Flu, COVID-19, and RSV: Your Complete Fall Vaccine Guide for a Safer Season

Fall and winter bring a host of respiratory virus infections like influenza, COVID-19 and respiratory syncytial virus (RSV). Each of these viruses can cause serious illness, especially in certain populations, so getting vaccinated is a key part of staying healthy.

Here’s what you need to know to decide which vaccines are right for you and when to get them.

Flu Vaccine (Influenza)

The flu virus changes every year, so an annual vaccine is recommended. Vaccination helps protect us from severe illness, hospitalization and death.

Who should get the flu vaccine:

The CDC recommends everyone over six months should get a flu vaccine, but vaccination is highly recommended for those most at risk of having serious complications from influenza: people over 65, people with chronic medical conditions (i.e. asthma and other lung disease, diabetes, heart disease, kidney and liver disease) and pregnant women. Here’s additional information for those at higher risk of flu complications.

Health care workers and caregivers should get vaccinated to protect themselves and those around them. People over age 65 should get the high-dose flu vaccine, which has more antigen to create a better immune response.

When to get the flu shot

The virus starts to become active in October and peaks from December through February. I recommend getting your vaccine anytime from the end of September through Halloween. Of course, you can always get a vaccine later, but it takes about two weeks for the vaccine to be fully effective so best to be prepared before the virus is actively spreading.

Flu vaccine side effects

Side effects include a sore arm, possible redness, low-grade fever, fatigue, headache and muscle aches.  Symptoms should not last more than one or two days and should resolve on their own. You can find more information on the flu vaccine from the CDC.

COVID-19 Vaccine

The Food and Drug Administration (FDA) recently approved updated vaccines from Moderna, Pfizer/BioNtech and Novovax that cover the current variants. Similar to the flu, the COVID-19 virus has been changing so vaccines need to be updated to protect against the current variants. The Moderna and Pfizer/BioNtech vaccines are mRNA vaccines. The Novovax vaccine is a more traditional vaccine, a protein subunit vaccine, where a version of the spike protein that has been made in a laboratory is introduced along with an adjuvant to stimulate the immune system.

When to get the COVID vaccine

An updated COVID-19 vaccine is recommended now, especially for those over 65 and those at increased risk for severe COVID-19 infection. If you recently received the prior COVID-19 vaccine you should wait at least two months before receiving the updated one.

COVID-19 typically has a peak in the winter, but we also see smaller surges throughout the year due to new variants and waning immunity, as we saw this summer. If you recently had a COVID infection, I recommend waiting at least three months before receiving the vaccine.

Another option is to time the vaccine before an important event like a family gathering or trip abroad where you really do not want COVID-19. In these cases, I recommend the vaccine two weeks before the event. 

COVID-19 side effects

Side effects are similar to the flu vaccine. CDC studies show it is safe to get the flu and COVID-19 vaccines at the same time, but side effects may be slightly worse. If it is most convenient for you to get the vaccines together, you should go ahead and do so. If you have the time, I would try to get each vaccine separately. Here is some more information about the COVID-19 vaccine from the CDC.

RSV vaccine (Respiratory Syncytial Virus)

RSV is another seasonal respiratory virus that starts spreading in September and peaks in December. You may be familiar with it if you have children or grandchildren as it is the leading cause of hospitalization of babies under the age of one. Adults can get RSV as well. It usually presents with cold symptoms but sometimes can cause severe lower respiratory tract disease and hospitalization.

The Food and Drug Administration (FDA) approved the first two RSV protein subunit vaccines in 2023 (Arexvy by GSK and Abrysvo by Pfizer). In their first season of use, these vaccines were 77% and 79% effective in preventing RSV-associated emergency department encounters and 85% and 73% effective in preventing RSV-associated hospitalizations in adults 60 and older. In May of this year, a third RSV vaccine using mRNA technology, mResvia from Moderna, was also approved by the FDA. 

Who should get the RSV vaccine

The CDC currently  recommends everyone over the age of 75 get an RSV vaccine as well as those aged 60 and 74 if they have chronic health conditions that place them at increased risk for severe RSV infection. 

When to get the RSV vaccine

The RSV vaccine can be given any time of the year but is most effective if given in late summer or early fall, August through October, before the RSV season. Currently the CDC recommends only a single dose of RSV vaccine but there is ongoing surveillance and evaluation to determine whether additional doses will be beneficial. 

RSV vaccine side effects

The most common side effects of the RSV vaccine include pain, redness and swelling at the injection site, muscle or joint pain, headaches, fatigue, nausea, diarrhea and fever. Side effects are typically mild and usually resolve in a day or two.

Early safety surveillance data from the CDC and FDA-Centers for Medicare and Medicaid Service (CMS) partnership suggest a potential for an increased risk of Guillain-Barre Syndrome (GBS) after RSV vaccination in adults ages 60 and older. However, these data are only preliminary so at this time an increased risk of GBS cannot be confirmed.

There were no reports of GBS among adults who received Moderna’s mResvia vaccine in clinical trials, but ongoing surveillance is necessary. Vaccine safety monitoring systems will continue to monitor for GBS caused by any RSV vaccine.

According to the CDC, the risk of being hospitalized from RSV is significantly higher than any GBS risk from vaccines in adults 75 and older and in adults 60 to 74 who have health conditions that increase risk of severe disease. Data on immunogenicity of RSV vaccines and other vaccines when coadministered are currently limited.

Limited data show coadministration of RSV with other respiratory virus vaccines may result in lower antibody titers, but the clinical significance of this is unknown. If possible, I would get this vaccine on a separate day.

You can find out more information on the RSV vaccine from the CDC.

Stay Protected This Season

Each of these vaccines—flu, COVID-19 and RSV—plays a vital role in protecting against potentially severe illnesses. By understanding the timing and recommendations for each vaccine, risks for severe disease and risks of the vaccines, you can make well-informed decisions that best suit your health needs and preferences.

While mild side effects are possible, the benefits of vaccination in preventing serious disease far outweighs these risks. Vaccination not only safeguards your health but also helps protect those around you, especially the most vulnerable.

As we navigate through the peak of respiratory virus season, taking these proactive steps ensures a healthier, safer winter for everyone. For more detailed guidance, refer to resources provided by the CDC and consult with your healthcare provider.

MUSC Accel Health is here to help

Here at MUSC Accel Health we currently have the regular flu vaccine and the high-dose vaccine for those over 65. The flu, COVID and RSV vaccines are all available at your local pharmacy. You can look up vaccine availability here Find pharmacies near you (vaccines.gov).

About the Author

Dr. Erika Blank is a concierge primary care provider at MUSC Accel Health. She is board-certified in Internal Medicine and Lifestyle Medicine. Please visit MUSC Accel Health to learn more about her approach to primary care. Sign up to join the waitlist or call 843-876-9360.