Mandy Cohen, MD, MPH, plans to get her young daughters vaccinated, with recommended vaccines they are eligible for, as soon as possible to get ready for the 2024–2025 fall and winter respiratory virus season.
While some people are at higher risk for severe illness, physicians can’t always predict who will get seriously ill. For example, 30% of all children hospitalized for COVID-19 have no underlying conditions.
“Immunizations are our best defense,” said Dr. Cohen, director of the Centers for Disease Control and Prevention (CDC).
In a CDC Project Firstline webinar, she urged physicians to strongly recommend that patients get vaccinated against influenza, SARS-CoV-2, and respiratory syncytial virus (RSV), if applicable. Even if a patient hesitates on vaccination, they might eventually agree especially if they have high-risk conditions and visit the doctor often.
Be open to questions and make sure this is a dialogue, Dr. Cohen said. Physicians can quickly engage their patients by saying, “This is what I’d do for my own family.”
Dr. Cohen joined AMA President Bruce A. Scott, MD, and two other experts from CDC National Center for Immunization and Respiratory Diseases. Demetre Daskalakis, MD, MPH, directs that CDC center and Manisha Patel, MD, MS, is its chief medical officer. Together, the panelists discussed vaccinations, treatment and tips for encouraging immunization.
Know who is eligible for vaccination
The updated 2024–2025 COVID-19 and influenza recommendations are quite straightforward, said Dr. Cohen. Everyone 6 months or older should get the updated COVID-19 vaccine and, with rare exceptions, the flu vaccine, including pregnant people.
Children 6 months to 8 years old receiving their first influenza vaccine, who have not previously received a total of two or more doses in their lives, or whose influenza vaccination history is unknown need two doses.
In adults 65 or older, the CDC preferentially recommends a higher dose flu vaccine or adjuvanted flu vaccine over standard-dose unadjuvanted flu vaccines, if available.
For RSV, all infants under 8 months as well as children 8 months–19 months with risk factors should get the monoclonal antibody nirsevimab, which is typically given October through March. There is also a maternal RSV vaccine, which is recommended during pregnancy between 32- and 36-weeks’ gestation. This is typically given September through January.
Both products offer substantial protection for infants against severe RSV, said Dr. Patel. She reminded physicians that patients who are pregnant should only get the ABRYSVO vaccine manufactured by Pfizer.
For older adults, the CDC clarified the recommendations going into this season. All adults 75 or older, as well as adults 60 through 74 who are at increased risk for severe RSV, are recommended to get the RSV vaccine. Risk factors for severe RSV include underlying conditions such as obesity, diabetes, heart or lung disease, or living in a nursing home Physicians can make decisions on RSV need, based on the information they have about a specific patient and their risk, said Dr. Daskalakis.
RSV vaccines are 70% and 90% effective in preventing hospitalizations in older adults and infants, respectively.
“If folks are at higher risk, make sure you are having a conversation with them about the RSV vaccine,” said Dr. Cohen.
The CDC is seeing more RSV circulating in nursing homes, so “we really want to make sure anyone who is residing in that group setting is protected from RSV going into this season,” she urged.
Prepare your office
It’s important that your office is set up and prepared for having conversations with patients about vaccination, so you don’t miss an opportunity to give out those doses. “Every time someone walks into your office is an opportunity,” she said.
Ideally administration of the updated 2024-2025 flu vaccine, should happen in September through October, but flu vaccination is recommended as long as influenza viruses are circulating in the community. The recommended window for the RSV vaccine during pregnancy, runs from September through January, and the infant RSV monoclonal antibody should ideally be administered October through March.
However, it is important to note, the timing of the onset, peak and decline of RSV activity vary geographically. Physicians may adjust timing of administration based on guidance from public health authorities such as the CDC and local health departments.
Note that the CDC has new tools on its website to make ordering immunizations easier.
Meanwhile, the AMA will continue to partner with the CDC to support and advise health professionals and patients during this respiratory season, said Dr. Scott.
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Continue to encourage vaccination
The CDC continues to see lower uptake of these annual vaccines than preferred, “but we know that they are our best defense against those serious illnesses that we know make our patients sick each and every fall and winter season,” said Dr. Cohen.
One of the main reasons someone doesn't get a vaccine is their doctor didn't recommend it. Making that strong recommendation for either the updated 2024-2025 COVID-19 vaccine, flu shot or both if co-administering, is very critical. This doesn’t have to be an hour-long conversation.
You could say to the patient, “You're due for your updated flu and COVID-19 vaccines today. I've gotten these vaccines myself and I recommend them for you too,” said Dr. Cohen.
Even if a patient declines one time, “don't make that a permanent way of them approaching vaccination. Your voice matters. They trust you and your recommendation,” she urged. People may not say yes in that moment, but they could come back the next time and be more open to it.
Physicians should also make sure they’re embedding vaccination into their office workflows, setting reminder calls for patients and using clinical decision support tools. An example of this is a care gaps list that can track what immunizations your patients may need.
Concerns over medical contraindications is another reason why physicians don't recommend vaccines.
“We want to reiterate that contraindications to these vaccines are exceptionally rare,” said Dr. Cohen.
Address cost barriers
Cost is a real barrier to vaccination for some patients. “The good news is we do have an ability to cover a lot of that cost for our children,” said Dr. Cohen.
She urged that physicians join the CDC’s Vaccines for Children's program, which provides free vaccines to children, Medicaid-eligible adults, Native Americans and other populations.
Many private insurers are required to cover these vaccines without charging a co-payment or co-insurance when they're given by an in-network provider. Medicare Part B also covers COVID-19 and flu vaccines.
This free continuing education webinar was developed in collaboration with the AMA and CDC’s Project Firstline.
This webinar is part of the AMA Ed Hub™️, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking, and reporting for some states and specialty boards.
Learn more about AMA CME accreditation.
