Is it safe to get the RSV, flu and COVID shots at the same time? What Texas doctors say

Three viruses — the flu, RSV and COVID — are circulating this fall.

Last year, a “tripledemic” caused millions across the country to become sick with COVID-19, influenza and respiratory syncytial virus, many of whom were older, immunocompromised adults. This time around, with flu and RSV season coming up and a new COVID wave starting in Texas, we’re better equipped to help combat the spread of the illnesses.

All three are highly contagious respiratory infections caused by viruses. Symptoms of a cold, the flu, respiratory syncytial virus and COVID-19 may look the same.

Along with flu vaccines available for everyone, the first-ever RSV vaccine became available for seniors 60 and older and the latest COVID-19 boosters are coming out later this month.

When should you get each vaccination to maximize your immunity against the three viruses? Here’s what Texas medical professionals say.

COVID booster

With COVID levels rising in Texas, many are wondering when the right time is to get their COVID booster. Bivalent boosters are currently available that target both the original strain and omicron variant strains of COVID. Soon, monovalent boosters targeting a newer strain of the omicron variant are expected to be available.

Pending approval from the U.S. Food and Drug Administration, the new monovalent COVID-19 booster shot will be available in mid to late September depending on your location. It’s widely expected that the CDC will recommend adults 65 and older and the immunocompromised get the vaccine promptly, says Dr. Theresa Brown at CenterWell Senior Primary Care. Dr. Pedro Piedra at Baylor College of Medicine said the decision about when to get vaccinated should be based on personal risk factors and COVID levels in your community.

“If you have not had a previous bivalent booster, I recommend getting one now, especially if you are in an at-risk group. It’s better to have some protection than no protection,” Piedra said. “If you have already received your bivalent booster and you are relatively healthy, you may want to wait for the monovalent booster.”

COVID-19 boosters will continue to be free for most people, including those with private insurance, Medicare and Medicaid.

Annual flu vaccine

The Centers for Disease Control and Prevention recommends getting the flu vaccine in September or October, before the flu season peaks from December to February. Likewise, Piedra recommends getting your flu shot in October to build immunity before the season begins. Make a plan for where you will receive the vaccine; talk to your physician about setting an appointment or find out when vaccines will be available at your local pharmacy.

“The seasonality of the influenza virus has changed the last couple of years due to the COVID-19 pandemic,” Piedra says. “This year, we may come back to the regular season, which usually sees flu activity begin in November and peak somewhere between January and March.”

Everyone 6 months and older is recommended to get the flu vaccine, but the options differ based on age group. Children younger than 8 years old who haven’t been vaccinated before require two doses, four weeks apart. Full immunity isn’t until two weeks after the second dose, so children should start vaccination earlier. FluMist is an alternative for children who are afraid of shots. For adults 65 years and older, there are vaccines with a higher antigen content, or adjuvant, to help the immune system respond better.

The flu vaccine is free for most people with private insurance, Medicaid and through Medicare Part B. Check with your health plan before scheduling an appointment to ensure you have coverage, Brown recommends.

If you get the flu, Piedra recommends immediate treatment with antivirals, within two days of symptoms starting. Make a plan with your physician about the best way to get your prescription filled quickly in case of illness, he suggests.

RSV vaccine

RSV vaccines are now available for adults over age 60. Though RSV activity in Texas is currently low, RSV season begins earlier than flu season, so Piedra recommends that older adults talk to their physician about getting vaccinated now.

“The timing of the onset, peak, and decline of RSV activity varies each year, so the ideal time to start vaccinating cannot be predicted, but it is recommended to receive the vaccine before the onset of RSV activity in the community,” Brown says.

The FDA has also approved a vaccine for pregnant women, which prevents RSV in infants during their first three months when they are at greatest risk for severe infection. Pregnant women should consult their doctor about vaccination, Piedra says.

A long-acting monoclonal antibody called Nirsevimab was approved for infants less than 8 months old. Infants born now, during the RSV season, are recommended to receive a single dose during their first week, Piedra said, which can provide protection against severe RSV infection. Infants 8-19 months, who are at increased risk for severe RSV infection and entering into their second RSV season, should also receive a single injection of Nirsevimab.

The RSV vaccine is covered for people with private insurance without a copay and those with Medicare Part D.

Is it safe to take them together?

Because people with chronic medical conditions or compromised immune systems are at a greater risk of severe illness from the flu, RSV and COVID-19, the CDC recommends immunizations for eligible individuals.

RSV, flu and COVID-19 boosters can be taken simultaneously, according to the CDC. While it is safe to get the flu, RSV and COVID vaccines at the same time, you may consider getting them at different times based on estimated peak activity for each virus, Piedra said.

Experts recommend seniors 65 and older receive all three before the viruses spread in their community. Talk to your doctor about your eligibility for each, Brown says. Immune response might be lessened for people on certain medications or treatment regimens, so your doctor can give you a personalized recommendation.