COVID, RSV and flu shots: What do I need to know about the latest fall vaccines?

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Colder temperatures are coming for Iowa, and with them, another unpredictable respiratory viral season. But this year, Iowans will have more tools to help reduce the risk of infections.

Last year, clinics and hospitals across the state were inundated with sick patients from a "tripledemic" of respiratory illnesses: COVID-19, influenza and RSV, or respiratory syncytial virus.

Emergency rooms at Iowa's children's hospitals were filled with young patients infected with RSV, while urgent care clinics were forced to implement a scheduling process after scores of patients sick with the flu and coronavirus created long wait times.

This year, vaccines will soon be available to reduce hospitalizations and deaths from all three viruses.

In addition to annual flu shots, federal health officials have recently approved a new round of COVID-19 booster shots. New immunizations for RSV, approved for the most at-risk populations, will also be available this winter.

Here's what you should know:

Libby Moench gets a flu shot from CMA Emily Howard at the UnityPoint Clinic in Norwalk, Friday, Sept. 15, 2023.
Libby Moench gets a flu shot from CMA Emily Howard at the UnityPoint Clinic in Norwalk, Friday, Sept. 15, 2023.

What's the latest with new COVID-19 boosters?

Virtually all Americans are recommended to get a COVID-19 booster once shots become available later this month.

Earlier this month, the U.S. Centers for Disease Control and Prevention recommended everyone over the age of 6 months receive an updated COVID-19 booster shot this winter.

Federal regulators recently approved two shots from Pfizer and Moderna, both of which are crafted to target an omicron subvariant of the virus called XBB. Though new variants have emerged to drive up new COVID-19 infections, experts say the updated shots will still adequately reduce risk of serious illness.

Pfizer-BioNTech 2023-24 COVID-19 vaccine. This mRNA formulation offers protection against BA.2, BA.2.86 “Pirola,” EG.5 “Eris” and the XBB.1.5 COVID variants. Researchers say the vaccine provides needed immunity as COVID hospitalizations rise going into fall and winter.
Pfizer-BioNTech 2023-24 COVID-19 vaccine. This mRNA formulation offers protection against BA.2, BA.2.86 “Pirola,” EG.5 “Eris” and the XBB.1.5 COVID variants. Researchers say the vaccine provides needed immunity as COVID hospitalizations rise going into fall and winter.

Studies have shown boosters re-upping coronavirus vaccines administered in 2021 offer strong protection against infection, reducing risk of serious illness, hospitalization and death among those most at risk, such as the elderly and those who are immunocompromised.

The approval represents federal health officials' new push to put COVID-19 shots on an annual schedule, similar to how Americans receive flu shots once a year. Just like influenza shots, vaccine manufacturers will identify the strain most likely to circulate the following winter and develop a shot targeting that particular strain.

"I think it's safe to anticipate an annual COVID-19 (booster), similar to an annual flu shot," said Lina Tucker Reinders, executive director of the Iowa Public Health Association. "… We've crossed the threshold from pandemic to endemic, and endemic means the condition exists but it's relatively predictable. There seems to be more a seasonality to it, so we can predict when the highs and lows are going to be."

What does the end of the public health emergency mean for COVID vaccines?

These are also the newest COVID-19 shots since the end of the federal public health emergency in May, making this the first round of shots not fully paid for by the federal government.

Shots are still guaranteed for free for people on public or private insurance plans, but some experts have raised concerns about the potential cost facing the estimated 25 million uninsured Americans. Earlier this month, federal health officials and manufacturers announced a partnership to temporarily provide free vaccines to uninsured individuals using leftover pandemic emergency funds.

Iowans can find free or low-cost options for vaccines through the federal website. Uninsured and underinsured children are guaranteed free access to vaccines through the federal Vaccines for Children Program.

Local residents can also find clinics offering free or low-cost vaccines by contacting the Polk County Health Department or visiting

However, it's unclear how many people will seek out the boosters, as uptake of the vaccine has dropped in recent years. Only 20.6% of Iowans are up-to-date on their COVID-19 vaccinations as of Aug. 31, according to the CDC.

When can I get the new COVID booster shot?

COVID-19 booster shots should be available in the coming days. Shipments are still arriving at clinics and pharmacies across the state, but some providers are beginning to schedule appointments. Check with your doctor or local retail pharmacy.

Experts say individuals should wait at least two months after getting the last dose of any COVID-19 vaccine before getting the latest booster.

Beyond that, the timing of the shot may depend on your risk factors or your and your family's schedule, Tucker Reinders said. However, it's important that individuals check their calendars and make sure they get the vaccine before interacting with any at-risk loved one, especially if cases start to increase as temperatures drop.

"Especially as we head into the holiday season, we want to make sure that we are as protected as possible before we gather with family members, friends or whoever might have weaker immune systems or might otherwise be medically fragile," she said.

What are the new RSV vaccines?

RSV is one of the most common respiratory viruses in the United States, with nearly everyone getting infected by the time they reach the age of 2, according to the CDC.

Symptoms are similar to a cold for most, but the virus poses a heightened risk to young infants and seniors, said Dr. Pat Winokur, an infectious disease specialist and co-director of the Institute for Clinical and Translational Science at the University of Iowa.

Now, these vulnerable groups have additional protection.

Respiratory syncytial virus vaccine vial.
Respiratory syncytial virus vaccine vial.

Federal regulators recently approved two vaccines — developed by pharmaceutical companies GSK and Pfizer — to reduce risk of infection in adults ages 60 and older. Clinical studies of both these vaccines offer strong protection against infection and an even higher rate of success in preventing severe disease in older adults, Winokur said.

In addition, the vaccine offers protection for two RSV seasons.

A vaccine administered to pregnant women in their third trimester has also been approved by federal health regulators and was recently backed by CDC experts, clearing the way for the shot to hit the market in the near future. Made by Pfizer, the vaccine would be given to pregnant people who reach 32 to 36 weeks of gestation between September to January.

The goal is to protect babies born between October and March, when the risk of RSV infection is at its highest. Studies have shown the new vaccine is effective in preventing severe disease in infants up to six months after birth.

A new preventive monoclonal antibody treatment will also be available for babies and some infants. The new drug, called Beyfortus, can be given to babies under 8 months old entering their first RSV season and to those ages 8 months to 19 months who are at increased risk of severe disease.

Who qualifies for the new RSV vaccine for older adults?

The CDC is not recommending all adults ages 60 and older get the RSV vaccine. Instead, individuals 60 and older should talk with their health care provider to decide whether the vaccine is appropriate for them.

"If you are 60 and very healthy with no chronic medical conditions, maybe this isn't the vaccine that you need," Winokur said. "If you are 65 or 70 and you have chronic lung disease or chronic cardiac disease or you have other chronic medical conditions, this may be a very important vaccine for you."

Clinical studies did detect rare, but severe, side effects in both vaccines, prompting federal regulators to take a more measured recommendation for the initial rollout, Winokur said. However, she emphasized that health officials will continue to monitor the vaccine's effectiveness and any potential side effects.

Winokur noted that flu vaccines, which are now recommended for virtually all Americans, had a similar rollout when first introduced in the United States.

"This measured approach has been done before, and flu vaccines are a great example," she said.

How can I get an RSV vaccine?

Iowans will likely need to seek out the new vaccines at their doctor's office, especially for babies and young infants, Winokur said.

However, retail pharmacies like Walgreens have announced plans to offer RSV vaccines to older adults in the coming weeks.

Winokur said the new vaccines and monoclonal antibodies against RSV should be available by October.

Pre-filled flu shots at the UnityPoint Clinic in Norwalk, Friday, Sept. 15, 2023.
Pre-filled flu shots at the UnityPoint Clinic in Norwalk, Friday, Sept. 15, 2023.

What do I need to know about this year's flu shot?

The CDC recommends all Americans ages 6 months and older get a vaccine against influenza. Clinics and retail pharmacies are already scheduling appointments, and federal health officials say September and October are the best times for most people to get a shot.

Tucker Reinders encouraged Iowans to get the shot ahead of any holiday gatherings or other family events, especially if they will be interacting with babies, elderly relatives or other at-risk loved ones.

"Protecting ourselves with a vaccine isn't just about us. It's also about caring for those around us," she said.

Can I get my COVID booster, flu shot and RSV vaccine together?

Health officials are confident individuals of all ages can safely receive their COVID and influenza vaccines at the same time, Winokur said. Iowans can typically receive these shots at the same time at retail pharmacies and clinics across the state.

The CDC says individuals can receive the RSV vaccine at the same time as other vaccines. However, there's no data on how this new shot will interact with the updated COVID-19 booster.

Because individuals will likely have to seek out RSV vaccines at their local doctor's office, Winokur said Iowans will likely have to schedule separate appointments regardless.

Either way, Winokur said individuals should talk with their doctor if they have questions about the appropriate timing.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: What you need to know about new fall shots for the flu, COVID and RSV