Update: Fall immunizations: COVID-19, flu, and RSV

Update: On September 11, 2023, the U.S. Food and Drug Administration (FDA) approved updated mRNA COVID-19 vaccines from Moderna and Pfizer-BioNTech for those 12 years old and older. The updated version of the vaccine targets the XBB.1.5 strain and was also authorized under emergency use authorization (EUA) by the FDA for those 6 months through 11 years of age. The following day, the U.S. Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP) recommended that all individuals 6 months old and older should receive at least one dose of the updated COVID-19 vaccine. Individuals who have been boosted with the previous version of the COVID-19 vaccine should receive the new version at least two months after their last booster dose.

In addition to the change in the strain being targeted, this version of the vaccine is available through the commercial market rather than pre-purchased government stocks. Individuals with public or private insurance will still be able to access the vaccine for free because the Affordable Care Act mandates that health insurance plans cover all ACIP-recommended immunizations at no cost. However, those who are uninsured face prices from $110-130 per dose.

Uninsured children can access free doses of the updated COVID-19 vaccine through the CDC's Vaccines for Children program. For uninsured adults, the Bridge Access program, also run by the CDC and authorized through December 2024, will provide updated COVID-19 vaccine doses to local health centers. The program also reimburses three large pharmacy chains, Walgreens, CVS, and eTrueNorth, for the cost of administering the vaccine. Both Pfizer and Moderna have indicated that they will provide vaccine doses to those who are uninsured for free, but they have not provided details on how those will be distributed. Browse or call vaccines.gov for the most up-to-date information on how to receive a free updated COVID-19 vaccine as an uninsured adult.

Originally published on September 5, 2023

In the U.S., respiratory viruses run amok from mid-fall to mid-spring each year. Commonly known as “cold and flu season,” this time of year also brings upticks in other respiratory viruses, like respiratory syncytial virus (RSV). Safeguard yourself and your loved ones by getting vaccines that offer protection from the big ‘cold and flu season’ players.

COVID-19

COVID-19 continues to cause a significant number of hospitalizations and deaths. As of the beginning of September, the Centers for Disease Control and Prevention (CDC) has reported more than 47,000 deaths from COVID-19 in 2023. That’s significantly lower than previous years, but COVID-19’s still on pace to be more lethal than the flu this year. And, with both wastewater monitoring and hospitalizations for COVID-19 trending up, it’s important to renew your COVID-19 protection. 

A new version of the COVID-19 vaccine targeted to the Omicron subvariant XBB.1.5 will be available by mid-September. It will replace the bivalent booster dose that targeted the original strain and BA.4/5. If you are due for another bivalent booster dose while the updated COVID-19 vaccine is not yet available, talk to your healthcare provider about whether you should get boosted or wait.

Like both the original COVID-19 vaccine and the bivalent booster, none of the vaccines targeting XBB.1.5 will contain live virus, and people with PI and their close contacts cannot contract or spread COVID-19 by receiving a vaccine. While XBB.1.5 itself is causing a lower proportion of infections than in previous months, emerging strains like EG.5 (also known as Eris) and FL.1.5.1 are subvariants of the same family. Both Pfizer and Moderna have released data showing that the new vaccine formulation is effective against Eris. New data also show that recent infection with XBB.1.5 provided good protection against the BA.2.86 variant (also known as Pirola), which means that the XBB.1.5 version of the vaccine is likely to protect against BA.2.86 as well.

It is likely that the CDC’s Advisory Committee on Immunization Practices (ACIP) will recommend that every eligible person receive a dose of the new vaccine this fall. ACIP may recommend that those who are immunocompromised receive more than one dose, so ask your healthcare provider about the latest recommendations.

Influenza 

Experts recommend that all people with PI and their household members older than 6 months of age get vaccinated against seasonal influenza (the flu) with either an inactivated or recombinant vaccine. Again, these vaccines do not contain live virus and cannot ‘give’ the flu to anyone regardless of immune status. Because flu strains shift from year to year, and immunity from the vaccine lessens over time, it’s important to get a flu shot every year.

For 2023-2024, all flu vaccines are quadrivalent, which means they protect against four different influenza strains: one influenza A and two influenza B strains that were part of the 2022-2023 vaccines, plus one new influenza A strain. As in 2022, ACIP again recommends that adults age 65 and older receive either high-dose inactivated (Fluzone High-Dose Quadrivalent), adjuvanted inactivated (Fluad Quadrivalent), or recombinant (Flublok Quadrivalent) flu vaccines, which have been shown to produce greater protection in this age group.

Seasonal flu vaccines typically become available in August, but ACIP recommends that most people get the shot in September or October so that protection lasts through the entire season. The exceptions are pregnant people in their third trimester and children who need two doses of the flu vaccine (typically, those ages 6 months to 8 years old who have not had at least two doses of flu vaccine prior to July 1, 2023). For children who need two doses, they must be given at least four weeks apart.

Respiratory syncytial virus

This is the first respiratory virus season that vaccines and a monoclonal antibody for respiratory syncytial virus (RSV) will be available. RSV is a leading cause of hospitalizations in infants and young children, as well as in older adults. In addition, a 2012 paper found that children with PI are 3.8 times more likely to be hospitalized for an RSV infection than children without a chronic condition.

Two RSV vaccines are currently approved for those 60 years of age and older. Again, neither approved vaccine contains live virus, so those with PI cannot become infected with RSV by getting a vaccine. ACIP has recommended that those ages 60 and older talk to their healthcare providers about whether to get an RSV vaccine.

One of the vaccines, Abrysvo, was also approved for use at 32-36 weeks of pregnancy to protect newborns. ACIP has not yet issued recommendations for its use in this population, though they should be forthcoming.

ACIP did recommend that all children eight months old or younger at the start of cold and flu season, or born during cold and flu season, receive a one-time intramuscular injection of nirsevimab, a long-lasting monoclonal antibody targeting RSV. Healthcare providers are also advised to consider nirsevimab for children entering their second RSV season if they are at high risk for severe RSV—a category that includes most children with a PI. Talk to your child’s healthcare provider about receiving nirsevimab.

Other tips

Because it’s safe to receive multiple vaccines at the same time, you can get all of your fall immunizations at one appointment. However, each shot should be given at a site that is at least one inch away from any other site. 

Also, remember that vaccines are a crucial tool during respiratory virus season, but you should take advantage of other tools, too. Masking indoors, maintaining a distance of six feet from others when possible, and good hand and surface hygiene can cut down on your exposure to all germs, not just the big ‘cold and flu season’ offenders.