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The Fall Virus Season Is Approaching. Which Vaccines Should You Get?
A new COVID variant is circulating. Flu season is about to begin. Respiratory syncytial virus (known as RSV) is becoming a greater cause of hospitalizations.
But this fall, something is different. The country has new vaccines for COVID, influenza and RSV, the three fall respiratory viruses that hospitalize and kill hundreds of thousands annually.
"Go get those vaccines and it will make a dramatic difference in your getting sick this winter," Dr. Ashish Jha, former White House COVID response coordinator told NPR. "We are going to be dealing with respiratory viruses forever but we are getting better at building treatments and vaccines. No one loves getting shots but these shots are literally saving lives."
Here's a guide to fall vaccines, how to time them right, and where they are available.
Seasonal influenza (flu)Doctors recommend an annual flu shot before the start of the season. In Florida, the 2022–23 flu season began in early October and went through May 20.
What's new this year: Each year the influenza vaccine is reformulated, but it doesn't always match perfectly with the circulating virus. Katelyn Jetelina, founder of Your Local Epidemiologist, a viral newsletter, says she is optimistic that this year's is a good match because the vaccine composition matches flu strains that recently circulated in Australia, which tends to be a predictor of what happens in the United States.
Who should get it: Everyone ages 6 months and older is eligible for the basic flu vaccine.
Bianca Perez, nurse practitioner at CVS Minute Clinic in Miramar, prepares a flu vaccine for a patient on Wednesday. (Carline Jean/South Florida Sun Sentinel) For those over 65, there is a high-dose influenza vaccine specially formulated to provide added protection to older adults. (AARP estimates that 70% to 85% of flu-related deaths and 50% to 70% of flu-related hospitalizations occur in people 65 and older.)
Bianca Perez at CVS Minute Clinic in Miramar said she also administers a specially formulated flu shot for people 50 to 64. "We have all three types at the Minute Clinic but it depends on insurance. Some don't cover this one."
The American Academy of Pediatrics urges all children over 6 months to get vaccinated and wants to see at least 70% immunized. Last year only about 55% were vaccinated.
"We know for children under age 5, influenza is unpredictable, it can be very serious, it leads a lot of children into the hospital and unfortunately we see tragic pediatric flu deaths every year," said Dr. Jennifer Ashton, a medical expert for Good Morning America. "We are encouraging those young children to get vaccinated starting now until the end of October."
When is the optimal timing: Pharmacies and doctors' offices in Florida already have the flu shot in stock. However, you don't want to get your shot too early and see your immunity wane before flu activity peaks. For most people, early October is the best time to get vaccinated so you have protection before the season fully kicks in, yet can keep your immunity until it ends, experts say. When timing your shot, consider it takes about two weeks after being vaccinated before you develop peak level of antibodies.
What else to know: You can get a flu shot at the same time as a COVID booster. Some Florida pharmacies offer coupons when you get vaccinated. CVS pharmacies and clinics are offering $5 off a $20 store purchase with a flu shot. At the CVS pharmacies in Target you can use your coupon at any Target store.
"I am hoping this year we will have an uptick in people who get a flu vaccine," Perez said. "We even had flu in Florida in the middle of summer which was rare. We had a very sick summer, and if that's any precursor of what's to come in the fall, it's going to be a sick winter as well."
COVID-19 vaccineWhat's new this year: The fall COVID-19 booster will have an updated formula targeting the newer omicron variant, XBB.1.5. Moderna, Pfizer, and Novavax all plan to have boosters on the market this fall. The exact timing hasn't been released but CDC director Mandy Cohen has said the booster should be available for most people by the third or fourth week of September.
While vaccine makers have been manufacturing updated vaccines that target XBB to ensure enough doses are ready by the fall and winter season, several new variants emerged. One of those new variants, BA.2.86, also known as "Pirola," appears more likely to infect people who have been vaccinated or have had previous infections. So how much protection will the booster give you? The manufacturers say early findings indicate that because the newer variants are still part of the Omicron family, the vaccines made to target XBB should still be effective against them, and the booster should offer some protection against BA.2.86
Who should get it: The CDC will determine who is eligible after the FDA fully approves the vaccine. The FDA can only fully approve it once the manufacturers submit data showing the vaccines are safe.
Bianca Perez, nurse practitioner at CVS Minute Clinic in Miramar, prepares a flu vaccine for a patient on Wednesday. (Carline Jean/South Florida Sun Sentinel) Last year, though, eligibility was dependent on the manufacturer, and it will likely be the same this year: Moderna: 6 months and older; Pfizer: 6 months and older; Novavax: 18 years and older.
Experts clash over who should get a COVID booster and who doesn't really need to get one. There's wide agreement that older adults should get one as well as people younger than 65 who have chronic conditions.
An FDA official said this week that for people ages 65 and older, an additional shot may be "reasonable" a few months after the first.
Jha, who has returned to Brown University's School of Public Health, said he believes children should get a COVID booster. "Kids still can get sick from COVID. When they get vaccines they are less likely to get sick and miss school," he told NPR. I want them in school … that's why my kids are going to get a COVID and flu vaccine. It just keeps them healthier."
When is the optimal timing: The ideal timing for each person is different depending on when you had your last booster, were infected with COVID, or want to get the most protection. Keep in mind that protection wanes after a few months so it makes sense to time your next shot to last into the winter.
What else to know: This fall season, the federal government is not paying for the vaccines and a program to provide them to uninsured people probably won't launch until mid-October.
Getting the booster in the same arm as your last COVID-19 shot may slightly boost your immune response, according to a study published in the journal eBioMedicine. Also, if you have had COVID recently, you will want to wait 90 days before getting the new COVID booster.
RSV vaccineWhat is new this year: For the first time, an RSV vaccine is available for people 60 and older, and from two manufacturers — GSK and Pfizer. Both effectively protect against severe illness, with up to 89% efficacy. The two vaccines are slightly different in design: The Pfizer vaccine, called Abrysvo, was 89% effective in clinical trials at preventing lower respiratory symptoms while the GSK vaccine, called Arexvy, was 83% effective. Experts believe the vaccine will need to be given every two years.
Who should get it: People ages 60 and older "may" get the vaccine in the U.S. The CDC advises people to consult with their doctor. Someone with underlying health conditions (like heart or lung disease or diabetes) and those living in long-term care facilities should strongly consider the vaccine, CDC guidance says.
When is the optimal timing: RSV vaccines do not wane like flu and COVID-19 vaccines, so getting one now should protect you throughout the entire season and most likely next season, too. The RSV vaccines are available at doctors' offices and some pharmacies, including Walgreens and CVS, this fall.
Special consideration: Pregnant woman may be able to get the RSV vaccine. Because babies tend to get RSV, the FDA has approved giving the Pfizer vaccine to pregnant women so they will pass on antibodies to their babies through the placenta. The vaccine is recommended to be given between 32 to 36 weeks of pregnancy.
What else to know: Medicare Part D covers the RSV vaccine, but some private health insurance plans don't.
Combining vaccinesThere is not a combined vaccine for all three viruses, so if you want to be fully vaccinated, you will need three shots. While it may be more convenient to get three on the same day, the safety risks haven't been studied. So far, what has been proved safe is flu and COVID shots at the same time. Clinical trials for the RSV vaccine found that when it's given at the same time as a flu shot, there were rare instances of severe side effects.
Other vaccinesShingles: This virus causes a painful rash in which the pain can last for months or even years after the rash goes away. Your risk of getting shingles increases as you get older. Adults 50 years and older should get two doses of Shingrix, separated by two to six months.
Pneumococcal vaccine: There are two kinds of pneumococcal vaccines available in the United States with new formulations. The shots are recommended for adults 65 or older and for all babies and children younger than 5 years old. "If you get one this year and a second a year later, you are good for five years," said Perez at CVS Minute Clinic.
Each of the above vaccines can be combined with the flu shot if given in different arms, she said.
Health experts recommend waiting at least seven days between the shingles vaccine and a COVID-19 vaccine, so that if you have any side effects you will know which vaccine they were from.
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.Com.
What Vaccines Does My Child Need By Age 18 Months?
by Dr. Edith Bracho-Sánchez, American Academy of Pediatrics
Have you ever wondered why babies get vaccines starting from the day they're born? One big reason: The youngest are most at risk of diseases. It's also the time in your child's development that their immune system learns the most from vaccines.
August is National Immunization Awareness Month, a good time to check whether your child is up to date on vaccines, which help to provide immunity before kids are exposed to potentially life-threatening diseases. Of all age groups, babies are more often hospitalized, and sometimes die, from diseases we can prevent with vaccines. That's why most of the childhood vaccines are recommended during your baby's first 12 to 18 months of life.
The Centers for Disease Control and Prevention, the American Academy of Pediatrics and other medical groups have all agreed on a schedule for immunizations for kids. The recommended schedule is based on research showing us the best timing for each vaccine dose.
Your pediatrician keeps track of your child's vaccines. They make sure your child is protected at the right time.
Hepatitis B is the first vaccine most babies receive. It is given within 24 hours of birth. Your baby will get a second dose of hepatitis B vaccine when they are 1 month to 2 months old and the third dose when they are 6 months to 18 months old.
Why do we give the first dose so quickly? More than 1 million people in the U.S. Have long-term hepatitis B infections. People who are infected with hepatitis B as a baby have a 90% chance of developing serious, chronic conditions like liver cancer in their lifetime. And because people may not know they are infected, they may spread the virus if they come in close contact with your baby. The vaccine is a safe, effective way to eliminate that risk right away.
2 months oldThe first doses of the vaccines given at 2 months of age protect babies from seven diseases. The letters stand for the diseases that used to cause serious infections in children.
Children get five doses of diphtheria, tetanus and acellular pertussis (DTaP) vaccine, which prevents serious illness from three diseases:
Haemophilus influenzae type B (Hib) vaccine (three to four doses) prevents several types of illness, including ear infections, lung infection, swelling in the throat and swelling in the lining of the brain and spinal cord (meningitis). Infections can be life-threatening. If babies have not been vaccinated and have symptoms of meningitis, they may need a spinal tap to test the spinal fluid for the bacteria.
Polio (IPV) vaccine (four doses) prevents a disease that causes death and paralysis. Polio outbreaks still occur in the United States, so unvaccinated children are at risk.
The pneumococcal vaccine (four doses) prevents disease caused by bacteria called Streptococcus pneumoniae. When these bacteria invade the lungs, they cause pneumonia. When they invade the bloodstream, they can cause an overwhelming infection called sepsis. When they invade the tissue around the brain, they cause meningitis. They can also cause ear infections, which can be painful and occur frequently. Since we have had this vaccine, the number of kids developing these illnesses has dropped dramatically.
Rotavirus (RV) vaccine (two or three doses) stops the main cause of diarrhea in children. This virus spreads very easily—on your hands, soiled diapers or toys and through the air. Rotavirus infections cause severe, watery diarrhea, vomiting, fever and abdominal pain. Sometimes the virus causes children to become so dehydrated they need hospital care.
6 months oldThe COVID-19 vaccine is recommended for everyone starting at 6 months of age, with rare exceptions. Young children are especially at risk if they get sick. The vaccine can help protect against severe complications, including pneumonia (infection in the lungs), respiratory failure, blood clots, bleeding disorder, injury to liver, heart or kidney, multisystem inflammatory syndrome, post-COVID conditions and death.
The flu vaccine is recommended for everyone starting at 6 months of age, with rare exceptions. The first time your child gets the flu vaccine, if they are younger than 9 years old, they will also need a second dose four weeks later. Even healthy kids can develop severe complications from the flu that requires a hospital stay. Flu viruses change from year to year, so everyone needs to get a flu shot each year. Annual flu shots keep children from severe disease.
12 to 18 months oldAt your child's first birthday checkup or soon after, they will get shots that protect them from five more diseases. They also may get second, third or fourth doses of the vaccines they started during the first year.
Children get two doses of the measles, mumps, and rubella (MMR) vaccine. Some children at higher risk may need three doses in the event of a disease outbreak. Most people who are vaccinated with MMR will be protected for life. The vaccine prevents serious illness from three diseases:
Varicella vaccine (two doses) prevents "chicken pox," which used to infect 4 million people in the United States every year. A mild case can cause a child to miss school for a week or more. Usually, the MMR vaccine and varicella vaccine are given separately for the first dose. But the MMRV vaccine may be used for the first dose instead if parents express a preference.
Hepatitis A vaccine (two doses given six months apart) provides lifelong protection from a serious liver disease. The disease can spread through contaminated food or water or direct contact with an infected person—even someone who doesn't show symptoms.
Vaccines also protect babies before birth. Babies get antibodies during pregnancy from some vaccines their mothers have had. For example, the baby is protected for a short time after they are born if their mother has had the measles vaccine.
However, this protection moms give their babies during pregnancy starts to wear off at around 1 year of age. That's why, when they are 12 months to 18 months old, babies get a shot to keep their immune system protected them from measles.
We know from decades of research, in millions of children, that the vaccines work best at these ages, and with this spacing between doses.
When they follow the schedule, children develop lasting immunity—and protect others—from serious diseases. If you have questions, talk with your pediatrician. We are here to partner with you to help your child stay healthy and thrive.
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When Will The Next COVID Vaccine Be Available, And Who Should Get It?
As the summer winds to a close, and we reluctantly trade beach days and late sunsets for cooler weather and school or work, we also have to confront the reality that COVID will remain a part of our lives. The U.S. Has already seen a summer bump in cases in recent weeks, with hospitalizations and wastewater levels of the virus creeping back up. So many people may be wondering when they can get another COVID vaccine.
According to the U.S. Food and Drug Administration, the updated fall COVID booster will likely be available around mid-September—once the agency authorizes it. The Centers for Disease Control and Prevention will then issue recommendations on which groups of people can or should get vaccinated.
An FDA advisory committee met in June to determine which strains of the COVID-causing virus SARS-CoV-2 should be included in the fall booster. It settled on XBB.1.5, which has been the dominant variant in the U.S. For much of this year. Recently a new variant called BA.2.86 was detected, and it has more than 35 new mutations, compared with XBB.1.5. Cases of the BA.2.86—which, like XBB.1.5, is an offshoot of the well-known Omicron variant—have been found in the U.S., Denmark, Israel and other countries. The new variant currently makes up only a tiny fraction of cases, although SARS-CoV-2 is being sequenced and tracked far less closely today. Whether BA.2.86 is better at evading the immune system or causes more severe disease remains to be seen, but FDA scientists say the fall COVID booster and prior immunity should still help protect against serious illness.
"If authorized or approved, based upon the available evidence, the FDA believes these vaccines with a monovalent XBB.1.5 composition will provide the best available protection against the most serious consequences of the disease resulting from currently circulating variants," the agency told Scientific American in an e-mail.
Experts that Scientific American spoke with agree that those who would benefit most from the fall COVID booster are people age 65 and above, as well as those who are chronically ill, immunocompromised or pregnant. "I always worry about the people for whom boosters would provide the greatest benefit, and that's people who are at high risk for severe illness. So people 65 and older and also people with underlying health conditions," says Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University of Public Health.
Paul Offit, director of the Vaccine Education Center and an attending physician at Children's Hospital of Philadelphia, agrees. "We should focus on those groups that are most at risk," says Offit, who is a member of the FDA's Vaccines and Related Biological Products Advisory Committee. "The goal is not to prevent all illness. The goal is to keep people out of the hospital."
Stanley Perlman, a professor of microbiology and immunology at the University of Iowa Carver College of Medicine, adds that infants aged six months or older who have not been vaccinated are also at increased risk from COVID and could benefit from getting the vaccine's primary series.
There is less evidence of an additional booster's potential benefits for healthy people under age 65 who have already been vaccinated or infected, but it remains to be seen what the CDC will recommend. "For everyone else, it's a little bit more complicated and a little bit less clear what the benefits are," Nuzzo says. There is some evidence that boosting increases antibody levels in the short term, which might be helpful. "In the past, I've timed getting a booster dose to just give myself a little bit of potential extra protection during times when I know I'm more likely to have exposures like holiday travel, gathering with lots of people I don't normally spend time with, etcetera," she says. But she also advises waiting to see what the CDC recommends.
Offit notes that any vaccine or medicine has risks and benefits. In very rare cases, the mRNA COVID vaccines have been associated with myocarditis or pericarditis—inflammation of the heart muscle or lining, respectively. Although these conditions normally resolve on their own and can be caused by infections such as COVID itself, Offit says healthy young people may want to weigh the potential risks—however small—against the potential benefit of additional booster shots.
Others say the benefits outweigh the risks, however. Even though healthy adults ages 18 to 50 are much less likely to be hospitalized or die from COVID, it is still one of the leading causes of death in those age groups, Perlman says. "People that age don't usually die—the vast, vast, vast majority don't—but if you have a low frequency of dying, you want to protect yourself," Perlman adds.
Like most vaccines, those for COVID are intended to prevent severe disease, not infection altogether. When the Pfizer and Moderna vaccines were first authorized in late 2020, they were about 95 percent protective against even mild disease. But viruses evolve. And as SARS-CoV-2 did so, the level of antibodies produced in response to the vaccines also waned—so those vaccines no longer totally protected against infection. Immune cells known as T cells persist and continue to protect against severe disease, however.
People at the highest risk for severe COVID—those older than age 75 and those who are severely immunocompromised—may not mount a strong immune response to vaccination. If you're one of these people, and you get COVID, your best bet is to test yourself promptly to confirm the infection and then, if eligible, obtain the antiviral drug Paxlovid as soon as possible. "If you look at people who get hospitalized or die [from COVID now], most haven't had an antiviral," Offit says. But it's important to get the drug within the first three to five days of infection; otherwise it won't have much effect.
Is it possible to have too many vaccine doses? One concern with vaccinating multiple times with the same strain of a virus is that it could train the immune system to only protect against that strain, a phenomenon known as immune imprinting. Offit says that is unlikely to be a big concern with the COVID vaccines, however.
As for when the best time to get vaccinated is, experts say it's now probably worth waiting for the new booster to come out—but don't delay too long. "The best time to get vaccinated is before you get sick," Nuzzo says.
Offit and others recommend getting flu vaccinations as well. Flu season tends to peak a bit later in the winter, and vaccine protection tends to wane, so one could wait until late October to get the shot. But it's also fine to get both the COVID and flu vaccines at the same time if that's more convenient. This year adults age 60 and older and pregnant people will also be eligible for a respiratory syncytial virus (RSV) vaccine. RSV sends up to 160,000 older adults and up to 80,000 children to the hospital each year, and it kills up to 10,000 adults and 300 children. Those who are eligible should talk to their doctors about whether the vaccine is right for them.
As we head into yet another respiratory virus season, one thing is clear: COVID is here to stay. "It will join the pantheon of other winter respiratory viruses that cause hundreds of thousands to be hospitalized and thousands to die every year," Offit says. "We are out of the pandemic, but the virus isn't gone."
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