Flu, COVID, RSV: What you need to know about vaccines this autumn

[MUSIC PLAYING] INTERVIEWER: With kids back and school underway and cooler weather, cold and flu season will be here before you know it. And today, we're learning that the upcoming COVID-19 booster is expected to be available as early as next week.

There are a few other vaccines you might want to roll up your sleeve for too. CVS is announcing today that it will carry the new RSV vaccine for those over the age of 60, Walgreens will as well. And then, of course, there is the flu shot. That's a lot to keep track of to stay healthy.

So here to help us navigate this upcoming virus season is Dr. Mark Schleiss, Professor of Pediatrics with a specialty in infectious disease at the University of Minnesota Medical School. He's also on staff at Children's Minnesota. Doctor, welcome to the program.

MARK SCHLEISS: Thank you so much. It's great to be here with you this morning.

INTERVIEWER: Thanks for taking the time. Say, let's start with the COVID vaccines. What is this new vaccine formula targeting specifically?

MARK SCHLEISS: Yeah, so the new vaccines that were really contemplated last spring were focused on the knowledge that we have constant emergence of new variants of COVID-19 virus. And so the new vaccines were designed to target the XBB. 1 strains.

Now what happened over the course of the summer and early fall is we've seen changes from those strains to new variants. But it turns out that the XBB. 1 variant that was used to design the updated vaccine induces antibodies that are perfectly good at neutralizing the new variant.

The new variant is the so-called BA. 2.86 variant. It also has gone by the nickname Pirola. And great news just in the last couple of days is that the vaccine update, the updated immunization, will provide some protection against the new variant.

So I feel really encouraged and really hopeful that we will see augmentation of protection in those that need boosters. And of course, we need to be mindful that there are many people who haven't been immunized at all who should receive COVID vaccine as well.

INTERVIEWER: Well, let's start with those who might have gotten at least one vaccine or a couple. It's been a while and it's confusing to remember how many have I had, how many am I supposed to have. So remind folks the guidelines of who should be getting the booster, maybe even additional doses.

MARK SCHLEISS: Yeah, it's very simple. Everybody should be getting the new booster variant irrespective of how many vaccines you've had in the past. So everybody is a candidate for updated immunization with the new booster variant.

Now, there are some individuals who have one or two previous immunizations. Some older individuals may have had as many as four or even five immunizations. But essentially everyone is a candidate and should receive the new variant vaccine this fall.

INTERVIEWER: OK, in terms of timing, you said fall. Now it's the 6 of September. What is the most advantageous timing? Would it be early October and then take a flu shot with that?

MARK SCHLEISS: Well, so the answer is that people need to wait about six or seven days. That's how soon it will be available. It will be out next week. There are those who say, well, flu, flu doesn't really begin to hit its peak until mid winter, December, January. Maybe I should delay getting my flu shot until it's a little bit closer to flu season. And that way I'll be sure to have a good strong response with no waning immunity.

My answer to that is seize the day, right? And we're Minnesotans. We don't let the perfect be the enemy of the good. If you have an opportunity to get a flu shot next week, do it because you never know what's going to happen a month from now.

The best laid plans of mice and men often go awry. And you may plan to get the perfect flu immunization on November 2 and something may happen and you just can't. So I would say seize the opportunity now. Go in and get your flu shot and your COVID booster. And if you're over the age of 60, get your RSV vaccine as well.

INTERVIEWER: Oh, thanks for bringing that up. I was just going to ask about the RSV vaccine. What do you know about it?

MARK SCHLEISS: Well, the RSV vaccine has been something that's been something of the Holy Grail for immunization design for 50 years. The first generation RSV vaccines dating back to the 1970s were fraught with different kinds of issues, and it really was a major breakthrough in vaccinology to decipher the confirmation.

We talk about the confirmation of the viral envelope glycoprotein. What that means is that we now understand how to recapitulate the structure of the protein in the immunization, in the shot itself to induce an antibody that will neutralize the virus. Major scientific breakthrough just in the last three or four years. And that's now been translated into two new licensed vaccines for RSV.

Both should be received-- one or the other should be received for individuals over the age of 60 and one of these vaccines is actually approved for pregnant patients now as well. And so it's recommended that during pregnancy, sometime between 32 and 36 weeks, you should receive an RSV vaccine.

And why is that? The major issue here is that RSV fills up children's hospitals in the winter months. It's the single most common reason for hospitalization in a young infant. Babies in the first six or eight weeks of life are very vulnerable to RSV. If you can immunize the pregnant individual before delivery, then that newborn infant will have a chance for a better outcome.

Individuals over the age of 60 is estimated that there are about 10,000 deaths a year in the United States in elderly individuals from RSV. And so in addition to being the leading cause of hospitalization for young children, it's actually an underreported and underrecognized cause of mortality in older adults too.

So that's why this niche has been carved out for the first wave of RSV immunization, older folks over the age of 60, pregnant patients. And it's really a very, very exciting development and vaccinology, probably one of the most exciting things we've seen in many, many years.

INTERVIEWER: So I know that vaccine uptake is low. I believe in Minneapolis, gosh, nearly 40% of kids are not up to date on their required vaccines and adults uptake is probably not that great either. So do you have worry of hospitals filling up with folks with RSV and COVID and flu this winter?

MARK SCHLEISS: Well, of course. And of course, the truth is that that happens every winter. So I don't know that any of this is unprecedented. What we've seen in recent years largely driven by the COVID pandemic is an increased recognition of the importance of testing, home testing kits. And this is good. I mean, the more knowledge you can have about your health status the better.

But some of what, I think, drives these discussions about hospitals filling up is really just better recognition of the circulation of these viruses. We know that these are going to be winter viruses that cause a lot of respiratory tract disease. And that's why I think it's so important for people to get immunized and to get their kids immunized.

Less than 10% of Minnesota children that are eligible for COVID vaccine in young children, school-aged children have received one. And the same thing for parents. We have to recognize that the decision to immunize yourself against COVID-19 or influenza is not just about you.

It's about the people you love, it's about the people you live with, it's about the people you care for, the elderly people in your life, the young children, perhaps the vulnerable child who has asthma or diabetes or is being treated for a chronic disease.

And so I look to the licensure of these new vaccines as an exciting development that we can all get behind and say yes, yes, let's do this. Let's use our knowledge and our expertise to improve people's health. And so I look for an uptick in not only these new vaccines, but in other vaccines, as you allude to.

We need to make sure people are up to date with their measles shots, with their chickenpox vaccination, with whooping cough, which is still a persistent problem in underimmunized populations. And so all of these vaccines are very exciting opportunities to improve not only your health, but the health of the people you love.

INTERVIEWER: You did a good job explaining the importance of each of these vaccines. And I'm wondering, getting back to the timing of receiving the vaccines, what if someone had COVID within the last couple of months? Might they want to wait to get vaccinated?

MARK SCHLEISS: Yeah, I mean, I understand those issues. And I think that there is a room for legitimate differences of opinion about this question. As I said earlier, I believe in seizing the opportunity, seizing the moment. And I view any delay in an opportunity to immunize yourself against any of these infections as a wasted opportunity.

There's no biological or scientific reason to believe that if you had COVID a month ago or six weeks ago or two months ago, that you would be less likely to receive benefit from an immunization. We'd like to not vaccinate people if they're sick and that's been true for decades. If you go into the pediatrician's office and your child is ill, we usually defer immunizations.

But even that is not really a scientific decision. That's a decision driven more by fear of confusing the issue if a child's in the middle of a febrile illness. It doesn't have anything to do with the biology of your immune system.

The human immune system is an amazing thing and the ability to respond to so many diverse different kinds of what we call epitopes in proteins is virtually infinite. And that's why I always sort of feel bad when people say we're going to overwhelm the immune system with too many vaccines at once. That's actually biologically not even a plausible viewpoint.

And so I appreciate your question and I think people have to make their own decisions with things that they feel comfortable with. But from a medical and biological basis, there's no reason to delay.

And as I alluded to, you can wait and wait and wait for the perfect moment to time that flu shot, but we don't know, we don't know if the flu season it's going to hit this year in November, or if it's going to hit in January, or if it's going to hit in March. We see that much of a variability from year-to-year in the timing of these winter outbreaks.

And so I'm a firm believer in the idea of seize the day, take advantage of the opportunity. If you can get vaccinated tomorrow, do it. If you're at the state fair, which just ended Monday-- but I always encourage people get your shot, get your flu shot when you're at the state fair because it's an opportunity. And why waste that opportunity waiting for the perfect moment when you can do a good thing that will improve your health in the moment?

INTERVIEWER: All right, doctor, I appreciate your time. Thank you so much.

MARK SCHLEISS: My pleasure. And thank you for having me on and thank you for the discussion about vaccines.

INTERVIEWER: Dr. Mark Schleiss has been with us, a professor of Pediatrics at the U of M Medical School. He's also on staff at Children's Minnesota.