Can COVID, Flu, and RSV Shots Be Given at the Same Time?

Many adults ages 60 and up will be eligible for three vaccines this fall -- a COVID booster, the flu shot, and the new respiratory syncytial virus (RSV) vaccine -- so the big question is, can they get them all at once?

Since there are no data on giving this trio of vaccines at the same time, most experts advise a different strategy.

Take flu and COVID together, they told MedPage Today. The CDC endorses this, as there's evidence and experience that people can take this combination just fine.

There's also some evidence from the clinical trials of the two RSV vaccines that it's okay to give flu and RSV shots together, said William Schaffner, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, who is also a spokesperson for the Infectious Diseases Society of America (IDSA).

But Schaffner told MedPage Today that some practitioners may be "a little bit more cautious about giving RSV along with the others," and there "may not be too many people who want to get all three at the same time."

"If there's one [shot] that doctors might want to treat separately, it might be this newbie [RSV], because there simply hasn't been that much experience with it," he said.

It's a single-dose vaccine, so that means seniors would need just two appointments this fall: one for COVID and flu, and the other for RSV.

Schaffner and other experts recommended getting the RSV vaccine at least 2 weeks on either side of the COVID and flu combination, and getting the RSV shot as soon as possible, since it's currently available, and since its protection is likely to sustain through the entire winter and RSV season.

"We can start giving this right now because it's supposed to, according to the data, provide substantial long-term protection through at least one RSV season, and maybe longer," Schaffner said. "It looks as though there is indeed longer-term protection than we get with flu or COVID [vaccines]."

That said, it's OK to give all three at once if that is the only opportunity to do so, said Aaron Glatt, MD, of Mount Sinai South Nassau in Oceanside, New York, who is also a spokesperson for IDSA.

"We don't have a ton of data, but if someone is really that sick, I'd want them to get all those vaccines," Glatt told MedPage Today. "The problem with waiting is, will they get the vaccine? If they need three visits to the doctor, how many people are willing to do that?"

Unlike the second dose of the original COVID vaccine, experts didn't seem concerned about similar side effects with the RSV vaccine.

Currently, there are two RSV vaccines approved for people ages 60 and up: one from Pfizer (Abrysvo) and one from GSK (Arexvy).

Trials did turn up signals that physicians should keep an eye out for, including Guillain-Barré syndrome, which occurred in trials of both vaccines and was likely related to vaccination, according to the FDA and trial investigators. In addition, for Arexvy, atrial fibrillation within 30 days was reported in 10 vaccine recipients versus four placebo patients.

"Of course you're giving [the vaccine] to a very high-risk population," Schaffner said. "Older persons are the ones who get [atrial fibrillation], but that will be looked at very carefully going forward."

CDC's Advisory Committee on Immunization Practices (ACIP) didn't give a blanket recommendation that every 60-year-old should get the RSV vaccine. Instead, the group recommended shared clinical decision making for adults 60 and older, noting that those in this age group at highest risk for severe disease include those with chronic conditions such as lung diseases, heart failure and coronary artery disease, immunocompromise, and other conditions.

"Not every 60-year-old needs to get this vaccine," said Glatt. "I would definitely give it to a 62-year-old with lung disease. I wouldn't give it to a 72-year-old who's perfectly healthy otherwise. But if they want to get it, no problem."

ACIP has yet to weigh in on recommendations for fall COVID boosters, though experts expect that they will be strongly recommended for at-risk groups, including older people.

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