The flu shot is as familiar an October ritual as football, foliage and Halloween.
But health officials are urging Americans to get the new flu shot and COVID booster at the same time — the sooner, the better.
“Right where we are now — that’s a good time to be vaccinated,” influenza expert Dr. Lisa Grohskopf of the U.S. Centers for Disease Control and Prevention told the nation’s physicians in a conference call late last week.
That’s ahead of time, by traditional measures. Flu season most often peaks in February, and our levels of protective antibodies are at their highest about two weeks after the shot, then wane over the next four to six months.
Yet this year’s season could start early if it follows the pattern seen elsewhere in the world. So a delay could catch people unprepared.
There’s another concern: People may not want to make two trips to the vaccination clinic, so they may get the new COVID booster but fail to return for the flu.
Is there a perfect time to be vaccinated?
If you have a crystal ball, “it’s 14 days before the flu attacks the community that you’re living in,” said Dr. Darvin Scott Smith, clinical lead for flu vaccination at Kaiser Permanente Northern California, who has already gotten his shot.
Here’s the problem: Nobody knows when that will be.
Nearly four decades of CDC data show that 45% of flu seasons peak in February.
But 18% of the time, the season peaks as early as December. In another 16%, it peaks as late as March. Protection isn’t assured until two weeks after your shot.
Seth Herald/AFP/Getty Images
A sign directing traffic to a drive-through flu shot clinic is pictured in downtown Detroit, Michigan, on Nov. 10, 2020.
“It is impossible to predict the flu season with any accuracy,” said Dr. Kelly L. Moore, president of Immunize.org, a nonprofit group that works to increase immunization rates.
If you want to save time and travel, said Moore, get your flu shot when you get the new COVID booster. It’s safe and will spare you a return trip. There’s no data to show that side effects will be worse.
A flu shot won’t protect against COVID, and a COVID shot won’t protect against flu. The two vaccines are very different.
Children who need two doses of the flu vaccine — those six months through 8 years who have never been vaccinated — should receive their first dose immediately, said experts.
A September shot will create antibodies that can persist long enough to help fend off a later infection, experts said. And even if they don’t, you’ll get less seriously ill than if you weren’t vaccinated at all.
“I’m going to try to get my flu vaccine at the earliest opportunity,” said Dr. Bali Pulendran, professor of immunology at Stanford University School of Medicine. “Even if the durability of the antibody response is just a few months, I should be good throughout the season.”
September also offers a practical advantage: It’s easier to get an appointment. Everyone won’t all be rushing in at once, as could happen once the virus arrives.
October is the optimal time from an immunological perspective, experts said. Like all cells, antibodies die of old age. A Kaiser study found a 16% increase in the odds of catching the flu every additional 28 days after peak protection.
That’s especially true for older adults, who experience a greater waning of protection than younger people.
“Just don’t forget,” said Moore. “When the opportunity arises, get it.”
If you’re not vaccinated by October, it’s not too late. Vaccines help as long as flu viruses are circulating.
Once spring comes, you may be worried about protection. But don’t get a second flu vaccine, said Smith.
Forecasting a flu season is always a challenge. It can vary in different parts of the country. Every year is different.
Because COVID has changed our behaviors, “the old rules — what we knew about when flu starts, when it ends — may not work this year,” said UCSC infectious disease expert Dr. Peter Chin-Hong, who aims to get his shot in mid-October.
“I wouldn’t game the system,” he said. “If the flu has a slow burn, you’ll want it before it peaks.”
There are three reasons to be cautious, said Smith.
Based on this year’s experience in the Southern Hemisphere, flu season could come early. U.S. health officials look to Australian trends for guidance — and cases there started in April instead of the usual June.
It also was a worse season than the two previous years when people were masked and distancing, said Kaiser’s Smith. Behaviors have changed. People are going out more.
Finally, we have less overall immunity to the flu because we’ve been sitting it out for two years, with lower vaccination rates and reduced exposure to the flu virus.
Last year, flu season was mild but ran long. Experts were surprised by a second small peak, with cases jumping in April and May.
Infectious disease trends “are all whacked out,” said Chin-Hong. It’s not just flu — the timing of the common respiratory syncytial virus (RSV), monkeypox and other pathogens have proved startling, he said.
To be sure, flu vaccines are far from perfect. CDC data show that efficacy ranges widely from year to year, falling to 19% in 2014-15 and climbing to 52% in 2013-14. This year’s vaccines are “quadrivalent,” meaning they target four different strains of the flu virus; of these, two are different from last year’s shot.
Circulating viruses may also genetically drift over time, so a vaccine that is well matched in September may be mismatched in March.
Scientists are now striving to build a better flu vaccine, so it’s less critical to time shots perfectly, said Pulendran.
The biggest worry now is not whether the shots are perfectly scheduled — but that people will skip the vaccines altogether, or just forget, said Moore.
“If you sit down at the Thanksgiving table with someone who is sick,” she said, “it’s too late.”
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Should you get your flu shot and COVID booster together? Here’s what experts say
Pfizer via AP
Answer: They're combination or "bivalent" shots that contain half the original vaccine that's been used since December 2020 and half protection against today's dominant omicron versions, BA.4 and BA.5. It's the first update to COVID-19 vaccines ever cleared by the Food and Drug Administration.
Pfizer via AP
Answer: They're combination or "bivalent" shots that contain half the original vaccine that's been used since December 2020 and half protection against today's dominant omicron versions, BA.4 and BA.5. It's the first update to COVID-19 vaccines ever cleared by the Food and Drug Administration.
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Should you get your flu shot and COVID booster together? Here’s what experts say
AP file
Answer: Updated shots made by Pfizer and its partner BioNTech are authorized for anyone 12 and older, and rival Moderna's version is for adults. They're to be used as a booster for anyone who's already had their primary vaccination series -- using shots from any U.S.-cleared company -- and regardless of how many boosters they've already gotten.
AP file
Answer: Updated shots made by Pfizer and its partner BioNTech are authorized for anyone 12 and older, and rival Moderna's version is for adults. They're to be used as a booster for anyone who's already had their primary vaccination series -- using shots from any U.S.-cleared company -- and regardless of how many boosters they've already gotten.
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Should you get your flu shot and COVID booster together? Here’s what experts say
Pfizer via AP
Answer: No. The FDA set the minimum wait time at two months. But advisers to the Centers for Disease Control and Prevention said it's better to wait longer. Some advise at least three months, another said someone who's not at high risk might wait as long as six months.
"If you wait a little more time, you get a better immunologic response," said CDC adviser Dr. Sarah Long of Drexel University.
That's because someone who recently got a booster already has more virus-fighting antibodies in their bloodstream. Antibodies gradually wane over time, and another shot too soon won't offer much extra benefit, explained Wherry, who wasn't involved with the government's decision-making.
Pfizer via AP
Answer: No. The FDA set the minimum wait time at two months. But advisers to the Centers for Disease Control and Prevention said it's better to wait longer. Some advise at least three months, another said someone who's not at high risk might wait as long as six months.
"If you wait a little more time, you get a better immunologic response," said CDC adviser Dr. Sarah Long of Drexel University.
That's because someone who recently got a booster already has more virus-fighting antibodies in their bloodstream. Antibodies gradually wane over time, and another shot too soon won't offer much extra benefit, explained Wherry, who wasn't involved with the government's decision-making.
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Should you get your flu shot and COVID booster together? Here’s what experts say
Pfizer via AP
Answer: It's still important to get vaccinated even if you've already been infected -- but timing matters here, too.
The CDC has long told people to defer vaccination until they've recovered but also that people may consider waiting for three months after recovering to get a vaccination. And several CDC advisers say waiting the three months is important, both for potentially more benefit from the shot and to reduce chances of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.
Pfizer via AP
Answer: It's still important to get vaccinated even if you've already been infected -- but timing matters here, too.
The CDC has long told people to defer vaccination until they've recovered but also that people may consider waiting for three months after recovering to get a vaccination. And several CDC advisers say waiting the three months is important, both for potentially more benefit from the shot and to reduce chances of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.
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Should you get your flu shot and COVID booster together? Here’s what experts say
Pfizer via AP
Answer: That's not clear, because tests of this exact recipe have only just begun in people.
The FDA cleared the new boosters based in large part on human studies of a similarly tweaked vaccine that's just been recommended by regulators in Europe. Those tweaked shots target an earlier omicron strain, BA.1, that circulated last winter, and studies found they revved up people's virus-fighting antibodies.
With that earlier omicron version now replaced by BA.4 and BA.5, the FDA ordered an additional tweak to the shots — and tests in mice showed they spark an equally good immune response.
There's no way to know if antibodies produced by an omicron-matched booster might last longer than a few months. But a booster also is supposed to strengthen immune system memory, adding to protection against serious illness from the ever-mutating virus.
Pfizer via AP
Answer: That's not clear, because tests of this exact recipe have only just begun in people.
The FDA cleared the new boosters based in large part on human studies of a similarly tweaked vaccine that's just been recommended by regulators in Europe. Those tweaked shots target an earlier omicron strain, BA.1, that circulated last winter, and studies found they revved up people's virus-fighting antibodies.
With that earlier omicron version now replaced by BA.4 and BA.5, the FDA ordered an additional tweak to the shots — and tests in mice showed they spark an equally good immune response.
There's no way to know if antibodies produced by an omicron-matched booster might last longer than a few months. But a booster also is supposed to strengthen immune system memory, adding to protection against serious illness from the ever-mutating virus.
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Should you get your flu shot and COVID booster together? Here’s what experts say
AP file
Answer: The basic ingredients used in both omicron-targeting updated vaccines are the same. Testing by Pfizer and Moderna of their BA.1-targeted versions proved safe in human studies and CDC's advisers concluded the additional small recipe change should be no different.
Flu vaccines are updated every year without human trials.
AP file
Answer: The basic ingredients used in both omicron-targeting updated vaccines are the same. Testing by Pfizer and Moderna of their BA.1-targeted versions proved safe in human studies and CDC's advisers concluded the additional small recipe change should be no different.
Flu vaccines are updated every year without human trials.
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Should you get your flu shot and COVID booster together? Here’s what experts say
AP file
Answer: Yes, one in each arm.
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Should you get your flu shot and COVID booster together? Here’s what experts say
AP file
Answer: People at high risk from COVID-19 are encouraged to get the new booster when they're due. After all, BA.5 still is spreading widely and hospitalization rates in older adults have increased since spring.
Most Americans eligible for an updated booster have gone at least six months since their last shot, according to the CDC — plenty of time that another shot should trigger a good immune response.
But the original formula still offers good protection against severe illness and death, especially after that all-important first booster. So it's not uncommon for younger and healthier people to time boosters to take advantage of a shot's temporary jump in protection against even a mild infection.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
AP file
Answer: People at high risk from COVID-19 are encouraged to get the new booster when they're due. After all, BA.5 still is spreading widely and hospitalization rates in older adults have increased since spring.
Most Americans eligible for an updated booster have gone at least six months since their last shot, according to the CDC — plenty of time that another shot should trigger a good immune response.
But the original formula still offers good protection against severe illness and death, especially after that all-important first booster. So it's not uncommon for younger and healthier people to time boosters to take advantage of a shot's temporary jump in protection against even a mild infection.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
