Guest Op-Ed: An Update on the “Triple-Demic:” COVID-19, Influenza, and Respiratory Syncytial Virus (RSV)

By Ange Uwimana, Medical Student, and Whitney Schutzbank MD, MPH, and Jim Morrill, MD, PhD
MGH Charlestown HealthCare Center

Hard to believe, but we’re heading into cold weather season, and with colder temperatures comes an increase in viruses and colds. Thankfully, there are now vaccines to help decrease the severity of illness from three of the most common viruses–COVID-19, Influenza (flu), and Respiratory Syncytial Virus (RSV).

Our world has been changed by the COVID-19 pandemic. COVID-19 is a novel pathogen that causes an acute viral respiratory illness that can range from mild sinus congestion to a severe flu-like illness and viral pneumonia. Thanks to science, the first COVID-19 vaccine was released in record time in December 2020.

Influenza or flu virus causes upper and lower respiratory diseases with symptoms such as fever, chills, and muscle aches. More severe diseases, including pneumonia, can affect the elderly, those with chronic conditions, and people with compromised immune systems.   The longstanding and annually updated flu vaccine is one important way to protect yourself from severe flu.

Respiratory syncytial virus (RSV) causes respiratory tract and lung infections. In most adults, it causes mild cold-like symptoms such as a runny nose, sore throat, cough, and headache. But RSV can also lead to severe symptoms in adults older than 65 years and children less than two years old. Fortunately, the FDA has now approved two vaccines against RSV this year for adults over age 60– Arexvy (made by Glaxo-SmithKline) and Abrysvo (made by Pfizer) which have similar efficacy. The RSV vaccine is also recommended for pregnant women between 32-36 weeks gestation. And a preventive monoclonal RSV antibody treatment has been released for young infants.

Here are some answers to frequently asked questions about prevention of COVID-19, Influenza, and RSV:

• What are the recommendations for the use of COVID-19 vaccines in the US for 2023-2024?

o Everyone ages five years and older should receive one dose of the 2023-2024 Moderna or Pfizer BioNTech mRNA COVID-19 vaccine.

o People who are immunocompromised or severely ill may receive an additional dose at least two months after the first dose.

o Children aged six months to four years who are unvaccinated should receive either two doses of the 2023-2024 Moderna vaccine or three doses of the 2023-2024 Pfizer. For those who have already completed a primary vaccine series, one dose of the updated vaccine should be administered.

• I recently had a COVID-19 infection. When should I get the updated 2023-2024 COVID-19 vaccine?

o Because you will have immunity from your infection, it is reasonable to wait three months after a COVID-19 infection to receive the vaccine, although there are no safety concerns if the vaccine is given prior to three months.

• I recently received the bivalent COVID-19 vaccine. When should I get the updated 2023-2024 COVID-19 vaccine?

o You should wait three months after a prior COVID vaccine, although as with prior COVID infection, there are no safety concerns if the vaccine is given sooner.

• What are the recommendations for the flu vaccine?

o Annual flu vaccine vaccination is recommended for everyone aged aged six months and older who do not have contraindications.

o Adults aged 65 years and older should receive a higher dose of the Flu vaccine.

• I received the Flu vaccine last year. Why should I get vaccinated again?

o Every year, new strains of the flu emerge, and scientists work hard to make new vaccines to target these new strains.

• Can the COVID-19, Flu, and RSV vaccines make me sick?

o The COVID-19, Flu and RSV vaccines are not live vaccines and cannot cause infection.

o Side effects of the vaccines include fever, muscle aches, headaches, and fatigue, which may mimic the initial symptoms of infection. These symptoms generally resolve after 24 to 48 hours.

o It is possible to get other respiratory viruses, such as rhinovirus, adenovirus, and parainfluenza viruses despite vaccination for COVID-19, Flu, and RSV.

o The vaccines may not fully prevent COVID-19, Influenza, or RSV infection, but they can lessen the severity of symptoms and reduce the risk of hospitalization.

• What are the recommendations for RSV vaccination or preventive monoclonal antibody use in 2023?

o Adults aged 60 years and older may receive a single dose of the RSV vaccine after talking with their doctor.

o The vaccine is especially recommended for adults over 60 with underlying medical conditions such as lung, cardiovascular, kidney, or liver disease, immune compromise, diabetes, or neurological or neuromuscular conditions or older adults living in nursing homes.

o One dose of the monoclonal antibody nirsevimab (Beyfortus) is recommended for all infants younger than eight months of age entering their first RSV season. Unfortunately, due to supply chain issues, the current supply is variable and limited.

o The Abrysvo (Pfizer) RSV vaccine is approved for pregnant individuals at 32 through 36 weeks of gestational age. Giving pregnant moms the vaccine helps prevent RSV in infants under six months of age.

• What are the universal precautions to protect from COVID-19, Flu, and RSV?

o Stay up to date with age-appropriate COVID-19, Flu, and RSV vaccines, as above.

o Wash your hands frequently with soap and water or use a hand sanitizers.

o Avoid crowded indoor spaces or wear masks in those spaces.

o Avoid contact with people who are sick.

o If you or a family member gets sick or respiratory develops symptoms, stay home, avoid gatherings, and seek care with your primary doctor for testing and treatment as appropriate.

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