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.

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 vaccine

What'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.

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 vaccine

What 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 vaccines

There 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 vaccines

Shingles: 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.

2023 South Florida Sun Sentinel.
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