With flu season approaching, now is the time to talk to patients about fall vaccinations—which encompass more than just the influenza vaccine. Per recommendations from the Centers for Disease Control and Prevention (CDC), physicians should encourage patients to get the flu shot, updated COVID-19 booster, and, depending on age and risk factors, an RSV shot.

“This is the first fall and winter virus season where vaccines are available for the three viruses responsible for most hospitalizations – COVID-19, RSV, and flu,” the CDC wrote in a press release.

The RSV shot, which protects against respiratory syncytial virus (RSV), is new as of 2023. The agency recommends this shot for some adults ages 60 and older, saying that some of these patients “may receive a single dose of RSV vaccine using shared clinical decision-making.” The agency also recommends RSV shots for infants under the age of 8 months and some older babies, depending on risk factors.

Ali Khan, MD, MPP, FACP, a Chicago-based primary care doctor and chief medical officer of Value Based Care Strategy at Oak Street Health, says that this clinical decision-making should involve assessing people’s current health status and underlying risk factors for RSV. Still, he adds that the first line of defense should be to vaccinate people against COVID-19 and the flu, as those are recommended for a wider range of people. After that, “for folks who are at risk, particularly seniors over the age of 60 or folks with chronic conditions, the RSV vaccine feels like the next highest priority.” Among others, risk factors can include conditions like asthma, diabetes, or congestive heart failure, he says.

Saying up to date on recommended vaccinations is “the smart thing to do to be able to protect themselves and protect their loved ones,” Dr. Khan says.

Here’s what to know about recommendations for the flu shot, COVID-19 booster, and RSV vaccine this fall.

 

The Flu Shot

 

The CDC has recommended annual flu shots for everyone ages six months and older since 2010, and these core recommendations have not changed for the 2023-2024 flu season. Slight changes to the recommendation center on the make-up of the shot itself, which has been revised to match circulating strains of the flu. If patients express skepticism about the new flu shots, remind them that these revisions are protocol and happen yearly.

Centers for Disease Control and Prevention.2023-2024 CDC Flu Vaccination Recommendations Adopted. June 29, 2023.

 

The CDC is now recommending the two current flu vaccines, one that is egg-based and one that is cell-based or recombinant. The latter can be tolerated by people with egg allergies.

Per the CDC recommendation, practitioners should encourage patients to get vaccinated with either of these vaccines in September or October.

 

Updated COVID-19 booster

 

The CDC is recommending everyone ages six months and older (and who have not received a COVID-19 vaccination in two months or longer) get an updated COVID-19 booster shot this fall. The shots should be available in the coming days, if not already at your local pharmacy. The new boosters are updated to protect against virus strains of the XBB lineage, which is the family of circulating new variants.

Appleby J. Timing and Cost of New Vaccines Vary by Virus and Health Insurance Status. Kaiser Family Foundation. August 24, 2023.

Centers for Disease Control and Prevention. CDC Recommends Updated COVID-19 Vaccine for Fall/Winter Virus Season. September 12, 2023.

 

 

RSV vaccine

 

The CDC does not recommend the RSV vaccine for everyone, but they stress its importance for young babies and certain adults 60 or older.

RSV is the leading cause of infant hospitalizations in the United States and one of the most common causes of childhood respiratory illnesses in all age groups, according to the CDC. Further, about 100 to 300 deaths from RSV occur each year in children under five years old, according to the CDC.

Centers for Disease Control and Prevention. CDC Recommends a Powerful New Tool to Protect Infants from the Leading Cause of Hospitalization. August 3, 2023.

 

Dr. Khan is a father and says that just last year, his young son was placed in the intensive care unit to recover from RSV. He stresses the importance of vaccinating babies to reduce risks of contracting the virus or from severe complications.

 

Costs

 

Most insurance companies cover seasonal vaccinations, but this isn’t a given.

For RSV, in particular, people may run into some difficulties. The Kaiser Family Foundation (KFF) warns patients that because the RSV shot is so new, insurers may not list coverage on forms as of yet. They advise patients to check in with their insurance company before scheduling an appointment. The RSV shot is covered by Medicare, so long as people are signed up for Medicare Part D. 

Appleby J. Timing and Cost of New Vaccines Vary by Virus and Health Insurance Status. Kaiser Family Foundation. August 24, 2023.

 

People who are uninsured may experience financial issues with any of the shots. Visiting a low-cost clinic or health department for a vaccine can help reduce or get rid of costs.

 

Discussing vaccine side effects

 

By now, many patients have already had their first flu shots and COVID-19 shots (or even the combination) and probably know what to expect with post-inoculation side effects. Still, it can be helpful to remind people of potential side effects so that they can better understand what is happening to their body and deal with the aftermath.

Side effects from flu or COVID-19 boosters can include localized discomfort like aching around the inoculation site or systemic symptoms like body aches, headache, or a fever.

Dr. Khan says he likes to encourage patients to hydrate, rest, and, in some cases, care for their body as they would after a night of drinking.

“I often say some Gatorade Zero and French fries—sort of like you’re treating a hangover—can sometimes be helpful,” Dr. Khan says.

Over-the-counter fever-reducing drugs, like Benadryl, can also be helpful remedies (unless the patient cannot take this for other reasons).

Potential side effects from the RSV shot are less well-known since it is so new. If recommending a patient get all three vaccines, consider telling them to come in at a separate date for their RSV vaccine—even if they choose to get the flu and COVID-19 shots together—Dr. Khan says. Spreading these out can help even out potential side effects and allow patients and practitioners to more clearly see side effects that may be linked to the RSV vaccine.