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Fall Vaccine Checklist

Last winter COVID-19, the flu, and RSV (respiratory syncytial virus) hit the population hard. Typical seasonal viral patterns were altered by the pandemic, and viral activity has been unpredictable. With COVID-19 cases and hospitalizations already ticking up1, it is time to take action to protect yourself and your family. There is good news this fall, as for the first time, there will be vaccines available to provide protection against all three viral threats: the updated annual flu shot, updated COVID-19 vaccines, and recently approved RSV vaccines for at-risk populations, including pregnant women and older adults.

Here, we summarize the latest recommendations on these vaccines to help you protect yourself and stay as healthy as possible this season.

If you have symptoms of respiratory illness, it is important to get tested for flu and COVID-19, as there are treatments that can help lessen the severity and duration of your symptoms if taken early (Tamiflu® within 48-72 hours of symptom onset for flu and Paxlovid™ within 5 days symptom onset for COVID-19).

Flu

It is important to get a flu shot every year because the effectiveness of last year’s vaccine diminishes over time and new flu strains emerge each year. For 2023, the FDA’s Vaccines and Related Biological Products Advisory Committee (VBRAC) has recommended a quadrivalent flu vaccine that targets two strains of Influenza A and two strains of Influenza B.2 Vaccines targeting similar flu strains were used in the southern hemisphere this spring, during their flu season, where flu began to spike earlier than usual.3 Data from this region indicated that people who had this year’s flu vaccine were half as likely to be hospitalized with flu compared with people who were not vaccinated, demonstrating that these vaccines are a good, effective match for the strains of flu that are circulating.4

Flu vaccine recommendations

Everyone six months and older, especially adults over 65, children under 5, those with chronic health conditions and weakened immune systems, and those who are pregnant.5

Adults aged 65 and older should receive a higher dose of vaccine. Options include Fluzone® High-Dose Quadrivalent vaccine, Flublok® Quadrivalent recombinant flu vaccine and Fluad® Quadrivalent adjuvanted flu vaccine.6

It is recommended that children 6 months to 8 years old who are getting vaccinated for the first time, or who have previously only received one flu shot in a prior flu season, get two doses of the flu vaccine, at least four weeks apart, to bolster protection.7

COVID-19

Vaccination against COVID-19 reduces the risk of severe illness and hospitalization, and it can lower the chance of developing Long COVID. However, immune protection wanes over time as we get further from our last dose and the virus evolves.

To improve protection, the FDA recently approved updated mRNA COVID-19 vaccines (Moderna,
Pfizer-BioNTech). The vaccines target a subvariant of the XBB-lineage of the Omicron family, which
is closely related to the variants that are currently dominant in the U.S. Research has shown that the
updated vaccines can help protect against these common variants as well as a highly mutated
variant (BA.2.86), which has been on the radar of researchers.8

On September 12th, the CDC recommended these updated COVID-19 vaccines for all individuals
aged 6 months and older. The updated vaccines are available now in your local pharmacy.

Updated COVID-19 vaccine recommendations
Everyone 5 years and older (regardless of previous vaccination status)
  • One dose of an updated COVID-19 vaccine* at least 2 months after any previous vaccine dose
Children between 6 months and 4 years
  • Unvaccinated children should receive 3 doses of the updated Pfizer-BioNTech vaccine or 2 doses of the updated Moderna vaccine
  • Children who have been vaccinated should get one dose of an updated COVID-19 vaccine (may get 2 doses if they previously had only 1 Pfizer-BioNTech dose)
Moderate to severely immunocompromised individuals
  • Complete an initial COVID-19 vaccination series (usually 3 mRNA vaccine doses)
  • At least 1 updated vaccine dose
  • May get 1 or more additional updated vaccine dose, depending on level of risk
*Updated Novavax vaccine, which works differently than mRNA vaccines, is also being evaluated and is expected to become available later this fall.

RSV
A highly contagious virus that causes flu-like illness, RSV can be severe or even life-threatening. While it is often associated with babies and young children, it can also be dangerous for older adults and those who are immunocompromised.

The FDA recently approved the world’s first RSV vaccines for those 60 years and older and for
pregnant women to protect their babies. A new monoclonal antibody for babies called Beyfortus™
was also approved and is expected to become available in early October. Beyfortus™ is an
important new tool that can drastically reduce RSV disease burden (or cases and severity) in this
vulnerable population.

RSV vaccine recommendations/eligibility
Adults 60 and older
  • Abrysvo™ and Arexvy™ are recommended for Adults 60 and older,9 particularly those with risk factors and underlying health conditions such as chronic heart or lung disease, weakened immune systems, and/or those living in nursing homes or long-term care facilities.10
Pregnant women, 32-36 weeks
  • For pregnant women, 32-36 weeks, Abrysvo™ has been approved by the FDA to prevent lower respiratory tract disease (LRTD) or severe LRTD caused by RSV in infants from birth through 6 months.11 The vaccine is expected to be available later this fall, after the CDC advisory committee meets and provides its recommendations.
RSV monoclonal antibody recommendations/eligibility
Children less than 8 months
  • Infants less than 8 months entering their first RSV season (typically fall through spring)11
Children between 8 months to 19 months
  • Infants 8 through 19 months who are at high risk for severe disease or immunocompromised or high risk a dose is recommended in their second RSV season12

Frequently asked questions

What if I just had COVID-19?
After testing positive for COVID-19, consider delaying your vaccine by either three months from when your
symptoms started or from when you received a positive test.13 If you are at high risk, talk with your doctor
about the right time to get vaccinated.

What if I already had the flu?
There are several strains of the influenza virus that circulate each year, so it is possible to catch the flu again. It is still beneficial to get a flu shot, even if you have already been sick with the flu this season.

Is it ok to mix and match Covid-19 vaccines?
Moderna and Pfizer vaccines can be mixed and matched following the completion of primary vaccine series. For example, if you had Pfizer for your initial series, it is ok to have subsequent Moderna shots. If you had the Johnson and Johnson primary series, it is safe (and encouraged) to follow with a Moderna or Pfizer vaccine.14

When should I get my shots?
In general, it takes about two weeks for vaccines to reach maximum effectiveness, so early fall is a good time to get vaccinated. For more personalized guidance on the timing of your vaccines, speak to your physician.

Flu and COVID-19
  • At the same time in different injection sites,14 or separated by a few weeks
  • The ideal time to get your Flu shot is mid-September through October.
  • If you have already had the Flu or COVID-19 this season, you can still get vaccinated to protect against another infection.
RSV
  • RSV vaccines are available now. If you’re currently eligible (age 60 or older), consider getting your shot soon as there are early signs that the RSV season is starting in the U.S.

  • While it is acceptable to get an RSV shot at the same time as your flu and/or COVID-19 shot, you might consider getting the RSV shot a few weeks before the Flu and COVID-19 shots. Because this vaccine is new, there is little information on how it might interact with the other two vaccines.

References

  1. CDC. COVID Data Tracker. Centers for Disease Control and Prevention https://covid.cdc.gov/covid-data-tracker (2020).
  2. Research, C. for B. E. and. Influenza Vaccine for the 2023-2024 Season. FDA (2023).
  3. CDC. CDC Tracks Ongoing Flu Activity in the Southern Hemisphere. Centers for Disease Control and Prevention https://www.cdc.gov/flu/spotlights/2022-2023/ongoing-flu-southern-hemisphere.htm (2023).
  4. 9-8-2023 Flu in the Southern Hemisphere | CDC. https://www.cdc.gov/respiratory-viruses/whats-new/flu-southern-hemisphere.html (2023).
  5. CDC. Who Should and Who Should NOT Get Vaccinated. Centers for Disease Control and Prevention https://t.cdc.gov/2S49 (2022).
  6. CDC. Fluzone High-Dose Seasonal Influenza Vaccine. Centers for Disease Control and Prevention https://www.cdc.gov/flu/prevent/qa_fluzone.htm (2023).
  7. CDC. Flu (Influenza) and the Vaccine. Centers for Disease Control and Prevention https://www.cdc.gov/vaccines/parents/diseases/flu.html (2019).
  8. Updated COVID-19 Vaccine Recommendations Now Available | CDC. https://www.cdc.gov/respiratory-viruses/whats-new/covid-vaccine-recommendations-9-12-2023.html (2023).
  9. RSV Vaccine Information Statement | CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html (2023).
  10. CDC. Learn about RSV in older adults with chronic medical conditions. Centers for Disease Control and Prevention https://www.cdc.gov/rsv/high-risk/older-adults.html (2023).
  11. Commissioner, O. of the. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. FDA https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants (2023).
  12. CDC. Learn about RSV in Infants and Young Children. Centers for Disease Control and Prevention https://www.cdc.gov/rsv/high-risk/infants-young-children.html (2023).
  13. CDC. Frequently Asked Questions about COVID-19 Vaccination. Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html (2023).
  14. Mixing and Matching COVID-19 Vaccine Booster Doses. NIH COVID-19 Research https://covid19.nih.gov/news-and-stories/mixing-matching-covid-19-vaccine-booster-doses.
  15. CDC. Getting a Flu Vaccine and a COVID-19 Vaccine at the Same Time. Centers for Disease Control and Prevention https://t.cdc.gov/000DF (2022).
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