COVID, Flu and RSV Vaccines: Your Guide to Which Vaccines You Need

There are three vaccines available now that we’re heading into fall and winter season, when cold weather has more people spending time indoors, where respiratory viruses thrive.

New formulas of COVID-19 vaccines are approved for all adults and for children as young as six months, as are the annual flu vaccines. Totally new to the vaccine game this year are RSV (respiratory syncytial virus) shots, which the US Centers for Disease Control and Prevention have made available to older adults as well as pregnant people in the third trimester (the immunity will be passed to newborns). 

This means that everyone, most importantly people at highest risk of severe disease from respiratory viruses, now has tools to get protected ahead of winter. And if you haven’t gotten a flu, COVID or RSV shot yet, don’t stress: October is a great time to get protected ahead of winter and holiday season.

All vaccine recommendations and guidance aren’t equal, however. Your age; whether you have an underlying health condition; and when your last vaccine dose or positive COVID test was all create a little nuance regarding which vaccines you should run to first, and how fast.

“There’s an art of taking that guidance and applying it to the patient in front of you,” said Dr. Amesh Adalja, senior scholar with the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. 

To help you sift through the guidance, here’s a look at the vaccines and when to schedule your appointments. 

Read more: Take 2 Minutes and Order 4 Free COVID Tests

Adults in their 60s and up may get three vaccines

If you’re in your 60s or older, you have a higher risk of getting really sick from flu, COVID-19 and RSV. Here’s what the CDC says about all three recommendations for your age group.

COVID vaccine: Strong yes 

You can get a new formula and single shot of Pfizer’s or Moderna’s COVID-19 vaccine right now, as long as it’s been two months since your last dose (or three months since your last positive COVID-19 test). To find a shot near you, enter your ZIP code in Vaccines.gov. Your insurance (private or Medicare) should cover the entire cost of the shot, but you can check with your provider to make sure you’re going to a place in-network. 

If you don’t have health insurance, the COVID shot will still be free if you book your appointment at a pharmacy participating in the Bridge Access Program, which includes many CVS and Walgreens locations. (Click the “Bridge Access Program” box when you make your appointment online.) 

Flu vaccine: Strong yes

Older adults have a higher risk of severe illness from the flu. In recent years, it’s been estimated that between 70% and 85% of deaths from the flu were in people age 65 or older. Of the different flu vaccines available each year, the CDC recommends older adults get a higher-dose flu vaccine, if one’s available near you and it’s convenient to get. 

RSV vaccine: Up to you and your doctor 

There are two RSV vaccines available for adults 60 and older. When the CDC recommended the RSV vaccine for this group, it did so with something called “shared clinical decision-making.” This means that though all older adults have the option to receive the vaccine, health officials have acknowledged that the risk of RSV isn’t identical across the age group. Having heart disease, asthma, COPD, diabetes or other health conditions can increase the severity of RSV. 

In simple terms, Adalja said, shared clinical decision-making is “why you have a doctor.” 

If you’re unsure, talk to your doctor or pharmacist about scheduling an RSV vaccine. According to the CDC, RSV causes approximately 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths every year among older adults.

Can you get all three at once? 

The CDC says it’s safe to get RSV, flu and COVID-19 vaccines all at the same time. However, due to limited information on the side effect profile of all three together, you might consider getting two vaccines at one appointment (COVID and flu, for example), and then the third (RSV) a couple of weeks later, according to Jennifer Bourgeois, a pharmacist and health and pharmacy expert with SingleCare. 

But it also depends on your ability to make it back for a second appointment, Bourgeois said.

“If it’s a situation where the patient may have reduced access to the vaccinations, then I would recommend all vaccines together,” Bourgeois said.  

Pregnant? You may also get three shots  

Health officials have always stressed the importance of getting vaccinated against the flu during pregnancy because of the potential for complications the virus can cause. The same is true for COVID-19 — the vaccines are recommended by medical organizations that treat pregnant people and their newborns, including the American College of Obstetricians and Gynecologists. 

The RSV vaccine is recommended for use in pregnancy during weeks 32 through 36 of pregnancy. When it’s given during pregnancy, the antibodies will offer babies some protection in the months after they’re born. According to the CDC, the RSV vaccine has been shown to reduce the risk of RSV hospitalization for babies by 57% in the first six months after birth.

The vaccine isn’t the only RSV news for people who are pregnant and their babies. Also this year, the FDA approved and the CDC recommended a new monoclonal antibody treatment for very young children that can reduce the risk of hospitalizations from RSV by up to 80%, called nirsevimab. It can be given to young children like a shot to all babies in their first RSV season, and some children 8 to 19 months in their second RSV season.

The CDC noted that most babies will only need one shot — either the maternal vaccine through their parent when pregnant or the monoclonal antibody. 

Everyone else 

Everyone age 6 months and older, with rare exceptions, should get an annual flu vaccine, according to the CDC. While there are a few different flu shots available, if you’re younger than age 65, it shouldn’t matter which one you get (save, of course, people with allergies). However, certain people (including people who are pregnant, people with weakened immune systems and other health conditions) shouldn’t get the nasal spray vaccine. 

To find a flu vaccine, you can use Vaccines.gov to search for appointments and pharmacies near you. 

Similarly, everyone age 6 months and older can get an updated COVID-19 shot, as long as it’s been at least two months since your last dose. And if you recently had COVID-19, the CDC says, you can consider waiting three months since your infection to get the COVID shot. Adalja stresses it’s good to wait at least three months since your last confirmed COVID case (possibly a bit longer, if you’re a lower-risk adult), because getting a boost too close to infection won’t add to your immunity the way you want it to.

“This is an updated vaccine, so you want to add to your repertoire of immune response that you have,” he added.

As we move out of the COVID-19 pandemic, but the virus remains very much with us, the emphasis from a public health standpoint has been on protecting people most vulnerable to severe disease. In addition to your age, you want to consider your personal health factors and make sure you have the best tools available for protection, whether it’s from the flu, COVID or RSV.

“The higher risk you are, the more you want your protection buffed up,” Adalja said.   

Read on for information about free COVID tests and treatment, as well as how to use the government program for free COVID vaccines for adults without health insurance. 

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