COVID; Prevention

Flu, COVID, and RSV vaccines: Who should get them and when

COVID; Prevention

Everyone 6 months and older should get an annual flu shot. Reformulated COVID-19 vaccines and the new RSV vaccine are also available.

September and early October in North Texas can still feel like the dead of summer, but there are plenty of signs that fall is in the air. Kids are back in school. Football is in full swing. Halloween candy is on store shelves.

And reminders to get your flu shot are everywhere.

This season, though, vaccines designed to prevent serious illness from influenza (flu), COVID-19, and RSV – the trifecta of respiratory viruses – are all available.

And many people are wondering: Which ones should I consider for myself and my family?

The answer depends on several key risk factors:

  • Age: Older patients are more susceptible to infection and serious illness from respiratory diseases.
  • Overall health: If you have an underlying condition such as heart disease, diabetes, obesity, or chronic lung disease, or a weakened immune system, these vaccines may be even more important for your health.
  • Environment: Respiratory viruses thrive in crowded, indoor spaces, so where you live, work, or spend most of your time can increase your risk of exposure. And depending on your health, it also can increase your risk of severe illness. Also, if you live with an infant, older adult, or someone with chronic illnesses, getting vaccinated will reduce their risk of infection.

Vaccines may not prevent illness entirely, but they can curtail how sick you get if you are infected. Getting the flu shot, for example, can decrease illness severity by 40% to 70% and can even reduce the risk of having a heart attack. For some people, that could be the difference between life and death.

With the impending triple threat of flu, COVID, and RSV, we are urging everyone to get vaccinated against the flu and follow the CDC's recommendation that everyone 6 months and older receive the reformulated COVID-19 vaccine, which was recently approved by the FDA to provide protection against Omicron subvariants.

Talk with your health care provider about whether you should get the new RSV vaccine.

Related reading: 5 vaccines adults should consider


According to the Centers for Disease Control and Prevention (CDC), the flu put about 650,000 people in the hospital during the 2022-23 flu season and caused approximately 58,000 deaths. The flu vaccine can lower your risk of getting the flu and having serious illness and needing to go to the hospital.

Who should get a flu shot?

It’s recommended that everyone 6 months or older get an annual flu shot. People older than 65 should request the high-dose flu vaccine that offers even more protection.

The flu shot is safe during any stage of pregnancy, and it’s one of the best ways to protect yourself and your newborn. Pregnant women who get a flu shot pass along the antibodies that protect against the virus to their newborns, which is important because babies aren’t eligible for a flu shot until they are 6 months old.

This year for the first time, the CDC says people with an egg allergy can get any flu vaccine, regardless of how severe their allergy is. While most of the vaccines still contain a small amount of egg protein, the chance of a severe allergic reaction is highly unlikely.

Related reading: Where and how to get a flu shot at UT Southwestern

What types of influenza does this year’s vaccine protect against?

It's not unusual for a patient to tell us, “I got the flu shot last year, but I still got the flu.” That can happen because strains of the influenza virus are constantly changing, so flu vaccines are updated every year. Experts monitor the flu virus as it moves across seasons and hemispheres to select which strains to include for the upcoming season.

This year’s flu vaccine is designed to protect against four strains: two influenza A viruses (H1N1 and H3N2) and two influenza B viruses.

It’s possible for the influenza virus to mutate between the time the vaccine was created and when the flu season begins. Even when there is a mismatch, the mutations are typically still related to the strains in the vaccine, so getting a shot can offer some protection against the flu.

When should I get the flu shot?

The ideal time to get the shot is in late September or October, so it can carry you through the entire flu season. Pregnant women might want to consider getting a flu shot earlier, depending on their due date and whether the vaccine is available. This allows antibodies passed to babies to last throughout the flu season.

COVID spike protein
The reformulated COVID-19 vaccines are expected to provide added protection against Omicron subvariants.


The nation’s three-year public health emergency may have ended in May, but the virus that causes COVID-19 is still circulating and leading to hospitalizations and deaths. COVID appears to be mutating faster than influenza, which is why booster doses of the vaccine have become necessary to shore up protection against the virus.

On Sept. 11, 2023, the U.S. Food and Drug Administration (FDA) approved the updated COVID-19 mRNA Moderna and Pfizer vaccines. On Sept. 12, the CDC’s Advisory Committee on Immunization Practices recommended them for everyone 6 months and older.

Who should definitely get a COVID booster?

People who are 65 or older or who are immunocompromised – and have not been vaccinated within four to six months – should get the reformulated COVID vaccine. So should other individuals who haven’t been vaccinated in the last year.

People who work in medical facilities or group living communities such as nursing homes, assisted living centers, or housing cooperatives should consider the new booster. It’s also recommended that pregnant women get it.

If you do not fall into any of these groups, talk to your health care provider about whether the new COVID booster could be beneficial for you. Find a vaccination site near you.

Which COVID variant does the current vaccine protect against?

The newest COVID booster, which is expected to be available in mid-September 2023, is a monovalent vaccine that specifically targets the Omicron subvariant XBB.1.5. This subvariant has been the main circulating subvariant for the past several months.

Meanwhile, the Omicron subvariant known as EG.5, or Eris, is gaining ground, accounting for about 20% of cases. The good news is that the updated vaccine is expected to provide some protection against this variant, as well as BA2.86 (Pirola).

When should I get a COVID booster?

The COVID booster isn’t tied to a specific time of year. Instead, it depends on when the new booster dose comes out and how long it has been since your last COVID shot. Talk to your health care provider about if and when you should get it.


As many as 10,000 older adults in the U.S. die due to respiratory syncytial virus every year, and it’s the leading cause of hospitalization for infants. This year saw the approval of the first tools to prevent severe RSV infections in our youngest and oldest patients.

Who should get an RSV vaccine?

In May 2023, the FDA approved two vaccines (Arexvy and ABRYSVO) to protect against RSV in adults 60 or older. Then in August, it ruled that ABRYSVO could be given to women between 32 and 36 weeks of pregnancy to protect their newborns.

In July, the FDA approved a monoclonal antibody therapy to protect infants and toddlers. Vaccines teach the immune system to produce antibodies against a disease, while monoclonal antibodies provide an infusion of prefabricated antibodies.

The CDC recommends that all infants younger than 8 months at the start of RSV season should get the monoclonal antibody therapy. Children 8-19 months also should get the shot if they have an increased risk for severe disease, including if they are immunocompromised or have a preexisting lung condition.

Infants whose mothers received the RSV vaccine during pregnancy do not need to get the monoclonal antibody therapy, because they will already have the antibodies in their system.

When should I get the RSV vaccine?

If you are 60 or older, get the vaccine before RSV season starts, which typically is October. It is safe to get shots for RSV and the flu at the same time.

Because the vaccine is new, we’re still figuring out how long its protection lasts. Early evidence suggests it may last beyond a single RSV season, but you’ll need to talk to your health care provider about whether you need to receive another vaccine next year.

Additional protections against flu, COVID, RSV

Between work, social activities, and kids being back in school, it’s almost impossible to avoid exposure to the flu, COVID, and RSV entirely.

But reinforcing good hygiene habits can add protections.

  • Wash your hands frequently with soap and water for at least 20 seconds each time.
  • Cover coughs and sneezes with a tissue or shirtsleeve.
  • Don’t share drinking glasses or silverware.
  • Clean and disinfect high-touch surfaces, such as doorknobs, phones, and toys.
  • Avoid contact with people who have coldlike symptoms.
  • Try not to touch your face, mouth, or eyes.
  • Stay home as much as possible when you or your children are sick.
  • Wear a mask if you have symptoms and must be around people.

If you do begin experiencing symptoms of a respiratory virus, get tested – getting a COVID test at a medical facility such as UT Southwestern Medical Center allows us to gather data about which variants of the virus are circulating in our area, but rapid home tests are widely available as well. UT Southwestern and most retail pharmacies also have tests that check for COVID and influenza, which would be helpful in determining treatment options.

If you have symptoms of the flu, RSV, or COVID, call 214-645-8300 or request an appointment online.