As the season approaches when respiratory illnesses like COVID-19, influenza, and RSV can run rampant, it's crucial to take preventative measures. Predictions from the US Centers for Disease Control and Prevention (CDC) indicate that this year's respiratory illness season may mirror last year's peak, which saw over 20 hospitalizations per 100,000 individuals within a week—exceeding pre-pandemic levels. However, the potential for a reduced disease burden exists, with vaccination rates playing a pivotal role in this outcome. In the previous year, the US introduced vaccines against all three major respiratory viruses for the first time, yet the uptake was underwhelming. "The foremost advice for safeguarding yourself and your family from respiratory diseases is vaccination," stated CDC Director Dr. Mandy Cohen. "Plan now to get both the updated flu and COVID vaccines for you and your family this fall, before the respiratory virus season begins." Here's an overview of the vaccines available for protection this season.

The CDC advises that individuals six months and older should receive a COVID-19 vaccine to maintain protection. As the virus evolves, updated vaccines may offer enhanced protection against severe illness by targeting newer strains. Several options are available; the mRNA vaccines from Moderna and Pfizer have been updated to target the KP.2 variant, which has been prevalent in the US since May. These vaccines are suitable for individuals six months and older. Additionally, a more traditional protein-based vaccine from Novavax is available, targeting the JN.1 variant, which, while still circulating, is less dominant than it was a few months ago. The Novavax vaccine is authorized for individuals aged 12 and above. The practical effectiveness of these vaccines remains uncertain, but last season's COVID-19 vaccines provided 54% protection against symptomatic infection, according to CDC data, despite the emergence of new variants. The updated COVID-19 vaccines are now accessible, but the optimal timing for vaccination may vary based on individual circumstances. "You achieve the highest level of protection in the initial weeks to months post-vaccination, after which antibodies tend to decline," explained Dr. Sandra Fryhofer, the American Medical Association’s liaison to the CDC’s independent vaccine advisory committee and a member of its COVID-19 vaccine workgroup, on a recent podcast. "You might consider timing your vaccination to coincide with peak antibody levels for significant events like weddings or major conferences. However, remember that while you wait, you're still at risk of COVID-19 infection, and it's safer to build antibodies through vaccination rather than infection." CDC data from last season suggests that protection declines significantly about four months post-vaccination. For those receiving the vaccine now, this could result in reduced protection during the typical peak of the respiratory virus season. Others who were recently infected might consider waiting up to six months before getting an updated shot, as suggested by epidemiologist Katelyn Jetelina on her blog. "Waiting may not be detrimental, but some studies suggest that it allows our immune systems to update more effectively," she wrote. The CDC has also issued a new recommendation in October, stating that individuals aged 65 and older or those with moderate to severe immunocompromise should receive a second dose of this season's COVID-19 vaccine. These individuals should administer their second dose of the 2024-2025 COVID-19 vaccine six months after their initial dose. The recommendation also includes "shared clinical decision making," allowing those with moderate to severe immunocompromise to receive additional doses if advised by their healthcare provider.

A seasonal flu vaccine is also recommended for everyone six months and older, with September and October being the optimal times for vaccination, according to the CDC. Most individuals require only one dose of the flu vaccine annually. However, some children receiving the flu vaccine for the first time should receive two doses, spaced four weeks apart. A high-dose formulation of the flu vaccine is also available for those aged 65 and older. RSV can pose significant risks to older adults, as well as infants and young children. Vaccines are available to protect these vulnerable groups. The CDC has updated its recommendations for older adults this year, providing clearer guidance. All adults aged 75 and older should receive a single RSV shot, along with those aged 60 and older who are at increased risk due to certain chronic medical conditions such as lung or heart disease, or because they reside in a nursing home or long-term care facility. Unlike the flu and COVID-19 vaccines, the RSV vaccine requires only a one-time dose. Older adults who received an RSV vaccine last year do not need another one this year. Pregnant women can receive an RSV vaccine that will protect their newborn, or antibodies can be administered to an infant post-birth. The CDC states that it is safe to receive both a COVID-19 and flu vaccine simultaneously, which may be more convenient than delaying one and risking illness. If receiving more than one shot at a time, they can be administered in the same arm, at least one inch apart, or in different arms. The CDC also permits receiving COVID-19, flu, and RSV shots at once for those who are eligible, with no recommended waiting period between them. However, the agency notes that "people who receive an RSV vaccine and a flu vaccine during the same visit might be more likely to experience injection-site reactions or other common side effects post-vaccination. Further research is underway to better understand this phenomenon." Although no combination vaccine is currently available, the future may hold one—Moderna has announced plans to seek regulatory approval for a combined COVID-19-flu vaccine in 2024.

COVID-19, flu, and RSV vaccines are widely accessible at pharmacies across the US. The federal government offers a vaccine locator tool to assist in finding available doses, but it advises confirming appointments and availability directly with the provider. Vaccines may also be available through local health departments or physicians' offices, though not as readily. Parents should consult with their pediatrician for children and young infants. However, challenges from last year, such as age restrictions at pharmacies and limited stock at pediatricians' offices, may persist this season. Most insurance plans cover these vaccines. Individuals with private insurance, Medicare, or Medicaid can still receive vaccinations at no out-of-pocket cost. However, a federal program that previously provided free COVID-19 vaccines to uninsured adults and those whose insurance did not cover all vaccine costs has ended due to a lack of federal funding. For adults without insurance or those whose insurance does not cover the vaccine, obtaining the updated COVID-19 shot at a pharmacy could cost $201.99. Free shots may still be available for the uninsured in some locations. The CDC announced last month that it is allocating $62 million to state and local health departments to offer free COVID-19 vaccines to adults who would otherwise be unable to afford them.