Who needs new COVID, flu and RSV shots for fall 2023?

It’s flu shot season again, but depending on your age and health, you may want to roll up your sleeve three times this fall in hopes of staving off respiratory viruses.

Shots to reduce the odds of severe influenza and respiratory syncytial virus, or RSV, already are available in clinics around Colorado, and an updated COVID-19 booster is expected to start arriving over the next week after the Centers for Disease Control and Prevention recommended its use Tuesday.

Last season in Colorado, COVID-19 hospitalized 8,231 people, while flu hospitalized 3,076 between October and May. Statewide data on RSV hospitalizations isn’t collected, but 2,597 people were admitted for it in the Denver area. Doctors are hoping for a less severe season this year, but predicting how viruses will behave is always fraught.

In the last few weeks, Colorado has been seeing more cases of COVID-19 and other respiratory viruses, though the season hasn’t started in earnest yet, said Dr. Amy Duckro, executive director of population health at Kaiser Permanente Colorado. While people may be tired of thinking about viruses, it’s a good idea to get any shots you’re eligible for and to recommit to handwashing and staying home if you’re sick, she said.

“It’s very understandable that there was a lot of fatigue around getting the COVID vaccine,” she said. “I would urge everyone to reconsider.”

Who should get shots this fall?

The recommendations are simplest for flu: anyone six months and older should get the shot to reduce their risk of severe illness. The only people in that age group who shouldn’t get the flu shot are those who’ve had a severe allergic reaction to it in the past.

Similarly, for COVID-19, the CDC’s immunization advisory committee recommended that anyone six months and older get an updated shot from Pfizer or Moderna — if it’s been at least two months since their last dose. Novavax’s updated shot is still under review.

People who recently had the virus can choose whether to get the shot immediately or to wait. Babies and toddlers may need more than one shot, if they weren’t already fully vaccinated.

Adults 60 and older can get either of two new vaccines approved to prevent symptoms of RSV. The CDC didn’t issue a recommendation that all older adults should get those vaccines, though, because of the possibility of rare side effects. Instead, it recommended that older adults talk to their doctors about how much risk they would face from RSV, and if getting the shot makes sense for them.

A monoclonal antibody product — essentially a lab-made version of the substances the body produces to fight infections — will also be available in the near future to protect infants from RSV. It’s recommended for all babies under eight months, and those between eight and 19 months who have risk factors for severe disease.

How well will the shots work?

That won’t be certain until further into the season, but most of the currently circulating variants of COVID-19 are close to XBB.1.5, the subvariant that was chosen to make the new boosters. Researchers expect it’s going to be a good enough match to prevent most severe cases.

No one knows which flu strains will be dominant this year, but that shot is well-matched to the ones that circulated in the Southern Hemisphere over the last few months, according to the CDC. It cut the risk of hospitalization for flu roughly in half in the first three months of the flu season there.

RSV doesn’t mutate nearly as much year-to-year as COVID-19 and flu do, so matching strains isn’t a significant concern at this point. The shots were about 80% effective in preventing respiratory disease in trials.

Will I have to pay?

Insurers are required to cover flu shots every year. There initially were questions about whether the RSV monoclonal antibody for infants would be covered as vaccines are, but the CDC has said insurance companies should treat it as preventive care.

Unlike in previous years, the federal government isn’t buying COVID-19 shots for everyone this time. Insurance will cover the updated shots, though, and a federal program is in the works to supply free doses to uninsured people through clinics and pharmacies.

It gets a little more complicated with the adult RSV vaccines. Some people haven’t had to pay out of pocket, while others have been charged the full $300 price because their insurance opted not to cover it.

Can I get multiple shots at once?

It’s safe to get the flu and COVID shots together. There isn’t as much data on combining the RSV shot with other products, so talk to your doctor if you qualify for all three and would have trouble making it to two appointments.

Since it may take a while for your local clinic or pharmacy to get its stock of the new COVID-19 shots, it makes sense to go ahead and get your flu shot now instead of waiting to get them together, Duckro said. Of course, people who have specific situations, like a lack of transportation, may decide to wait, she said.

“There’s no reason to delay,” she said.

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