TCA, vol. 30. Your fall vaccine roundup.
What vaccines to get and when.
As the fall and winter approach, we are confronted yet again with “flu season”. I used to call this “cold and flu” season, but with the ubiquity of COVID, it now seems like the entire year is “cold season”. However, we should prepare ourselves for an uptick in flu infections by getting our flu shots. And while you’re at the pharmacy, maybe get these other ones too….
The Seasonal Flu Vaccine
There are many options for flu vaccines, but this year they are ALL quadravalent (meaning they include four different flu strains). The strains are:
an A/Victoria/4897/2022 (H1N1)pdm09-like virus; (Updated)
an A/Darwin/9/2021 (H3N2)-like virus;
a B/Austria/1359417/2021 (B/Victoria lineage)-like virus; and
a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.
The first of the bunch is a new strain that has been added to this year’s vaccine. The next three are the same as last year’s flu vaccine.
Here are your options, consult with your doctor or pharmacist to see which is best for you.
The Inactivated flu vaccine: Your regular old quadravalent flu vaccine, given as a shot in the arm. Good for anyone over the age of 6 months. Afluria, Fluarix, FluLaval and Fluzone.
The non-egg based vaccine: Most flu vaccines are grown in embryonated chicken eggs. If you are allergic to eggs, you should get one of these instead. Flucelvax for those over 6 months old, and Flublok for those over 18 years.
Flu vaccines with an extra punch: These are highly active and meant for those over the age of 65. Fluzone and Fluad.
The Live flu vaccine: The only flu vaccine that contains active (but weakened) viruses. Approved for ages 2-49, and given as a squirt up the nose. May not be appropriate for those with severe asthma or immunocompromised persons.
When should you get the flu vaccine?
October seems to be the best time, since that’s when flu season is just ramping up. If you get it way earlier than that, then your immune system response may be on the downswing by the time we get to February and March… when flu is still circulating.
But honestly, the best time to get the flu shot is when you will actually do it.
The updated COVID booster.
Yep, there’s a new one! The first Pfizer/Moderna COVID vaccines given in December of 2020 contained the original COVID strain. The bivalent boosters distributed in 2022 contained the original strain PLUS the Omicron strain. Now, we have the third round approved for Pfizer and Moderna…. and we are back to just a singleton. The new COVID boosters approved on September 11, 2023 contain one strain: the Omicron variant XBB.1.5.
In June, the Vaccines and Related Biological Products Advisory Committee recommended XBB.1.5 as the strain that they thought would be the dominant strain in the upcoming fall season. Certainly, XBB.1.5 was heavily dominant throughout the whole summer… but now it seems to be losing traction to a new offshoot called EG.5.1 (or Eris). These are all descendents of the original Omicron strain, so hopefully a vaccine to XBB.1.5 may give you some protection against Eris as well. Indeed, preliminary results from Moderna show that the 2023 COVID booster does indeed create antibodies that will neutralize Eris. This was all done in lab assays though (and its still an un-reviewed preprint, so keep that in mind). It remains to be seen how well this new booster will perform in a real person against Eris.
Is the new COVID booster for kids?
Here are the recs straight from the FDA:
Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.
Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 Vaccine.
When should you get the updated COVID vaccine?
Theres a bit of discussion about this. You should wait at least 2 months since your last COVID vaccine or COVID infection to get this the 2023 booster. If you are healthy and at low risk, you may want to wait even longer… maybe 3-6 months. Why? If you get it too soon, its like diminishing returns. Your antibodies are already really high if you’ve had a recent vaccine/infection, and there’s a maximum amount your body can make at any given time. Getting a booster when you are already maxxed out isn’t going to make you produce much more. Better to wait to when your antibody levels fall, so you can boost them back up.
If you are over 65, immunocompromised or at high risk of severe disease, though, they say go ahead and get one. It’s riskier to wait.
Can you get the COVID booster and the flu shot at the same time?
Absolutely. I would recommend getting them in different arms, but its not unsafe to get them in the same arm. If you are getting the “extra” flu vaccine for those over 65 (Fluzone or Fluad) then you should probably get them in different arms. Fluzone and Fluad are more likely to cause local side effects (redness, pain and swelling) in the arm, so get them in opposite arms to limit the side effects.
Another vaccine you may want to consider….
If you are over age 60 and at high risk for severe disease by Respiratory Syncytial Virus (RSV) then you may want to consider this one as well. Right now, they are not recommending this vaccine for everyone, so you’ll need to consult with your doctor. Some pharmacies are not distributing this vaccine without a prescription.
Read more about RSV in The Causative Agent, vol 23.
Stay happy, healthy and informed!
Jessica at the TCA
Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023
Safety and Immunogenicity of XBB.1.5-Containing mRNA Vaccines BMJ (preprint).
The new COVID boosters are coming: Here's what you need to know NPR
Getting a Flu Vaccine and a COVID-19 Vaccine at the Same Time CDC