• Posted September 15, 2023

It's Time to Start Preparing Against Flu, RSV & COVID-19

Kids are back in school and it's time to think about viruses, for both yourself and them.

It could be an early flu season in the United States, if what happened in the Southern Hemisphere offers any insight, according to Cedars-Sinai in Los Angeles.

The flu vaccine is now available in some locations. A new COVID-19 booster has been approved by federal health officials. And new respiratory syncytial virus (RSV) vaccines are recommended for some.

It's important to get the flu shot in September or October, said infectious disease specialist Dr. Soniya Gandhi, associate chief medical officer at Cedars-Sinai in Los Angeles.

"Even a typical flu season can be deadly and can cause significant hospitalization," Gandhi said in a Cedars-Sinai news release, pointing to 58,000 deaths in the United States and more than a half-million hospitalizations due to last year's flu. "We should do what we can to protect ourselves — and others — with the best tool we have: the flu vaccine."

Not only that, but COVID-19 and RSV could again spike at the same time as the flu, triggering a "tripledemic," Gandhi said.

When that happened last year, emergency departments across the country filled up and young patients strained children's hospitals. RSV can be dangerous, even deadly, for infants and older adults.

New RSV shots are available for babies and adults over 60.

"These new shots and vaccines could really help protect us and our community during the upcoming season," Gandhi said. "We need to preserve capacity in hospitals for those patients who really need that care."

RSV is the leading cause for infant hospitalization in the United States, even though many other people experience it as a mild cold.

"There's really no way to predict how your child would do, even if they're completely healthy," said Dr. Priya Soni, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children's. "If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures."

Nearly all infants are exposed to RSV by the time they're 2, with most infected during their first year.

The U.S. Food and Drug Administration recently approved an antibody shot called Beyfortus (nirsevimab-alip), which can be given to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season can also get the shot.

Soni said she "100%" recommends the immunization because of the positive results seen in clinical trials.

Women who are between 32 and 36 weeks pregnant can also protect their infants at birth by getting a new Pfizer RSV vaccine. This same vaccine was approved for adults 60 and older. Another vaccine from pharmaceutical company GSK was also approved for older adults.

The U.S. Centers for Disease Control and Prevention recommends these new vaccines for older adults only if they are at the highest risk of severe RSV. This includes patients with asthma, diabetes or heart failure.

Both vaccines are considered safe, but a very small number of cases of Guillain-Barre syndrome were reported after vaccination. In that condition, a person's immune system attacks their peripheral nerves.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC.

Dr. Sonja Rosen, section chief of geriatric medicine at Cedars-Sinai, recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness.

"Patients should speak with their physician and make an informed decision about whether this shot is right for them," Rosen said.

For boosting COVID immunity, two new booster shots add protection against a variant of Omicron called XBB.

She added she is grateful that "we're in a very different position in 2023,” because of the new booster, at-home tests and antiviral medications like Paxlovid.

Take advantage of the booster when it becomes available, she urged.

"We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time," Gandhi said. "I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion."

It's safe to get the COVID and flu vaccines together, Gandhi said. For older adults who opt for the RSV shot after talking with a physician, they should get that alone and two weeks apart from the other vaccines, if possible, Gandhi noted.

More information

The U.S. Centers for Disease Control and Prevention has more on flu vaccine.

SOURCE: Cedars-Sinai, news release, Sept. 12, 2023