Fall 2023 Vaccines: Considering Flu, COVID-19 and RSV

Fall 2023 vaccines: Considering flu, COVID-19 and RSV

Paul Offit, MD: Hi, my name is Paul Offit. I'm talking to you today from the Vaccine Education Center at the Children's Hospital of Philadelphia. It's Monday, September 18th, 2023. So, every year the FDA Vaccine Advisory Committee picks influenza strains for the coming season. The way that works is we sit down in March, and then we look at the strains that are circulating throughout the world. And with that, we try and pick what strains are going to be coming into the United States, usually looking at countries that have winters that precede ours. It's a six-month production cycle. It usually takes about six months to make the vaccine, and then the vaccine comes out in September.

Now, it's important to get a yearly flu vaccine for everybody over 6 months of age because it is a strain specific phenomenon. If we're wrong, and we've been wrong three times in the past 20 years, a miss is a mile. Even if you got a vaccine and you are infected with a strain that is not contained in that vaccine because we were wrong, it's as if you had very little protection, usually less than 20% protection against severe disease.

So, it's important then for everybody over 6 months of age to get a flu vaccine because even if you were immunized the year before or naturally infected the year before or both, you still are at risk of severe disease. That's influenza. Please get your influenza vaccine if you're over 6 months of age.

Now, there are two other vaccines that are also going to be given this winter, and they're a little different in that they're not, or at least reasonably, they don't need to be recommended for everybody. So, one of them is the COVID vaccine. Now, the COVID vaccine this year is a monovalent vaccine, meaning it just has one strain in it. It's the so-called XBB.1.5 strain, which is one of the omicron subvariants. Now, COVID is a little different. If you were naturally infected or vaccinated previously and you're a healthy young person, you are highly, highly likely to be protected against severe disease. So, a healthy young person could reasonably choose not to get this vaccine.

The people who should get this vaccine are those who are in high-risk groups. So, for example, people over 75, people who have chronic medical conditions, the kind of conditions that put them at high risk of serious disease like chronic lung disease or heart disease or kidney disease or liver disease or neurological disease or diabetes or obesity; people who are immune suppressed, typically because they're taking a drug or medicine that suppresses the immune system; and pregnant people. Those are really the people who really should get this vaccine.

Now, there's another vaccine, a third vaccine, against a virus called respiratory syncytial virus. And that's an important vaccine for older adults but not necessarily all older adults, and I'll explain what I mean. So, every year the respiratory syncytial virus causes about 80,000 to 120,000 hospitalizations every year. It causes about 10,000 to 14,000 deaths in elderly Americans every year. But those who are most at risk really are those over 80. There's also a great risk in those 70 to 80, but in that group, the group most likely to be hospitalized typically have, again, underlying medical conditions that put them at high risk — three of them specifically, chronic lung disease, chronic heart disease and diabetes. So, a healthy 65-year-old could reasonably choose not to get the RSV vaccine. So, I think if you're over 75, it is reasonable to get all three of these vaccines, and they can be given at the same time.

So, this is really the first year where we've had three vaccines available to prevent what are typically winter respiratory viruses, and you should talk to your doctor to see whether or not these vaccines are likely to be of benefit to you. Certainly, the flu vaccine is. I think for certain high-risk groups, the COVID and the RSV, or respiratory syncytial virus, vaccines are also of value.

Thank you.