What you need to know about COVID, flu and RSV vaccines

This fall will see the circulation of three viruses—influenza, respiratory syncytial (RSV) and SARS-CoV-2, the virus that causes COVID.

Dr. Pedro Piedra, professor of molecular virology and microbiology and of pediatrics at Baylor College of Medicine, provides tips on when to get vaccinated for each to maximize your immunity against all three viruses.

COVID booster

COVID levels already are rising in the Houston area, so many are wondering about the right time to get their COVID booster. Currently, bivalent boosters are available that target both the original strain and omicron variant strains of COVID. Monovalent boosters targeting a newer strain of the omicron variant are expected to be available soon. Piedra said the decision about when to get vaccinated should be based on personal risk factors and levels of COVID in your community.

"If you have not had a previous bivalent booster, I recommend getting one now, especially if you are in an at-risk group. It's better to have some protection than no protection," Piedra said. "If you have already received your bivalent booster and you are relatively healthy, you may want to wait for the monovalent booster."

Annual flu vaccine

It is safe to get flu, RSV and COVID vaccines at the same time, but you may consider getting them at different times based on estimated peak activity for each virus, Piedra said.

"The seasonality of the influenza virus has changed the last couple of years due to the COVID-19 pandemic," Piedra said. "This year, we may come back to the regular season, which usually sees flu activity begin in November and peak somewhere between January and March."

Piedra recommends getting your flu shot in October to build immunity before the season begins. Now is the time to make a plan for where you will receive the vaccine. Talk to your physician about setting an appointment or find out when vaccines will be available at your local pharmacy.

The flu vaccine is recommended for everyone 6 months of age and older, but there are different options available based on age. Children younger than 8 years of age who have not been vaccinated before will require two doses, four weeks apart. Full immunity is not achieved until two weeks after the second dose, so these children should start vaccination earlier. FluMist is a safe and effective alternative to the vaccine for children who are afraid of shots, Piedra said. For adults 65 years of age and older, there are specialized vaccines with a higher antigen content, or adjuvant, to help the immune system develop a better response.

If you do get the flu, Piedra recommends immediate treatment with antivirals. Treatment is most effective if started within two days of symptom onset. Make a plan with your physician now about the best way to get your prescription filled quickly in case of illness.

RSV vaccine for older people and pregnant women

For the first time ever, RSV vaccines are available for adults over age 60. According to Piedra, RSV activity in the Houston area currently is low. Because RSV season begins earlier than flu season, Piedra recommends that older adults talk to their physician about getting vaccinated now. The FDA also has approved a vaccine for pregnant women to prevent RSV in infants during their first three months of life when they are greatest at risk for severe infection. Pregnant women should consult their doctor about vaccination.

Nirsevimab, a long-acting monoclonal antibody, was also approved for all infants less than 8 months of age. A single dose can provide protection against severe RSV infection. Infants born now, during the RSV season, are recommended to receive a single dose during their first week of life, Piedra said. He added that infants 8-19 months of age who are at increased risk for severe RSV infection and entering into their second RSV season, should also receive a single intramuscular injection of nirsevimab.