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The time of year in which the flu season collides with COVID-19 activity in the United States is quickly approaching. But luckily, you have tools to protect yourself as an immunocompromised patient: the new bivalent COVID-19 booster shot, updated in an effort to guard against newer variants, and your annual flu shot.  

While the spread of COVID-19 has become more manageable and predictable since its onset, the disease is still taking its toll and causing imaginable hardship for many.  

This summer, COVID-19 has caused the death of 40,000 Americans, per The New York Times — and while hospitalizations are shrinking (they’ve declined by 14 percent over the past two weeks), more than 400 deaths are still reported per day on average. That’s more than twice the daily deaths seen in a high-activity flu season.  

As the spread of COVID-19 and the seasonal flu coincide, it’s important to take every step available to you to protect yourself. A key part of that: Staying up to date on your vaccines.   

How to Time the COVID-19 Booster and Flu Shot

Now that you have two vaccines on your to-do list, let’s start with the timing for the flu shot.  

Signs for the flu shot typically go up in pharmacies in August, but if you haven’t gotten yours yet, don’t worry: Many experts recommend getting your flu shot in October so the protection lasts through the months of February (when flu usually peaks in the United States), March, and April.  

“August and September really are too early to get the flu shot,” says William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center. “Rather, aim for some time in October or drifting into those first couple of weeks in November, before Thanksgiving. That’s when we should all make time to get our flu vaccine.”  

If, for whatever reason, you can’t get your flu shot until later in the season, don’t abandon it altogether. It can still offer protection during the flu activity later in the season. 

“If you find yourself in December without a flu shot, run — do not walk — to get your flu vaccine,” says Dr. Schaffner. “It’ll take about 10 days for it to have its full effect.” 

Secondly, consider the new COVID-19 bivalent booster: The U.S. Food & Drug Administration (FDA) authorized bivalent formulations of the vaccines (bivalent means a vaccine works by stimulating an immune response against two different antigens) for use as a single booster dose at least two months after a primary or booster vaccination. Just as with the flu shot, now is a great time to get your latest COVID-19 booster. 

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” FDA Commissioner Robert M. Califf, MD, said in a statement. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.” 

Boosters will give you more protection heading into the colder months, especially if you’re immunocompromised. And as we’ve seen in previous years, COVID-19 activity may very well tick up this fall and winter. 

“If you skip the vaccine, you and your loved ones are at higher risk for infection and complications,” says Richard Zimmerman, MD, Vice Chair for Preventive Medicine Research at the University of Pittsburgh. “I would seek a COVID-19 bivalent booster as soon as possible.” 

It’s important to get both shots, because the flu shot does not provide protection against COVID-19 (and vice versa). You can get both the flu shot and the COVID-19 booster at the same time to save yourself an extra trip to the pharmacy.  

If you’ve been infected with COVID-19 recently, the U.S. Centers for Disease Control and Prevention (CDC) recommends waiting 90 days before you receive a booster shot for a better immune response. Reinfection is less likely in the weeks or months after infection. That said, certain factors like personal risk of severe disease or local COVID-19 spread could be reasons to get a booster as soon as you’re eligible to, per Yale Medicine. If you have questions about timing your COVID-19 booster, talk to your doctor.   

Potential Side Effects of the COVID Booster and Flu Shot

According to the FDA, commonly reported side effects of the bivalent vaccine are similar to what you might experience with the flu shot, including:

  • Pain, redness, and swelling at the injection site
  • Fatigue
  • Headache
  • Muscle pain
  • Joint pain
  • Chills 

However, the chance of experiencing side effects after receiving both shots at the same time is similar or only slightly higher than when receiving the COVID-19 vaccine alone, per research presented at a CDC Advisory Committee on Immunization Practices (ACIP) meeting.  

“It’s perfectly okay to get them both, though you may get two sore arms for a day or so,” says Dr. Schaffner.  

If you’re concerned about that, you may opt to get your COVID-19 booster and flu shot a day or two apart. However, you should only do this if you can commit to returning to the pharmacy for your second vaccine.  

“There’s an old adage that the vaccine deferred is often the vaccine never received,” says Dr. Schaffner. 

If you opt to get both vaccines at once, your clinician will likely opt to give one shot in each arm (rather than doubling up on one arm). “You can get them in the same arm, but then they have to be separated by an inch or inch and a half,” says Dr. Schaffner. “Most inoculators would prefer to give one in each arm — they think that’s more secure.”   

The shots need this separation to avoid the vaccines interfering with each other in the immune cells that are in and beneath the skin. Injecting them an inch or so apart helps the immune system “see” each vaccine separately and respond optimally to it.  

How the New COVID-19 Booster Is Different

The CDC recommends getting the updated COVID-19 bivalent booster from Pfizer (for those ages 12 and older) or Moderna (for those ages 18 and older). Although these booster shots are from Pfizer and Moderna, you can still receive them if you got a Novavax or Johnson & Johnson primary series. 

“I have already received the bivalent COVID booster, as has my wife and two of our children,” says Dr. Zimmerman. 

Also known as “updated boosters,” the bivalent COVID boosters contain the original SARS-CoV-2 strain and another strain common between the BA.4 and BA.5 lineages of the omicron variant, per the FDA. The Ba.4 and Ba.5 lineages of the omicron variant are causing the most COVID-19 cases in the U.S. right now and are predicted to circulate the fall and winter. 

The current vaccine formula is an effort to help restore protection that may have waned since your last vaccination and to target variants that spread and evade immunity more easily. More research will be needed to confirm how these boosters perform differently in real-world settings than the original vaccine, but for now, many experts agree that these boosters are most important for those at high-risk for severe COVID-19 infection.  

The original Pfizer and Moderna vaccine formulations can no longer be used as boosters, though they’ll continue to initiate the vaccination series for those who haven’t received a jab yet, per The University of Texas Medical Branch 

It’s worth noting that in a recent opinion piece for the The Wall Street Journal, FDA Vaccine Advisory Committee member Paul A. Offit, MD, said it makes sense to boost those at greatest risk of hospitalization with COVID-19 — but that experts should be careful about overselling the bivalent vaccine as something better than the existing vaccine until more data are available.  

In other words, the new COVID-19 booster shot isn’t a cure-all for managing the spread of the virus this winter and may not be necessary for everyone. However, if you’re immunocompromised, it can be one more important tool in your arsenal to protect yourself.  

“Once we all go indoors in the winter and it gets chilly, we do expect COVID-19 to surge again — not nearly the way it has in the past, but there will probably be an upswing this winter,” says Dr. Schaffner.  

Why the Flu Shot Is Important

Everyone who is six months of age and older should get an influenza (flu) vaccine every season, with rare exceptions, per the CDC. Vaccination is especially important for those who have a greater risk of developing serious flu complications, which includes people with a weakened immune system due to disease or medications, adults 65 years and older, and those who are pregnant.  

“My family is vaccinated every year to protect ourselves and to protect our loved ones,” says Dr. Zimmerman. “We have a family member with cancer and none of us wants to be the one to bring the flu to them. If you skip the vaccine, you and your loved ones are at higher risk for infection and complications.” 

For this flu season, the CDC and ACIP have recommended particular types of flu vaccines for those ages 65 years and older that may be more effective. “Seniors should receive a second-generation vaccine, such as Flublok, Fluad, or high-dose Fluzone,” says Dr. Zimmerman. “These vaccines appear to work better in seniors than do older, standard vaccines. They induce a stronger immune response against the virus.” 

It’s true some medication may impact how well the flu shot works, but that doesn’t mean you should skip it or stop taking your meds to get it. If you are unsure about when to get the flu shot with your current treatment, talk to your rheumatologist or pharmacist.

It’s difficult to predict the severity of an upcoming flu season, but data from the southern hemisphere (which had its winter during our summer) shows that flu activity may be high this season. 

“Australia had a moderately severe flu season,” says Dr. Schaffner. “There’s not always a correlation, but if there’s anything that gives a note of caution, that should be it — and should, if we need more motivation, give us resolve to get immunized against influenza.”   

Other Precautions to Take if You’re Immunocompromised

Both the flu and COVID-19 can coincide with pneumonia, an infection of the lungs that may cause mild to severe illness. Both the COVID-19 and flu vaccines can help prevent infection by some of the bacteria and viruses that can cause pneumonia, per the CDC 

Your provider may also recommend the pneumococcal vaccine (in particular, pneumococcal conjugate vaccines PCV15 or PCV20) if you’re 65 years or older or if you’re age 19 through 64 with certain medical conditions or risk factors, according to the CDC. If you receive PCV15, it should be followed by a dose of the pneumococcal polysaccharide vaccine (PPSV23).  

CDC data showed that in the United States during 2018, 1.5 million people were diagnosed with pneumonia in an emergency department and approximately 44,000 people died from it. 

But like COVID-19 and the flu, pneumonia is preventable — largely by getting vaccinated, but also by other healthy living practices. Overall, you can avoid respiratory infections this winter by washing your hands regularly, cleaning and disinfecting surfaces that are touched a lot, limiting contact with cigarette smoke or quitting smoking, and managing medical conditions like asthma, diabetes, or heart disease. 

Also speak to your doctor about preventive medication like Evusheld, which can be taken before exposure to COVID-19 and may provide an extra layer of protection for those who didn’t mount a full immune response to the vaccine.  

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Coronavirus in the U.S.: Latest Map and Case Count. The New York Times. September 29, 2022. https://www.nytimes.com/interactive/2021/us/covid-cases.html. 

Interview with William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center 

Coronavirus (COVID-19) Update: FDA Authorizes Moderna, Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose. August 31, 2022. U.S. Food & Drug Administration. August 31, 2022. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use 

Interview with Richard Zimmerman, MD, Vice Chair for Preventive Medicine Research at the University of Pittsburgh 

The Omicron Booster: Your Questions Answered. Yale Medicine. September 23, 2022. yalemedicine.org/news/omicron-booster-covid-19 

Interim Clinical Considerations for COVID-19 Vaccines: Bivalent Boosters. U.S. Centers for Disease Control and Prevention ACIP Meeting. September 1, 2022. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-09-01/09-COVID-Hall-508.pdf 

CDC Recommends the First Updated COVID-19 Booster. CDC Newsroom. U.S. Centers for Disease Control and Prevention. September 1, 2022. https://www.cdc.gov/media/releases/2022/s0901-covid-19-booster.html 

New bivalent COVID vaccine booster. UTMB Health. September 12, 2022. https://www.utmb.edu/covid-19/article/top-updates/2022/09/12/new-bivalent-covid-19-vaccine 

CDC Oversells the ‘Bivalent’ Covid Shot. The Wall Street Journal. September 21, 2022. https://www.wsj.com/articles/cdc-oversells-the-bivalent-covid-shot-hospitalizations-vaccine-booster-omicron-pandemic-pfizer-moderna-china-illness-death-11663793472 

Who Should and Who Should NOT Get a Flu Vaccine. Influenza (Flu). U.S. Centers for Disease Control and Prevention. August 25, 2022. https://www.cdc.gov/flu/prevent/whoshouldvax.htm 

Pneumonia Can Be Prevented—Vaccines Can Help. Pneumonia. U.S. Centers for Disease Control and Prevention. October 14, 2021. https://www.cdc.gov/pneumonia/prevention.html 

Pneumococcal Vaccination. Vaccines and Preventable Diseases. U.S. Centers for Disease Control and Prevention. January 24, 2022. https://www.cdc.gov/vaccines/vpd/pneumo/index.html 

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