COVID, flu, RSV boosters: Which shots should you get this fall?

If all those shots you got during the COVID-19 pandemic have become a blur, you may be wondering if or when you should get the latest booster. 

Plus, there’s now a vaccine for something called RSV—and what about the regular flu shot?

If it’s all making your head spin, don’t worry. We talked to local and national experts to sort it out for you. 

New COVID boosters are now approved. The U.S. Food and Drug Administration authorized them on Monday, and on Tuesday, the Centers for Disease Control and Prevention recommended that every American 6 months or older get them.

From now on, think of them as annual vaccines, doctors say. The new formulations, which target the XBB.1.5 variant, are expected to protect against severe infection from currently circulating forms of the virus that causes COVID.

Some pharmacies in Minnesota have opened up appointments to start administering the new shots by next week.

If you’re 60 or older, you can also get a vaccine for respiratory syncytial virus, or RSV. The virus is the cause of 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths in older Americans every year, according to the National Foundation for Infectious Diseases.

The RSV virus also causes hospitalizations among children, and a new drug is available for babies younger than 8 months old. The antibody treatment is not a vaccine, but it is effective for five months.

And yes, it’s also the time of year for the regular flu vaccine, which is recommended for everyone 6 months and older. 

Since COVID is no longer considered a public health emergency, it may take a bit of sleuthing to figure out when and where to find a free shot, especially if you’re uninsured (see below).

Still not sure what to do? Read on for answers to some common questions.

I’m a 20-year-old man who’s had four COVID shots. I don’t have any health problems, but I’m concerned about getting myocarditis from the vaccine. Should I get the new booster?

Males between the ages of 12 and 29 do have a slightly increased risk of myocarditis after getting MRNA COVID-19 vaccines, according to a 2022 study published in the Journal of the American Medical Association. 

However, the risk of contracting myocarditis is much higher from COVID itself, said Dr. Nathan Chomilo, a pediatrician, internist and Medicaid Medical Director at the Minnesota Department of Human Services.*

“So the general recommendation for those ages for those who identify as male is to continue to get the vaccine,” he said. “But it’s always best to talk to your doctor about specific risks and benefits if you have concerns.”

I had COVID and I was barely sick. The COVID shots, however, leave me feeling awful for the next day and a half. Is it OK to say that I’d rather just get COVID? 

Most of the time, you’ll come out ahead by getting the shot, the experts we talked to agreed. For one thing, you won’t necessarily have the same experience again after a vaccine. 

“One year might be rough, and the next year might not be as rough,” Dr. Chomilo said.

There appears to be a correlation between your reaction to the vaccine and your reaction to the actual virus, he said. 

“If you felt crummy for a day or two after getting the shot, that’s usually a sign that if you got the actual virus that’s circulating, you may feel crummy for much longer,” he said.

Being vaccinated could make the difference between being sick for a couple of days or laid up for a week or so, and prevent illness so severe you have to be hospitalized, he said. 

Will the new COVID booster keep me from getting infected with COVID? If not, what’s the point? 

The vaccine actually has five levels of protection, said Dr. Abe Jacob, a pediatrician and chief quality officer for M Health Fairview. Here’s his list of what the vaccines do:

1. They reduce the risk of getting infected (at least for several months).

2. They reduce the risk of severe infection (getting hospitalized or even dying).  

3. They reduce the severity and duration of the illness,  

4. They reduce the risk of long COVID.  

5. They increase “herd immunity” to protect the most vulnerable.

I lost track of which COVID shots I was getting: Moderna, Pfizer, J & J.  Will my health clinic ask me which shot I want? Please help!

The Food and Drug Administration approved shots from both Pfizer-BioNTech and Moderna. If you’ve already had your primary series, it doesn’t matter which you get this time—both have been shown to be effective, Dr. Chomilo said.

Things get a little more complicated for those getting shots for the first time. Here are specifics from the Minnesota Department of Health (your provider or clinic will also know what shots to give you or your child):

• People 5 years of age and older, regardless of previous vaccination, are eligible to receive a single dose of an updated mRNA COVID-19 vaccine after at least two months since their last dose of any COVID vaccine.
• Children 6 months through 4 years of age who have previously been vaccinated are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine. (The timing and number of doses depends on the previous COVID vaccine received.)
• Unvaccinated children 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer COVID-19 vaccine or two doses of the Moderna COVID-19 vaccine.

From now on, experts say, it may be better to think of the COVID shot like the flu shot.

“Don’t think about it by the number of shots anymore,” said Dr. Samreen Vora, an emergency room physician at Children’s Minnesota. “It will be more like when you think about the flu shot, that every year we have to go get it.”

Which vaccines do my kids need to attend school? Are there any we could skip? 

The School Immunization Law in Minnesota requires all students enrolled in grades kindergarten through 12 to show they have received certain immunizations, or to have an exemption. (Here is the list.) Here is how to access your family’s immunization records (they may also be available via an electronic health record such as MyChart). 

Although vaccines for seasonal viruses such as the flu, RSV and COVID are not required to attend school, the experts we interviewed recommend getting the full slate of shots offered.

“I’ve had parents lose jobs because the flu went through their household and they had to be home for a couple of weeks,” Dr. Chomilo said. 

Staying healthy can prevent such situations, he said, as well as prevent learning gaps by keeping children in school—especially because getting paid time off for sickness has changed as the emergency phase of the pandemic ended. 

I’m pregnant. Should I get the COVID booster and the flu shot?

Absolutely, Dr. Vora said. “When you’re pregnant, you’re more vulnerable, and it’s really important for you to be updated,” she said. “If you get COVID and you’re pregnant, you may get significantly sicker, especially with the variants.”

I had COVID in June. When should I get the new booster?

The official recommendation is to wait two months after your last booster and three months after a COVID infection, Dr. Jeffrey Duchin, health officer for Public Health-Seattle and King County (Washington state), said during an Infectious Diseases Society of America media briefing.

“That said, everybody needs to look at their own personal situation,” he said. “If you’re high risk, you would want to get it earlier in that waiting period, but someone who uses a lot of precautions or has a higher risk tolerance maybe will wait a few more months after a natural infection to try to extend their immunity.”

Can I get all three vaccines at the same time?

Yes, said Dr. Jacob. “COVID-19 and other vaccines may be administered at the same time. This includes simultaneous administration of COVID-19 and other vaccines on the same day, as well as co-administration within 14 days.

“It is safe to get the updated COVID vaccine and the seasonal flu shot at the same time, knocking out both shots during the same trip to the doctor or pharmacy in terms of convenience,” he said.

If you’re also eligible for an RSV shot, you can get that at the same time as well. There doesn’t seem to be any evidence that getting multiple shots at the same time increases side effects, Dr. Tina Tan, professor of pediatrics at the Feinberg School of Medicine at Northwestern University in Chicago, said during the media briefing.

“Everybody who has gotten them at the same time says that the side effects are no worse and they’re happy they did that,” she said.

I’m getting married in December. When should I get my shots?

“September and October are ideal times to get vaccinated so that you will be protected when the flu season starts,” said Dr. Jacob. “Flu season typically runs from October to March each year, and your body needs time to build antibodies to the flu virus after you have received your flu shot.

“COVID immunity—both vaccine-induced and disease-induced—starts to wane within 60 to 90 days, depending on how your body reacts, so for a December wedding, you should consider getting your COVID vaccination in October,” he said.

While you don’t need to run out today and get all of your shots, if you’re a one-and-done type of person, get everything you’re eligible for, Dr. Duchin said. 

*CLARIFICATION: This story has been updated to reflect Dr. Nathan Chomilo’s title at the Minnesota Department of Human Services, and to clarify that both the Pfizer and Moderna COVID-19 vaccines are effective.

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