top of your vaccination schedule.

"We're seeing increased hospitalizations related to COVD, this started 2-3 weeks ago," Topiel said. "We expect that with the return to school, both colleges, the elementary and local schools, that as in the past, this will cause further upticks. The challenge we have now is we're not in the same place because there were some people masking indoors in the past. Given that nobody's doing it now, there's more potential inadvertent exposures going on."

When should you get a flu shot?

As any doctor is quick to note, the flu shot is recommended for everyone. Wardlaw suggested getting it sometime between mid-September and late October to ensure protection throughout the cooler months.

Can you get all three vaccines at the same time?

Right now, it's not recommended. "Research studies have not been done for the co-administration of all the vaccines together," Wardlaw said. "The data's just not there. So doing the three together, that is a special circumstance that people need to discuss with their physicians."

Wardlaw and Topiel each stressed that the COVID-19 and flu vaccines can be taken at the same time. But patients who also need the RSV shot should schedule a second trip.

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