An annual flu shot for all. An annual Covid shot for some (Or many? Or most? Or all? We don’t know just yet.) That seems to be where we are headed. While there’s a reasonable debate about whether everyone needs an annual Covid booster (rather than only people with increased risks), let’s skip that for now. The rest of this article assumes patients who need both shots this fall.
Thank you again for more great sound practical advice. Could you explain why we are now worried about RSV in (older) adults. This has never been a concern. The focus was on infants. Has RSV become more dangerous for adults? More lethal when infected with covid etc.? More patients are questioning having to get this "new vax" now. Thank you.
My view is that we are now giving RSV its full due.
We always track influenza, but in reality it's flu AND a bunch of other viruses that cause so much morbidity and mortality each winter, for very young and older folks in particular.
With better surveillance, we are seeing this. I don't think RSV became more dangerous for adults, but with people living longer with more complex medical problems, there are more people vulnerable to things like RSV than there were, say, 50 years ago.
So I think that's why we are seeing it getting addressed.
In general, we talk a lot about viruses for which we have vaccines. For decades, RSV research was stalled. Now that we have something for it, there's a public health rationale for highlighting it.
Being immune compromised (heart transplant), I like the idea of more than one flu shot during influenza season. Kinda doubt that pharmacists will be willing to do this, even ignoring insurance issues.
This comment "Fortunately, very high-risk people can get a Covid booster more often than once." concerns me - not because of what you said which I believe accurately describes the CDC recommendation, but because of the approach the CDC has taken with respect to the frequency of boosters and their definition of high risk.
My quarrel is with their definition of high risk. The immunocompromised are not the only ones at very high risk. Older people with less robust immune systems and with specific medical conditions - obesity, heart problems like A-fib, both of which are very common - a much larger group in fact - are also at very high risk, but the CDC is treating them differently. Despite the fact that in other comments they have explicitly acknowledged that others than the "immunocompromised" are at high risk. Why do you think that they are doing so? What is your opinion? I'd really appreciate your thoughts since this question of defining high risk to exclude the older and potentially sicker has bothered me for quite a while.
Great question! I haven't seen a study on that (don't think there is one). So I would go with whatever the PCP advises. I'm not sure if CDC has guidance on this either. I'll check. thx!
“ Self-reported data from nearly 1 million Americans show an 8% to 11% higher rate of mostly mild systemic adverse events after simultaneous seasonal flu vaccine and mRNA COVID-19 booster (third) doses than with the COVID-19 booster alone.”
Also I diagnosed via rapid antigen point of care testing 2 cases of influenza B last week! I’m in Philly/Jersey region. Current flu activity map green with a little yellow creeping in the south:
Thank you for another excellent column, Dr. Faust.
You mention a bivalent Covid booster to be available this fall. My impression was that what is being produced is a monovalent vaccine. I turn 79 in November, and I’ve received a total of six Covid vaccines/boosters, the most recent last May. Can you clarify whether what’s being produced is a monovalent vaccine or a bivalent booster? My plan has been to get the Covid shot and the flu shot at the same time, and the RSV shot subsequently, and I just want to make sure that that plan makes sense.
Many thanks to you for your continuing invaluable information.
Hi Dr Faust
Thank you again for more great sound practical advice. Could you explain why we are now worried about RSV in (older) adults. This has never been a concern. The focus was on infants. Has RSV become more dangerous for adults? More lethal when infected with covid etc.? More patients are questioning having to get this "new vax" now. Thank you.
Glad you found it useful. GREAT QUESTION.
My view is that we are now giving RSV its full due.
We always track influenza, but in reality it's flu AND a bunch of other viruses that cause so much morbidity and mortality each winter, for very young and older folks in particular.
With better surveillance, we are seeing this. I don't think RSV became more dangerous for adults, but with people living longer with more complex medical problems, there are more people vulnerable to things like RSV than there were, say, 50 years ago.
So I think that's why we are seeing it getting addressed.
In general, we talk a lot about viruses for which we have vaccines. For decades, RSV research was stalled. Now that we have something for it, there's a public health rationale for highlighting it.
Does that make sense?
Being immune compromised (heart transplant), I like the idea of more than one flu shot during influenza season. Kinda doubt that pharmacists will be willing to do this, even ignoring insurance issues.
Dear Doctor,
This comment "Fortunately, very high-risk people can get a Covid booster more often than once." concerns me - not because of what you said which I believe accurately describes the CDC recommendation, but because of the approach the CDC has taken with respect to the frequency of boosters and their definition of high risk.
My quarrel is with their definition of high risk. The immunocompromised are not the only ones at very high risk. Older people with less robust immune systems and with specific medical conditions - obesity, heart problems like A-fib, both of which are very common - a much larger group in fact - are also at very high risk, but the CDC is treating them differently. Despite the fact that in other comments they have explicitly acknowledged that others than the "immunocompromised" are at high risk. Why do you think that they are doing so? What is your opinion? I'd really appreciate your thoughts since this question of defining high risk to exclude the older and potentially sicker has bothered me for quite a while.
What are your thoughts on getting the flu, COVID booster, and RSV vaccines all at the same time? Should my parents space those out in any way?
Great question! I haven't seen a study on that (don't think there is one). So I would go with whatever the PCP advises. I'm not sure if CDC has guidance on this either. I'll check. thx!
Interesting new study which seems to contradict last year’s study showing flu shot + covid booster = 10% more systemic reactions:
Article: https://www.cidrap.umn.edu/more-mostly-mild-side-effects-when-flu-vaccine-given-covid-booster
“ Self-reported data from nearly 1 million Americans show an 8% to 11% higher rate of mostly mild systemic adverse events after simultaneous seasonal flu vaccine and mRNA COVID-19 booster (third) doses than with the COVID-19 booster alone.”
Also I diagnosed via rapid antigen point of care testing 2 cases of influenza B last week! I’m in Philly/Jersey region. Current flu activity map green with a little yellow creeping in the south:
https://www.cdc.gov/flu/weekly/usmap.htm
Therefore thinking I’ll get my flu shot in September. Flu peaked in Nov/Dec last year, and was early in 2023 Southern hemisphere too.
I’ll gladly take the new xbb booster if they allow <50 yo… I’m almost there to 50 anyway 😱
Thank you for another excellent column, Dr. Faust.
You mention a bivalent Covid booster to be available this fall. My impression was that what is being produced is a monovalent vaccine. I turn 79 in November, and I’ve received a total of six Covid vaccines/boosters, the most recent last May. Can you clarify whether what’s being produced is a monovalent vaccine or a bivalent booster? My plan has been to get the Covid shot and the flu shot at the same time, and the RSV shot subsequently, and I just want to make sure that that plan makes sense.
Many thanks to you for your continuing invaluable information.
Thanks!
The new vaccine will be *monovalent* (Omicron-only).
The study I reported on looked at the bivalent version, but we expect the same results for the new formulation.
Sounds like your doctor has a good plan for you!