Seasonal Influenza (Flu)
What: The vaccine covers 3 strains of seasonal influenza and is offered by five pharmaceutical companies. The vaccine formula doesn’t always align perfectly with the circulating virus, but on average flu vaccines reduce the risk of needing to go to the doctor by 30-60%. The vaccines are all pretty similar, so which one you get doesn’t usually matter.
Notes:
- Nasal spray vaccine (FluMist) may work a bit better in children
- A study suggested that the adjuvanted flu vaccine (Fluad) might work better in older adults.
- The new mRNA flu vaccine (mFlusvia) may be more effective, but has more side effects (available for adults aged 50 and older).
Who: Everyone six months of age and older. Special formulations provide added protection for older adults.
When: October is the best time to get vaccinated.
Respiratory Syncitial Virus (RSV)
For Older Adults
What: Three vaccines (from GSK, Pfizer, and Moderna). GSK and Pfizer use traditional, protein-based biotechnology. They were available last year, so we have lots of “real world” safety and effectiveness data. There is a small risk of Guillain-Barre Syndrome (about the same risk as with flu vaccines). Moderna has an mRNA vaccine. There is no GBS safety signal, but protection wanes more quickly
Who: Not an annual vaccine. Getting a second vaccine doesn’t meaningfully enhance protection; if you received one before, you don’t need to get another one. People aged 50 years and older with high risk conditions, and those aged 75 years and older should get one dose.
When: RSV vaccines show initial waning in the first few weeks after vaccination, but then stabilize at a high level of protection for more than one year. Getting one now should protect you throughout the season.
For Pregnancy
What: One vaccine, Pfizer’s ABRYSVO, is available. Protection is passed from mother to baby, and baby is protected for the first 6 months of life (which is the riskiest time for severe RSV). Thousands of women got it last year, confirming safety and high effectiveness (75-89%).
Who: Pregnant people, during 32-36 weeks of pregnancy.
When: September to January. The vaccine can be given simultaneously with other routine vaccines for pregnancy (Tdap, COVID-19, and flu). Some data show that getting RSV vaccine at the same time as Tdap may reduce the antibody response to pertussis, so it may be worth getting Tdap a few weeks before.
RSV Monoclonal Antibody for Infants
What: Not a vaccine (they do not teach the body to make an immune response, but instead are a preventive medication, providing antibodies directly). Real world data show that severe RSV in infants who received monoclonal antibodies was drastically reduced – one study showed 90% effectiveness. Two options this year: nirsevimab or clesrovimab.
Who: All infants under 8 months of age should get it for their first RSV season, unless their mother receieved the RSV vaccine during pregnancy. High-risk children between 8-19 months should also get it.
When: As close to RSV season as possible (October-March). Protection holds up for at least 5 months.
COVID-19
What: Fall COVID-19 vaccines have an updated formula targeting XFG (Omicron subvariant). Updated vaccines have consistently provided approximately 30-60% additional protection against urgent care visits and hospitalization compared to those who didn’t get the vaccine.
Who: Professional organizations recommend:
- Kids: The American Academy of Pediatrics (AAP) recommends all children under 2 years old get vaccinated, as well as high-risk children or those living with someone who is high-risk.
- Pregnant People: The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women receive the vaccine at any point during pregnancy, when planning to become pregnant, in the postpartum period, or while lactating.
- Adults: The American College of Physicians (ACP) and the Infectious Diseases Society of America (IDSA) recommend the vaccine for adults and immunocompromised patients.
Which:
- COMIRNATY (Pfizer): Ages 5 years and older
- SPIKEVAX (Moderna): Ages 6 months and older
- mNEXSPIKE (Moderna): Ages 12 years and older
- NUVAXOVID (Novavax): Ages 12 years and older
When: Soon. If you were recently infected, wait 4-6 months. It won’t hurt if you get it earlier, but some research shows waiting allows our antibodies to update more effectively. If you haven’t been recently infected, you can wait until November-ish to increase protection against a winter wave.