Clinician Recommendation is Still the Best Way to get Flu, COVID-19, and RSV Shots into Arms

Physicians are the leaders of the nation’s efforts to get shots in arms for the fall respiratory illness season, said the director of the US Centers for Disease Control and Prevention (CDC).

The American Medical Association, in conjunction with CDC’s Project Firstline national training collaborative for infection prevention and control, held “Start preparing for respiratory virus season,” an August 6 webinar with CDC leaders to preview the upcoming flu season, with added risk from COVID-19 and respiratory syncytial virus (RSV).

Their message: Physicians making recommendations – or not – has an influence on patient decisions about getting vaccines, said CDC Director Mandy Cohen, MD, MPH.

“We continue to see lower uptake of these annual vaccines than we would like to see, but we know that they are our best defense against those serious illnesses that make our patients sick every fall and winter season,” Cohen said.

Physicians need to help patients understand the risks. Viruses can cause hospitalization and RSV is the No. 1 cause of infant hospitalization, she said.

“That is why vaccines are such a powerful tool,” Cohen said.

In CDC research, one of the major reasons a patient does not get a vaccine is because the doctor didn’t recommend it. “’It didn't come up so I assume it's not that important for me.’ And so making that strong recommendation for something like a COVID vaccine or a flu shot is really, really critical,” Cohen said.

In CDC research, one of the major reasons a patient does not get a vaccine is because the doctor didn’t recommend it. “’It didn't come up so I assume it's not that important for me.’ And so making that strong recommendation for something like a COVID vaccine or a flu shot is really, really critical.”

A strong recommendation “doesn’t have to be an hour-long conversation,” the director said. A sample explanation might sound like: “You're due for your flu and COVID vaccines today, I've gotten these vaccines myself and I recommend them for you too.

“That is a strong recommendation, we'd love to see here,” she added.

Some physicians don’t recommend the vaccines because of fears of contraindications. But allergic reactions, multi-inflammatory symptom in children, or myocarditis in adolescents or young males all are rare, Cohen said. Additional speakers were AMA President Bruce Scott, MD; Demetre Daskalakis, MD, MPH, director of the CDC National Center for Immunization and Respiratory Diseases (NCIRD); and Manisha Patel, MD, MS, MBA, NCIRD chief medical officer and captain in the U.S. Public Health Services.

Who gets what?

• COVID-19. CDC recommends COVID-19 and influenza vaccines for youths aged 6 months to 17 years. All adults aged 18 to 59 years, aged 60 years and older, and pregnant persons should get the COVID-19 and influenza vaccines.
• Nirsevimab. All infants less than 8 months old and children aged 8 through 19 months with risk factors should get nirsevimab. Typically, that happens October through March if the mother is not vaccinated with the maternal RSV vaccine.
• RSV. All adults aged 75 years and older should get one lifetime dose of RSV vaccine. Adults aged 60 to 74 years with risk factors, should get one lifetime dose of RSV vaccine. Risk factors include chronic cardiovascular disease, end state renal disease, residence in a nursing home, severe obesity, diabetes mellitus, chronic lung or respiratory disease, chronic hematologic conditions, chronic liver disease, neurological or neuromuscular conditions, moderate or severe immunocompromise, or other factors that a provider determines would increase risk of sever disease due to viral respiratory infection.
• Maternal RSV. Pregnant persons at 32 to 36 weeks gestation should get the RSV maternal vaccine.

Now's the time to order

The CDC leaders emphasized physicians should prepare their offices and clinics by ordering immunizations now.

“Ordering and offering immunizations in your clinics is one of the most powerful ways to improve vaccine confidence and increase immunization rates,” according to Cohen’s presentation. Convenience is a top reason for patient acceptance and making the shots available reduces missed opportunities for immunization.

CDC also has launched a new product web page with estimated launch dates, links to pre-ordering and early reservations, details on product type and return policies.

When to give the shots?

• COVID-19: vaccines can be administered as soon as they are available, any time of year.
• Flu: Early fall, with continued availability to unvaccinated people as long as flu viruses are circulating.
• Older adult RSV: Late summer or early fall.
• Maternal RSV vaccine: September through January in most of the continental United States.
• Infant RSV immunization, nirsevimab: October through March in most of the continental United States.

Timing questions answered

If a person gets COVID-19, the recommendation is to consider delaying their next dose of COVID-19 vaccine for about 3 months, Daskalakis said.

RSV tends to be seasonal in fall and winter, so if a pregnant person gets an RSV vaccination in February, and the child is born in March or April, it would be preferable to give the infant nirsevimab in October, Patel said.

Coadministration

Coadministering the 3 shots is a current best practice, Daskalakis said. Getting the 3 shots at one visit is safe and does not seem to blunt any of the immunologic response to any of the vaccines, he said.

“Coadministering these vaccines is really critical, especially for people where you only have one shot at getting them,” Daskalakis said.

Consider a champion

Physicians should consider identifying a champion for vaccination in their offices, Cohen said.

“That really helps to make sure your office is set up and prepared for having conversations with patients about vaccination, as well as not missing an opportunity to give out those doses,” she said. “So every time someone walks in up to your office is an opportunity, both to have that conversation and to make sure you're immunizing.”

Treatments are available

The CDC is emphasizing prevention, but there are treatments. If someone gets sick with COVID-19, Paxlovid cuts the risk of hospitalization and death, but it should be used early, Cohen said. No blood draw is necessary, although physicians should consider drug interactions and dosages, she said.