The new COVID-19, flu, and RSV vaccines are available. Here’s what to know.
As we head into the 2023-24 respiratory season, we face three viruses: COVID-19, influenza, and respiratory syncytial virus (RSV). The CDC expects that this year will be similar to last year in terms of total hospitalizations from COVID, flu, and RSV, meaning a higher number of hospitalizations than the nation was used to prior to the COVID-19 pandemic. This means with COVID-19 now in the seasonal respiratory virus mix, an average respiratory season could strain the nation’s healthcare system.
But for the first time in US history, all three viruses will have a vaccine to go with them this fall. There is an updated COVID-19 vaccine that is a good match to current strains, new much anticipated RSV vaccines for high-risk groups, and, of course, an updated flu vaccine.
What is the updated COVID-19 vaccine?
On September 11, 2023, the FDA announced its approval and emergency use authorization of updated COVID-19 vaccines from Pfizer-BioNTech and Moderna that are specifically designed to protect against the latest circulating variants of SARS-CoV-2. The 2023-24 formulation is a monovalent (single) component of genetic material from XBB.1.5, the Omicron subvariant that predominated in the United States in the summer of 2023. The vaccine should provide good protection against currently circulating variants, as the most common subvariants circulating now are closely related to XBB.1.5.
If we were tracking the history of COVID-19 vaccines from the start, we’d be calling this the third booster—but this updated vaccine no longer resembles the original vaccines given earlier in the pandemic. Indeed, all previous versions of the Pfizer-BioNTech and Moderna vaccines, such as the bivalent boosters and the original primary series, have been discontinued in the United States, replaced by the updated vaccine that is better matched to currently circulating variants. Like influenza, SARS-CoV-2 mutates rapidly, and the FDA expects that, similar to the flu vaccine, COVID-19 vaccines will need to be updated annually.
Who should get the updated COVID-19 vaccines?
The CDC recommends that everyone 6 months and older get the updated COVID-19 vaccine. For most people with health insurance, including Medicare or Medicaid, the updated COVID-19 vaccine is free, and programs exist to help those who are uninsured or underinsured get a free vaccine. For those who had COVID-19 recently, the CDC recommends getting the vaccine three months after the onset of symptoms or a positive test to maximize the protective benefits of the shot.
Does prior COVID-19 vaccination status affect eligibility for these new vaccines?
No—unlike previous COVID-19 vaccines where an individual was required to have a primary series in order to be eligible for a booster, prior COVID-19 vaccination status and vaccine type no longer impact eligibility for the new 2023-24 formulation. The FDA states that regardless of previous vaccination, all individuals 6 aged months and older are eligible for the updated COVID-19 vaccine, provided it has been at least two months since the last dose of any COVID-19 vaccine. For individuals ages 5 and older, this is given as a single dose of the updated vaccine. Children ages 6 months through 4 years who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated vaccine depending on the nature of previous vaccination. Unvaccinated children ages 6 months through 4 years are eligible to receive three doses of the updated Pfizer-BioNTech vaccine or two doses of the updated Moderna vaccine. An individual can get a 2023-24 vaccine from either manufacturer and be considered up-to-date, regardless of which, if any, primary series they received.
Are RSV vaccines available now, too?
Yes – over the summer, two vaccines and a preventive treatment for RSV were approved by the FDA ahead of the 2023-24 respiratory season. Two vaccines, Arexvy and Abrysvo, were approved for use in adults aged 60 years and older with risk factors for severe RSV disease. Abrysvo has also been approved for use in pregnant individuals to prevent severe RSV disease in infants from birth through 6 months of age. In the third trimester of pregnancy, maternal antibodies are transferred to the baby through the placenta, offering protection in the baby’s first few months of life.
While not technically a vaccine, a new therapeutic, Beyfortus, was approved by the FDA for use in newborns and infants to prevent RSV. It is designed to be administered to babies under 12 months of age born during or entering their first RSV season, and in children up to 24 months of age who remain especially vulnerable to severe RSV disease due to premature birth or congenital heart or lung conditions. Beyfortus, given as a single injection, contains the monoclonal antibody nirsevimab-alip, which can help prevent RSV disease for about five months.
Last winter, many parts of the country experienced tremendous surges in RSV, oftentimes earlier than previous seasons, in addition to COVID-19 and influenza. RSV typically presents as a mild respiratory illness in older children and adults, but it can have severe consequences in the very young and very old. Infants face high risk of complications as their small airways make them vulnerable to breathing difficulties. The new vaccines and monoclonal antibody could prevent a similar surge from happening this year.
When should we get the new COVID-19, flu, and RSV vaccines?
Soon! It is recommended that all individuals 6 months and older should get the updated COVID-19 vaccine and the annual flu vaccine as soon as possible. In the Rocky Mountain West and in many parts of the country, COVID-19 hospitalizations are already on the rise. The CDC recommends that in general, September and October are good times to get a flu shot, and that ideally, everyone who can be vaccinated against the flu should be vaccinated before the end of October, in a campaign many call “flu before boo.”
Appointments for the updated COVID-19 vaccine and flu shots are available now for all individuals aged 6 months and older through healthcare providers, pharmacies, and drugstores nationwide.
The CDC also recommends that those getting an RSV vaccine should get one as soon as possible for the 2023-24 RSV season, ideally before the number of RSV cases in the community begins to increase. It is difficult to say when RSV cases will ramp up for 2023-24, but during the 2021-22 and 2022-23 RSV seasons, some parts of the country began to see increases in RSV cases as early as July. The RSV vaccines are available now for adults aged 60 years and older and pregnant people between weeks 32 and 36 of pregnancy. Beyfortus, the RSV monoclonal antibody for infants, is likely to be available starting sometime in early October.
Should we get the COVID-19, flu, and RSV vaccines at the same time?
The CDC recommends getting both the updated COVID-19 vaccine and the flu vaccine at the same time, since one visit for a vaccine is more convenient than two. For flu and RSV, the CDC stated that when getting a flu and RSV vaccine at the same time, the two vaccines work well enough to meet an accepted immunogenicity standard. However, some evidence suggests that coadministration of the flu and RSV vaccines may lead to decreased immunogenicity and increased side effects. Individuals who have questions about vaccine coadministration can discuss with a healthcare provider or pharmacist before deciding how to proceed.
Stay knowledgeable,
The Team at Rocky Mountain COVID Data