With a potential winter and fall surge of the flu, Covid and RSV, some experts recommend getting all three shots at the same time, while limited research shows doing so might cause rare side effects.=
It’s “acceptable” to get the new respiratory syncytial virus (RSV) vaccine co-administered with other vaccines, including the flu and Covid vaccines, according to the Centers for Disease Control and Prevention.
For the first time, two RSV vaccines have been greenlit by the FDA to protect older Americans and infants against the virus, which are expected to be available this fall, and the agency also approved an antibody shot for infants and toddlers in August.
New monovalent Covid boosters to protect against variants of the dominant XBB lineage are being developed by Moderna, Pfizer and Novavax at the request of a Food and Drug Administration panel and also are predicted to be available this fall.
As the fall and winter seasons approach, there are concerns another respiratory virus “tripledemic”—caused by a simultaneous rise in flu, Covid and RSV cases, causing hospitals to become overwhelmed—may happen again this year.
It’s “more probable that we’ll have a high viral season” this year with people getting Covid, the flu and RSV around the same time, so getting vaccinated is an important preventative step, Sharon Nachman, the chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital, told Forbes.
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Covid hospitalizations in recent weeks ticked up, increasing by almost 19% between August 13 and August 19, while deaths increased almost 18% between July 8 and August 26, as EG.5, or the Eris variant, made up the majority of cases. Though national RSV cases have increased slightly since June—they went from 149 cases in the week of June 17 to 423 cases the week of August 26—cases were over four times higher around this time last year. Flu cases aren’t witnessing a spike just yet, as flu season is expected to begin in October, but updated vaccines are available for the upcoming season.
50,000. That’s how many people in the U.S. died from Covid infection between November 2022 and March 2023, according to the CDC. The flu accounted for around 58,000 deaths during last year’s tripledemic and RSV killed 10,000 people—mostly seniors—and caused twice as many hospitalizations than in prepandemic years.
A good number of patients last year were admitted into Nachman’s hospital with “more than one virus” at a time. So, she recommends those who are eligible to first get their doctors’ approval and then get all three shots in preparation for the upcoming seasons. Other than approving the co-administration of the RSV shot with other vaccines, the CDC also endorses co-administration of the Covid and flu vaccines. Nachman said there’s a “better immune response” when more than one vaccine is administered at the same time. A study published in Elsevier found dual vaccination of Covid and the flu saw a reduced risk of infection than in unvaccinated people.
Epidemiologist Richard Reithinger told Forbes, “People are a little bit more cautious” about getting the RSV vaccines at the same time as the other two because they were only recently approved by the FDA this year. There is limited evidence on whether the new RSV vaccines negatively interact with the Covid and flu vaccines. However, there were rare instances in a clinical trial where people developed severe side effects after getting the RSV and flu shots at the same time. Two 71-year-old participants developed acute disseminated encephalomyelitis (ADEM), a neurological disorder that causes widespread swelling in the brain and spinal cord that damages the nerves’ protective coating, according to a report by a CDC advisory committee. One of these instances resulted in death. However, researchers aren’t sure if these cases were a result of the vaccines being administered together, or just a coincidence. The study also found that RSV and flu antibodies were slightly lower when administered together, though the “clinical significance is unknown.” If people are unsure about getting all three vaccines at once, it’s okay to “just take the flu vaccine [right now] and then wait for the Covid-19 and RSV” vaccines to be released later this year, according to Reithinger. Although he believes getting all three vaccines at the same time is safe, he ultimately recommends people consult with their doctors on timing.