Most Americans have received one or more flu and COVID-19 vaccines. New this year are the first vaccines to protect older adults from respiratory syncytial virus (RSV), a lesser-known threat whose toll in terms of hospitalizations and deaths can rival that of influenza.
Federal health authorities hope that the widespread use of these three vaccines will stop another “triple pandemic” of respiratory illnesses like the one we saw last winter. For people with health insurance, all of these vaccines should be available free of charge.
“This in itself is a superabundance of riches,” said Ofer Levy, director of the precision vaccines program at Children’s Hospital Boston and an adviser to the Food and Drug Administration (FDA, for its acronym in English).
Here’s what he and other specialists say about who should get which vaccine and when.
What respiratory diseases will we face?
Coronavirus, influenza, and respiratory syncytial virus viruses are likely to reappear this fall, but exactly when and how much damage they will cause is not known. In part, that’s because the restrictions in place during the pandemic have changed the seasonal patterns of viruses.
Last winter, the flu peaked in December and not February as it normally does. This virus may have caused as many as 58,000 deaths, a higher number than usual. For most of the season, covid continued to see a steady number of infections and deaths, peaking in January.
Unlike its pre-pandemic pattern, RSV peaked several weeks earlier last year and circulated longer than usual.
RSV is increasingly being recognized as a major respiratory threat, especially for older adults, immunosuppressed individuals, and young children. “RSV has a disease burden similar to that of influenza in older adults; it can make us very sick,” said Helen Chu, an immunologist and physician at the University of Washington.
Scientists hope that, at some point, respiratory viruses will return to their pre-pandemic patterns, but “for the next two years it’s going to be unpredictable,” Chu said.
What vaccinations should I order?
According to specialists, this fall everyone should receive at least the flu and COVID-19 vaccines.
The annual flu vaccine is recommended starting at six months, but is most important for adults 65 and older, children under five, and people with weak immune systems.
This fall, the updated covid vaccines are from Pfizer, Moderna, and Novavax, and all are designed for the XBB.1.5 omicron variant that is currently responsible for about 27 percent of infections. Full recommendations will not be available until the FDA licenses the vaccines and the Centers for Disease Control and Prevention (CDC) evaluates new data.
Health authorities at the federal level are not talking about a primary series of vaccinations followed by boosters. (Officials don’t even call these doses “boosters” anymore.) Rather they are trying to orient Americans to the idea of a single immunization yearly with the latest version of the vaccine.
“It’s a good idea to keep wearing them, just like a car seat belt,” Camille Kotton, a Massachusetts General Hospital physician and CDC adviser, said of vaccines.
RSV is a common cause of respiratory disease among older adults, especially those age 75 and older who have other conditions such as cardiovascular disease, chronic lung disease, or diabetes.
The new RSV vaccine has not been licensed for Americans under 60 years of age. The CDC recommends that people age 60 and older register to receive the vaccine after consulting with their doctor.
While it’s true that the complications posed by any of these three viruses increase with age, one must remember that age 65 is not when the risks begin, Chu explained.
“Even those without pre-existing conditions can become seriously ill from these three viruses,” Chu stressed.
When should I get vaccinated?
No one knows when these viruses will reappear, so we need to get vaccinated as soon as possible in the fall in order to build immunity against the pathogens. Most people don’t want or can’t make several trips to the clinic or pharmacy to keep their shots spaced out.
That implies that it may have to be in September or October. Perhaps almost all Americans want to get the flu and covid vaccines at the same time in order to be prepared to deal with either virus. According to specialists, older adults who are not in good health—for example, who have heart or lung disease, or who need to use oxygen at home—should receive all three vaccines.
They have to “receive them as soon as possible and definitely before the season starts and do it at the same time,” Chu said.
If they haven’t already, adults 50 and older should also get the herpes vaccine and those 65 and older should register for the pneumococcal vaccine. But those shots don’t have to be given in the fall and should be scheduled at a different time, Chu said.
Is it safe to receive all three vaccines at the same time?
Last fall, the flu and COVID-19 vaccines were almost always given together, and that seems to have worked well. However, because the RSV vaccine is new, there is little information about how it might interact with other vaccines.
“Available data related to the administration of influenza and COVID-19 vaccines at the same time do not indicate safety concerns,” the Department of Health and Human Services said in a statement sent to The New York Times.
“The FDA and CDC systems monitor vaccine safety year-round and will continue to do so,” the department noted. “If any possible safety-related signals are detected, the FDA and CDC will conduct further evaluation and inform the public.”
Some studies suggest that RSV and influenza vaccines produce lower levels of antibodies when given together than when given one by one. But those levels may still be high enough to protect people against viruses, experts said.
There is also limited information on the safety of the two RSV vaccines. The clinical trials reported six cases of neurological problems, including Guillain-Barré syndrome, while the placebo groups had none.
In both cases the numbers were too small to determine whether the cases were the result of inoculations. There will be more clarity when the vaccines are applied on a large scale, Chu said.
The CDC is expected to issue recommendations about administering the vaccines together in the coming weeks.
Apoorva Mandavilli is a reporter for the Times, focusing on science and global health. In 2019 she won the Victor Cohn Award for Excellence in Medical Science Reporting. @apoorva_nyc
2023-07-07 09:00:35
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