Top US doctors offer updated flu and COVID vaccine recommendations, aiming to ease confusion

Leading U.S. medical groups are urging people to get updated flu and COVID-19 vaccinations this fall, banding together Wednesday to issue shot guidelines — and highlight the science behind them — saying they hope to ease confusion caused by the Trump administration's changing advice.

Flu vaccinations are beginning and COVID-19 shots are starting to arrive after the Food and Drug Administration approved this year’s updated versions last week. Winter also brings another vaccine-preventable risk called RSV. Exactly who should get one or all of these vaccines, and when?

That advice usually comes from the Centers for Disease Control and Prevention, with help from its independent advisers. But despite no new scientific evidence , Trump health officials last year began pulling back on some longstanding recommendations for fall virus protection and routine children's vaccinations. And that advisory panel, which influences state and insurance vaccine policies, is caught in a court battle. The CDC didn't respond to questions about any new fall guidance.

Doctors’ groups are filling the gap: the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and the Infectious Diseases Society of America each released vaccination guidelines for their patient populations.

“There’s been a lot of confusion and chaos regarding vaccine recommendations,” said Dr. Sandra Fryhofer, of the American Medical Association.

The AMA is putting all the groups' recommendations plus evidence on shot safety and effectiveness on a website, SpreadTheFacts.org, so “the public has clear, consistent, science-based guidance even while the federal process is in flux," she said.

Just about everybody starting at age 6 months needs flu vaccination, the medical societies agree. But flu is particularly dangerous for people 65 and older, pregnant women, young children and people of any age who have chronic health problems, including asthma, diabetes, heart disease and weak immune systems. The last two flu seasons were especially harsh, with unusually high numbers of child deaths — the vast majority of them in unvaccinated kids.

The vaccines don't block all flu infections but they do help prevent the worst outcomes, decreasing older adults' hospitalizations by 31%, according to the Vaccine Integrity Project, a public health group based at the University of Minnesota. Its analysis was published Wednesday in the medical journal JAMA.

Three “enhanced” flu vaccines are designed to better protect seniors. The American Academy of Family Physicians urges them to choose one — "but do not delay your vaccination if that one’s not available,” said AAFP’s Dr. Sarah Nosal.

There’s a new choice this year for people ages 50 and older, the first flu vaccine made with the same mRNA technology that was key to ending the COVID-19 pandemic. One study found Moderna's mFlusiva was 27% more effective against symptomatic illness among 50- to 64-year-olds than a standard shot. The FDA just approved the new option and the company expects some doses to be available soon at certain pharmacies.

The shot-averse could choose a nasal spray, FluMist, if they're ages 2 to 49 and meet other health criteria.

COVID-19 shots once were recommended for just about everyone by federal health agencies, but like last year, the FDA has only formally approved them for higher-risk people — those ages 65 and older or younger people with at least one health condition that increases their risk.

Still, the family physicians recommend all adults get a COVID-19 vaccination, especially seniors and those with other risk factors. Adults 65 and older should get a fall dose and then a second dose six months later, as immunity wanes over time, Nosal said.

The American Academy of Pediatrics recommends a COVID-19 shot for all children ages 6 months to 23 months, and for older kids with high-risk conditions. It also supports vaccination for any child whose parent wishes it.

With millions of shots administered, there’s no evidence that coronavirus vaccination during pregnancy increases the risk of miscarriage or other problems, “so please get the vaccine,” said ACOG’s Dr. Christina Davidson.

Depending on age, people can choose a shot from Moderna, Pfizer, or the only non-mRNA version from Novavax and Sanofi.

Just like with flu vaccines, these shots are better at preventing severe disease than mild cases. The Vaccine Integrity Project said last fall’s COVID-19 shots cut the risk of hospitalization by 53% in seniors and slashed emergency room visits for very young children.

Common side effects for flu and COVID-19 vaccines are mild and temporary, such as sore arms, fatigue, headaches, muscle aches, and mild fever. They occurred somewhat more often with the new mFlusiva than with standard flu shots.

While pediatricians and some clinics offer both flu and coronavirus shots, they're most common in pharmacies.

For COVID-19 shots, states have more pharmacy rules. For example, Walgreens says it offers those shots without a prescription in all but two states, Arizona and Oregon, but can provide doses for children as young as 3 in some states while others have higher age limits.

Medicare covers the fall shots and most private health insurers say they plan to continue doing so through 2027.

October is ideal for a flu vaccine, as influenza typically starts spreading in November. COVID-19 tends to rise in late summer, as it is now, and again after the winter holidays. Fryhofer says it’s fine to time the coronavirus shot a few weeks ahead of an event you wouldn’t want to miss because of illness, like a special trip or get-together.

RSV, or respiratory syncytial virus, typically is a cold-like nuisance during the fall, winter and early spring. But it can be severe, even life-threatening, for infants and older adults.

The family physicians recommend a one-time vaccination for adults 75 and older, people 50 to 74 who are at increased risk, or younger people with weak immune systems.

It’s also recommended during late pregnancy to protect infants born during RSV season. Separately, the pediatricians recommend a vaccine-like medication for high-risk infants.

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