The U.S. Centers for Disease Control and Prevention (CDC) has recommended updated vaccines for the fall to protect against common respiratory diseases. Among the changes: people age 75 and older should get vaccinated against RSV, the COVID-19 vaccine will target a new strain of the virus, and the updated flu shot will include only three strains instead of the four in last year’s shot. It made these changes after a committee that advises the CDC recommended them.
“Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated,” said CDC director Dr. Mandy Cohen in a statement supporting the new advice.
Here’s what to know about the shots you might need—and what’s different from past guidance.
RSV for some
Older adults and young babies are at highest risk for respiratory syncytial virus (RSV), and last year, vaccines became available for the former group for the first time. The advisory committee at the time recommended that anyone age 60 or older talk to their doctors about whether they should get an RSV shot. This year, it went further, saying that people 75 and older should get vaccinated.
Those who are 60 to 74 should get the vaccine only if they didn’t last year and are at higher risk of RSV, the committee decided. (The RSV shot is not currently an annual vaccination.)
But they didn’t recommend it for younger adults. Earlier this year, the U.S. Food and Drug Administration (FDA) approved GSK’s RSV vaccine for people 50 and up; however, the committee declined to recommend the shot for that age group, citing the risk of Guillain-Barre syndrome, a condition in which the body’s immune system attacks nerves. While the incidence of the syndrome among those who are vaccinated is small, the risk of RSV complications in younger people is also low—so the risk-benefit calculations don’t obviously favor vaccination, at least for now.
H5N1? Not just yet
The committee discussed the current outbreak of H5N1 avian influenza (also known as bird flu) in dairy cattle. The risk of bird flu in people remains low, according to the CDC scientists presenting the latest data to the advisory committee, so no vaccination plans were adopted. The CDC is preparing, however, to make decisions about vaccination if cases start spreading among people.
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In the current outbreak, three people—all dairy workers—have tested positive for H5N1. Agency scientists said that existing vaccines that are part of the national emergency stockpile, and two vaccine candidates the CDC is testing, are effective in protecting against the circulating version of H5N1.
Seasonal flu for most
As expected, the committee unanimously voted to recommend the seasonal flu vaccine for everyone age six months and older. The update targets three strains, including a new one, H3N2, that will likely circulate in coming months.
COVID-19 for most
The decision about whether to recommend COVID-19 vaccination for the upcoming season wasn’t as straightforward as it has been in previous years, when the SARS-CoV-2 virus caused more cases and fewer people had immunity against it. But now that almost every has either been exposed to the virus, vaccinated against it, or both, COVID-19 doesn’t have the same health impact on the population as it once did. Even though the virus is mutating into different variants, longer-lasting immunity based on T cells appears to be protecting most people from severe disease and death—which raises the question of how critical a yearly vaccine will continue to be.
However, the CDC provided data showing that the risk of severe COVID-19 remains significant for older people, especially those over 75, who account for most of the hospitalizations and deaths due to the disease. Among younger people, the risk is higher for those with underlying health conditions. But for other healthy adults, the risk-benefit calculations are shifting.
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“We are not thinking here about whether the vaccine protects absolutely, as we did when we had a [COVID-19] naïve population,” said Ruth Link-Gelles, a CDC epidemiologist and its vaccine effectiveness program lead, at the committee meeting. “We are thinking, in a population that already has some immunity, what [protection] can we give beyond that?” She noted that even if the yearly vaccine will always lag behind the currently circulating strain of SARS-CoV-2 because the virus mutates so quickly, a vaccine that reduces the risk of severe disease by 40% to 50% among those at high risk of COVID-19 complications can be important. “It may not be the 95% [reduction] we were seeing in the early days, but we also don’t need that level of protection, because we are looking to increase protection in people who already have existing protection,” she said.
That’s important, since data show that every encounter with COVID-19 can increase the risk of developing Long COVID, and that people who are vaccinated can reduce their risk of Long COVID.
One option the group considered was making a recommendation for high-risk people, rather than a universal recommendation for everyone six months and older to get vaccinated. But committee members expressed concern that the potentially confusing guidance about who should get vaccinated may lead to even an lower immunization rate than the current one; only about 20% of eligible people received the updated COVID-19 vaccine in 2023. In data cited by the CDC from a survey conducted by the agency with University of Iowa and the RAND Corporation, nearly half of physicians surveyed said they did not bring up COVID-19 vaccinations at appointments because they felt their patients would not be interested in getting immunized.
“It can feel very frustrating,” says Dr. Jen Brull, president-elect of the American Academy of Family Physicians, who is not a committee member. “But I still think that family physicians everywhere feel that it’s our responsibility to offer important preventive and and other chronic health treatments.”
In the end, the committee voted unanimously to continue recommending a COVID-19 shot for everyone six months and older. The FDA recently recommended updating the shot to target a newer strain, JN.1—a move that the CDC also supports. For the coming season, two of the shots will be based on mRNA technology, from Moderna and Pfizer-BioNTech, and one, from Novavax, will be protein-based and include a portion of the COVID-19 virus spike protein.
