The fall and winter months, once characterized by influenza (flu), are now faced with the intricate challenge of a potential “tripledemic,” due to the circulation of COVID-19, respiratory syncytial virus (RSV), and influenza. The circulation of these three viruses may result in overlapping activity peaks. As temperatures continue to drop and indoor gatherings become more common, the potential for these viruses to spread increases. Widespread infection can heavily burden public health and healthcare systems. The good news is this season there are more ways than ever to help protect yourself, your family, and your community, including:
- Safe, updated immunizations for all three diseases. Immunization against flu, COVID-19, and RSV remain the best way to safeguard against hospitalizations, long-term health impacts, and death. Eligibility and recommendations for vaccines are reviewed in more detail below;
- Widely available, effective treatments for flu and COVID-19 that can reduce the risk of severe illness, hospitalization, and death;
- Testing to detect viruses; and
- Everyday actions, like masking, physical distancing, washing hands, and improving airflow in the places where people live and work.
Mitigating the transmission of respiratory infections should be a priority for everyone. Respiratory diseases can be very serious, especially for those with heightened risk factors. This resource post consolidates key CDC recommendations for this year’s fall and winter virus season. CDC also provides more detailed weekly updates, including county-specific guidance, on their webpage, “Protect yourself and others from COVID-19, Flu, and RSV.”
Influenza (Flu)
As of late October, seasonal influenza activity remains low nationally, but small increases have been reported throughout the country. Peak season is typically between December and February. Preliminary data from between October 1, 2023, and November 11, 2023, indicates there have been up to 1.6 million cases, 770,000 medical visits, 17,000 hospitalizations, and 1,500 deaths due to influenza. Hospitalization rates are updated on CDC’s FluSurv-NET surveillance platform.
Vaccines
CDC recommends getting a flu vaccine yearly for everyone ages 6 months and older who do not have contraindications. Adults 65 and over should preferentially receive a higher dose or adjuvanted flu vaccine, such as Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, or the Fluad Quadrivalent adjuvanted flu vaccine. If these are not available, then any other age-appropriate flu vaccine can be used.
Most health care insurance plans cover flu vaccination at no cost to you. Vaccinations sites near you can be found by visiting www.vaccines.gov and entering your zip code or by contacting your local health department (LHD) to see if they are hosting vaccination clinics.
Treatment
Treatment with antiviral medication is recommended as soon as possible for any patient with suspected or confirmed flu who is hospitalized; has severe, complicated, or progressive illness; or is at high risk for flu complications. While these treatments are available, they are not a substitute for getting a vaccine. Vaccines help the body learn how to defend itself from disease without the dangers of a full-blown infection, which can be unpredictable and can have long-term consequences.
For more information on flu guidance for the 2023-24 season, visit these resources from the CDC:
Respiratory Syncytial Virus (RSV)
RSV is a common respiratory virus affecting all age groups, but like the flu, it significantly impacts children and older adults. Each year, it is estimated that between 60,000-160,000 older adults in the United States are hospitalized and 6,000-10,000 die due to RSV infection. Adults at highest risk for severe RSV infection include adults 65 and over as well as those with underlying medical conditions and other risk factors. RSV can also be dangerous for infants and young children. Each year in the United States, an estimated 58,000-80,000 children younger than 5 years are hospitalized due to RSV infection.
Vaccines
Two RSV vaccines were licensed in 2023, but not everyone is eligible. Those who are eligible include:
- Adults 60 years and older,
- Pregnant people who are 32-36 weeks pregnant during RSV season,
- Infants up to 8 months old (during or entering their first RSV season),
- And infants and toddlers between 8-19 months old (entering their second RSV season) if they are in one of the following groups:
- Children who have chronic lung disease from being born prematurely,
- Children who are severely immunocompromised,
- Children with cystic fibrosis who have severe disease, and/or
- American Indian and Alaska Native children.
To determine eligibility, consult with a healthcare provider. Flu, COVID-19, and RSV vaccines may be given at the same time, but if they are administered separately, there is no minimum waiting period between vaccines. Talk with a healthcare provider or pharmacist about your options. For more information on RSV guidance for the 2023-24 season, visit the CDC’s website here.
COVID-19
While most of the U.S. population has some level of COVID-19 immunity due to previous infection(s), vaccination, or both, vaccine and infection-induced immunity wanes over time and is challenged by the ongoing evolution of new viral variants. While the current burden of COVID-19 is lower than previous points in the pandemic, there are still thousands of hospitalizations and hundreds of deaths each week, the burden of which varies by age and underlying condition status.
Vaccines
CDC’s Advisory Committee for Immunization Practices (ACIP) and CDC recommends everyone 6 months and older get an updated COVID-19 vaccine, as highlighted in this issue of the Morbidity and Mortality Weekly Report. They recommend that most people 5 years and older receive one dose of the updated 2023-2024 vaccine, regardless of prior vaccination. Children 6 months to 5 years are recommended to get the original vaccine series as well as the updated vaccine. Additional considerations are outlined in the MMWR for other special populations.
While COVID-19 vaccines moved to the commercial market in September 2023, they are still available at no cost to many through private health insurance, Medicare, or Medicaid plans. Additionally, the CDC’s Bridge Access Program offers no-cost COVID-19 vaccines to eligible adults without health insurance and to those whose insurance does not cover all COVID-19 vaccine costs. The Bridge Access Program can be accessed through local health providers partnering with state and local health departments, HRSA-supported health centers, and select pharmacies. To find a provider a part of the Bridge Access Program, please visit vaccines.gov.
For more up-to-date information on COVID-19 vaccines, visit CDC’s resource Stay Up to Date with COVID-19 Vaccines.
Treatment
If already infected, COVID-19 treatment must be started within 5-7 days of symptomatic onset in order for it to be effective. Options include, but are not limited to, Nirmatrelvir with Ritonavir (Paxlovid), Remdesivir (Veklury), and Molnupiravir (Lagevrio). The Biden-Harris Administration launched a nationwide Treat to Test initiative to help people access treatments for COVID-19 at little to no cost.
Testing
The U.S. Department of Health and Human Service’s (HHS) Administration for Strategic Preparedness and Response has reopened orders for no-cost, at-home COVID-19 rapid antigen tests on https://www.covid.gov/tests. Every U.S. household that ordered this fall can submit one order for four more tests, and those that have not ordered this fall can submit two orders for a total of eight tests.
HHS also has a webpage to share what resources are available from state to state for low- or no-cost testing: https://www.hhs.gov/coronaviru....
Additional Resources
There are a variety of additional resources, toolkits, and guides, in addition to those linked above, that local health departments can utilize this season. These resources include social media posts and information for specific populations. Links to these can be found below:
- CDC: Resources to Prepare for Flu, COVID-19, and RSV
- CDC: Healthcare Provider Toolkit: Preparing Your Patients for the Fall and Winter Virus Season
- CDC: Influenza (Flu) Communication Resource Center
- HHS: 2023 Fall-Winter COVID-19 Vaccine Social Media Toolkit
- NACCHO: School Located Influenza Vaccination Toolkit
