Flu, COVID-19, RSV: What you need to know about vaccinations before the start of respiratory season

As the school year begins and the threat of outbreaks of respiratory viruses such as COVID-19, influenza, and respiratory syncytial virus (RSV) looms, many people are wondering how to stay healthy. CNN publishes advice from doctors on when and how to get vaccinated.

Typically, at this time of year, the US Centers for Disease Control and Prevention (CDC) launches its fall campaign recommending seasonal vaccinations, including the flu and COVID-19 vaccines. However, under the second Trump administration, the agency has remained largely silent this year.

The CDC has not issued new RSV immunization or COVID-19 vaccination recommendations for this season. Last year, the agency updated its COVID-19 vaccine recommendations, stating that patients should consult with a healthcare professional to receive the vaccine.

On the subject: The US has reduced the list of mandatory vaccinations for children.

On Tuesday, September 1, the agency updated its clinical recommendations for influenza vaccination, reiterating last year's guidelines and stating on its website that the seasonal influenza vaccination recommendations from the July 2025 immunization schedule remain in effect for the 2026-2027 season. The update does not mention the first mRNA influenza vaccine, which was approved by the U.S. Food and Drug Administration (FDA) last month for use in older adults.

To fill the void, the American Medical Association and the University of Minnesota's Vaccine Integrity Project launched their own independent reviews of fall vaccines, including those for influenza, COVID-19, and RSV. These reviews were published on September 2 in the medical journal JAMA.

"For more than 60 years, the United States benefited from a robust federal system for evaluating vaccine science and translating that data into recommendations for the public. At the core of this system was the Centers for Disease Control and Prevention and its Advisory Committee on Immunization Practices (ACIP)," said Dr. Bruce Gellin, chair of the Vaccine Integrity Project and professor of medicine at Georgetown University. "Unfortunately, the federal government is not fulfilling this function as it historically did. But the need for this work remains. Influenza, SARS-CoV-2, and RSV will circulate again this fall and winter."

"Clinicians will still treat patients. Parents will still make decisions for their children, and the elderly, pregnant women, and people with chronic conditions still need to understand how to best protect themselves," he noted. "We cannot allow the destruction of the federal healthcare system to create a vacuum in evidence-based vaccination recommendations."

The guidelines determine which vaccines are recommended for which groups and when the best time to get vaccinated is.

Flu and RSV vaccines are already available in major pharmacy chains, and updated COVID-19 vaccines were recently approved by the FDA and are gradually becoming available.

"What's especially encouraging is that insurance companies have informed primary care providers that they will cover these vaccinations," noted Sarah Nosal, president of the American Academy of Family Physicians. "Federal recommendations are changing, but the scientific basis for vaccination remains strong. These recommendations are based on the latest data, developed by public health experts, and reflect the experience of family physicians who see patients every day."

Immunization against RSV

Who should get vaccinated?

Groups recommended for RSV immunization include the elderly, pregnant women, and infants.

"High-risk individuals aged 50 and older, as well as everyone over 75, should receive one dose," Nosal said. "This is not an annual vaccine. If you've already received it, you don't need a booster this year. One dose protects throughout the season."

During pregnancy, RSV vaccination is recommended in the third trimester, between 32 and 36 weeks.

According to Dr. Andrew Racine, president of the American Academy of Pediatrics, RSV prophylaxis with a monoclonal antibody is recommended for children under 8 months of age if their mother did not receive RSV vaccination during pregnancy.

If the mother's immunization status is unknown, the child should be given prophylaxis, Racine added. Children aged 8 to 19 months who belong to certain high-risk groups for severe disease are also recommended to receive a monoclonal antibody against RSV.

It is noted that one dose of the RSV vaccine is recommended for adults with a weakened immune system.

"People with immunodeficiency are at higher risk of severe disease than people with normal immune status," said Dr. Dan Baruch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center. "Furthermore, vaccines are generally less effective in these patients."

When to get vaccinated

For older adults, RSV vaccination is usually recommended in late summer and early fall.

For pregnant women, the recommendation has changed slightly this year.

"The American College of Obstetricians and Gynecologists now recommends that pregnant women receive one dose of the maternal RSV vaccine Abrysvo between September 1 and March 1, instead of the previous window of January 31," said Dr. Christina Davidson, chief medical officer of the American College of Obstetricians and Gynecologists.

"This change is due to the RSV season now occurring later in the spring and becoming more severe than before. Extending the vaccination period will provide additional protection to pregnant women and their children," Davidson noted.

For infants, monoclonal antibodies against RSV are usually administered during the virus circulation season - from October to March.

Seasonal influenza vaccination

Who should get vaccinated?

An annual flu shot is recommended for all people over 6 months of age.

“On average, flu vaccines reduce the risk of visiting a doctor by 30%–60%,” Nosal argued.

"People 65 and older should receive the boosted vaccine—high-dose, adjuvanted, or recombinant—when it's available," she explained. "But don't delay vaccination if that specific version isn't available."

For the first time, an mRNA influenza vaccine is available for adults over 50.

The flu vaccine is recommended during pregnancy, however, pregnant women should avoid the nasal form of the vaccine.

"Pregnant women and women who have recently given birth still face a significantly higher risk of severe complications from infection than non-pregnant women," Davidson warned.

"Inactivated or recombinant influenza vaccines remain the only ones recommended during pregnancy at any stage, so be sure to discuss vaccination with your doctor or pharmacist," she added. "And most importantly, if you can get vaccinated during pregnancy, some of the immunity is passed on to your baby."

When to get vaccinated

October is considered the optimal time for vaccination, Nosal noted, since protection gradually declines throughout the season.

Some doctors are using the slogan "flu shot before Halloween" to remind people to get one before the end of October.

Updated COVID-19 vaccines

Who should get vaccinated?

The updated COVID-19 vaccine is recommended for adults.

"If you are over 19 years old, we recommend the COVID-19 vaccine," Nosal said.

"This is especially important for people over 65, those at high risk for severe infection, and those who have never received a COVID-19 vaccine," she explained. "For people over 65, a second dose of the updated vaccine is recommended six months after the first dose this season to maintain protection as immunity declines."

The vaccine is also recommended for children aged 6 to 23 months, as well as for children from risk groups or in cases where parents decide to vaccinate.

For people with immunodeficiency, an annual updated COVID-19 vaccine is recommended for ages 6 months and older.

Last year, the CDC recommended COVID-19 vaccination through a shared decision-making approach between the patient and the doctor, Baruch noted, but the agency emphasized that the risk-benefit ratio was most favorable for people in high-risk groups.

ACOG's Davidson confirmed that the vaccine is recommended during pregnancy.

"Most importantly, if you are pregnant, planning to become pregnant, have recently given birth, or are breastfeeding, please get vaccinated or get your annual booster. All four available COVID vaccines are safe," Davidson assured.

Moderna has two mRNA vaccines, Pfizer and BioNTech have another, and Sanofi and Novavax have a more traditional protein version.

"The COVID vaccination recommendation is based on more than five years of research and millions of doses administered," Davidson stated. "I want to emphasize that studies have not found an increased risk of miscarriage, stillbirth, preterm birth, fetal growth restriction, or congenital defects. On the contrary, the risks of complications from COVID for pregnant women and their babies are high. So please get vaccinated."

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When to get vaccinated

The updated vaccine is recommended for administration now, but if a person has recently had COVID-19, experts advise waiting four to six months before vaccination.

The updated COVID-19 vaccine "targets the most recent circulating strains, so it's the best way to update protection," said Dr. Sandra Adamson Freihofer of the American Medical Association.

"Your computer constantly needs updates. So does your immune system," she said, giving an example. "The greatest protection is developed in the first few months after vaccination. Therefore, if you have an important event coming up—a wedding, a trip, a birthday, or just a social gathering—it's worth considering getting vaccinated a couple of weeks beforehand to ensure maximum protection."

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