Most Americans have had one or more shots of the flu and COVID vaccine. New this year are the first vaccines to protect the elderly against respiratory syncytial virus, a lesser-known threat whose hospitalization and death toll could match that of the flu.
Federal health officials hope that widespread use of these three vaccines will avert another “triple epidemic” of respiratory illnesses, such as those seen last winter. For people with insurance, all vaccinations should be freely available.
“This is an embarrassment of riches,” said Dr. Ofer Levy, director of the Precision Vaccine Program at Boston Children’s Hospital and a consultant to the Food and Drug Administration.
Here’s what he and other experts say about who should receive the vaccines and when.
What are the respiratory diseases coming our way?
Coronaviruses, influenza and respiratory syncytial virus are likely to re-emerge this fall, but exactly when and how much damage they will do is unknown. This is partly because restrictions imposed during the pandemic have altered the seasonal patterns of viruses.
Last winter, the flu peaked in December instead of February, as it usually does. The virus may have killed 58,000 people, which is a higher number than usual. COVID maintained a steady number of infections and deaths for most of the season, peaking in January.
Compared to its pre-pandemic pattern, RSV peaked several weeks earlier than last year, and has been circulating for longer than usual.
RSV is increasingly being recognized as a major threat to the respiratory system, especially for the elderly, immunocompromised people, and young children. “RSV carries a disease burden similar to influenza in older adults — it can make you very, very sick,” said Dr. Helen Zhou, a physician and immunologist at the University of Washington.
Scientists expect respiratory viruses to return to their epidemic patterns eventually, but “it will be unpredictable for the next two years,” said Dr. Chu.
What vaccines should I look for?
Experts said everyone should at least get flu and covid vaccines this fall.
The annual flu vaccine is recommended for everyone 6 months of age and older, but it is more important for adults 65 and older, children under 5 and people with weakened immune systems.
Updated Covid shots come this fall from Pfizer, Moderna and Novavax, all designed to target XBB.1.5, the Omicron variant that is currently approximately 27 percent of cases. Full recommendations won’t be available until the Food and Drug Administration authorizes the shots and the CDC reviews the new data.
Federal health officials aren’t talking about an initial series of shots followed by boosters. (Administrators don’t call decisions “reinforcers” anymore.) Rather, they are Trying to steer Americans toward the idea of a single annual immunization The latest version of the vaccine.
“Like a seatbelt in a car, it’s a good idea to keep using it,” Dr. Camille Cotton, a physician at Massachusetts General Hospital and a consultant for the Centers for Disease Control and Prevention, said of a Covid vaccine.
RSV is a frequent cause of respiratory disease among the elderly, especially those 75 years of age or older and those with other conditions, such as cardiovascular disease, chronic lung disease, or diabetes.
The new RSV vaccine is not approved for Americans under the age of 60. The Centers for Disease Control and Prevention (CDC) recommends that people 60 and older sign up for the vaccine after consulting with their doctors.
While it is true that the risk posed by any of the three viruses increases with age, remember that “65 is not a magic cut-off point,” said Dr. Chu.
“Even those without pre-existing conditions can be completely infected with these three viruses,” she said.
When should I get the vaccinations?
No one knows when these viruses will re-emerge, so you should get vaccinated early enough in the fall to build up immunity to the pathogens. Most people won’t want or be able to make multiple trips to the clinic or pharmacy to get their shots apart.
Maybe that means September or October. Most Americans might want to consider getting the flu and Covid vaccines at the same time, so they’re prepared for either virus. Some experts have said that older people in poor health — those with heart or lung disease, for example, or who take home oxygen — should get all three injections.
They have to “get it as soon as possible and definitely before the season, and do it all at once,” said Dr. Chu.
Adults 50 and older should get the herpes zoster vaccine, if they haven’t already, and those 65 and older should sign up for the pneumococcal vaccine. Dr. Chu said these vaccines do not need to be given in the fall and need to be scheduled for a different time.
Is it safe to get these vaccines at once?
Flu and Covid vaccines were often given together last fall and they seem to be working well. Because the RSV vaccine is new, there is little information about how it might interact with the other two vaccines.
“The available data regarding the simultaneous administration of influenza 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 FDA and CDC regulations monitor vaccine safety throughout the year and will remain in place,” the department said. “If any new potential safety indications are identified, the FDA and CDC will further evaluate and inform the public.”
Some research suggests that RSV and RSV influenza vaccines produce lower levels of antibodies when given together than when they are given one after the other. But experts said those levels may still be high enough to protect people from viruses.
There is also limited data on the safety of the two RSV vaccines. The clinical trials recorded six cases of neurological problems, including Guillain-Barré syndrome, compared with no cases in the placebo groups.
But the numbers were too small to determine whether the cases were the result of vaccinations. More clarity will come from monitoring during the widespread administration of vaccines, Dr. Chu said.
The Centers for Disease Control and Prevention is expected to make recommendations about giving the vaccines together in the coming weeks.