The arrival of autumn heralds the return of changing leaves, pumpkin-spiced everything—and a higher incidence of respiratory illness including influenza and respiratory syncytial virus (RSV). And of course, the ever-evolving variants and subvariants of SARS-CoV-2, which causes COVID-19, are still with us.
The good news? New prevention tools, including vaccines and monoclonal antibodies, are available, along with age-specific recommendations from the Centers for Disease Control and Prevention (CDC). This is the first time vaccines are available for the three major respiratory viruses expected to circulate. Physicians continue to play a vital role in building vaccine confidence among our patients, by serving as vaccine ambassadors, by answering questions about vaccine science, safety and efficacy, and by helping to dispel the all-too-frequent misconceptions and misinformation that patients encounter.
Doing so builds trust that is at the heart of the patient-physician relationship, and offers patients their best chance at staying out of the hospital should they acquire one of these respiratory viruses. Taken together, these three viruses produce the greatest number of hospitalizations during the cold-weather months. Counseling patients on how to best protect themselves against respiratory illnesses is part of our responsibility as physicians. Preventing the nightmare scenario presented by last year’s “tripledemic” of flu, COVID-19 and RSV infections should top everyone’s agenda as we head into fall and winter.
Updated COVID-19 vaccines
The CDC currently recommends that everyone over the age of 6 months receive an updated COVID-19 vaccination to protect against serious illness, hospitalization, and death. The vaccine may also reduce the risk of developing long COVID, which can cause health problems that stretch over a period of months or even years. Updated mRNA COVID-19 vaccines produced by Pfizer-BioNTech and Moderna were shipped nationwide in mid-September, while an updated COVID-19 protein vaccine developed by Novavax remains under FDA review. Comprehensive CDC recommendations for the 2023–2024 COVID vaccines can be found here.
Because the COVID-19 public health emergency ended in May, federal funding that allowed for no-charge vaccine administration is no longer available and these vaccines have shifted to the commercial market. However, the Affordable Care Act and laws passed during the COVID-19 pandemic require private insurance plans to cover the cost, which starts at $120 per dose. Medicare and other government-sponsored health plans also provide full coverage. Uninsured and underinsured children and teens can receive the updated vaccine as part of the Vaccines for Children Program, while adults who are uninsured or underinsured can receive the shots for free through December 31, 2024 under the Bridge Access Program.
New RSV vaccines and monoclonal antibodies
The first-ever vaccines for RSV received FDA approval this spring for those age 60 and older The Advisory Committee on Immunization Practices (ACIP) recommended a shared clinical decision-making approach for this vaccine, which means that physicians and patients may consider the available evidence on who benefits from vaccination; the individual’s characteristics, values, and preferences; the health care professionals’ clinical discretion; and the characteristics of the vaccine.
RSV is seasonal in nature, similar to influenza, with outbreaks typically starting in the fall, peaking in winter and winding down during spring. However, onset and peak can vary.
The two approved vaccines—one made by GSK and another by Pfizer—are prefusion RSV F protein vaccines. The GSK vaccine contains a reduced amount of the same adjuvant found in that company’s shingles vaccine, while the Pfizer version offers protection against two strains of RSV, A and B. Both have demonstrated a high level of efficacy in preventing severe illness in older adults who contract this highly contagious virus. More than 90% of older adults who are hospitalized due to RSV have at least one comorbidity, and roughly half have three or more.
Protection against RSV is also available for infants and very young children, the other age cohort most at risk for severe complications. RSV is the leading cause of infant hospitalization in our nation. And while pre-term babies and those with chronic lung or congenital heart disease are most at risk for severe illness, most hospitalizations from RSV involve healthy, full-term infants who acquire the virus during the first few months of life.
In July, the FDA approved nirsevimab, a long-acting monoclonal antibody, under an accelerated pathway because it represents a breakthrough therapy. ACIP is recommending a dose of nirsevimab for babies under 8 months old who are entering their first RSV season, and a protective dose for infants ages 8–19 months old who are at risk of severe infection.
In August, the FDA approved the first RSV vaccine for pregnant people to protect their newborn from severe RSV illness. This new vaccine produced by Pfizer (known as Abrysvo), has been shown to reduce the risk of RSV hospitalization for babies by 57% in the first six months after birth. The CDC recommends seasonal administration of one dose of RSV vaccine for pregnant people during weeks 32 through 36 of pregnancy. Most infants will likely only need protection from either the maternal RSV vaccine or infant immunization, but not both. A full list of ACIP recommendations for infants and young children can be found here.
Seasonal flu vaccine
Preliminary estimates show that during the 2022-2023 flu season, an estimated 31 million people got sick with flu, 14 million people visited a health care professional for flu, 360,000 people were hospitalized for flu, and 21,000 people died due to flu illness or related complications. Similar to previous flu seasons, adults 65 years and older were hospitalized at the highest rate last season, followed by children younger than 5 years of age. Last season, 176 flu-related deaths in children were reported to CDC. Getting a flu vaccine reduced the risk of flu-related hospitalization among children by nearly three quarters and among adults by nearly half.
With rare exceptions, the CDC recommends that everyone over the age of 6 months receive an influenza vaccine, typically in September or October each year. Recognizing that our immune response weakens with age, ACIP issued updated recommendations for older adults last year that people 65 and older receive a higher dose or an adjuvanted flu vaccine, because research suggests these vaccines potentially offer greater protection than standard dose unadjuvanted vaccines by triggering a stronger immune response. The CDC’s updated 2023–2024 flu vaccination recommendations can be found here.
Vaccines remain one of our safest and most powerful tools in protecting public health. To help you be aware about the latest guidance, the AMA is constantly updating our vaccine-related resources to help physicians discuss vaccination with their patients and promote good health.
