U.S. health officials typically look to the Southern Hemisphere for an indication of what to expect, and Australia is wrapping up its worst flu season in five years. The Australian flu season also arrived significantly earlier than normal, with cases spiking two or three months before their typical peak.
“You can never predict with 100 percent certainty, but all signs predict influenza will be back this year, and data from Australia suggests it will be a strong flu season,” says Andrew Pekosz, a virologist and professor of microbiology at the Johns Hopkins University School of Public Health.
In addition, health officials anticipate another surge in COVID-19 cases as school starts, the weather cools and people move inside. Those patients could potentially compete for hospital beds with patients who have complications from the flu.
It’s also possible to get the flu and COVID-19 at the same time, and a recent study published in The Lancet found that adults who have a dual flu-COVID infection are at greater risk of severe disease and death than patients who have COVID-19 alone or with other viruses.
But there is a way to blunt influenza’s expected burden, and that’s with a flu shot. The vaccine is especially critical for older adults, who see a natural decline in immune function with age and are at higher risk of developing complications from the flu. Older adults are also at higher risk of COVID-19 complications.
Americans may be more susceptible to flu this year
The past two flu seasons have been milder than usual, with low numbers of cases and few hospitalizations and deaths. Experts attribute the decline to COVID-19 precautions such as wearing face masks and social distancing. People were also traveling less during the height of the pandemic.
“Now that people are out and about without masks, traveling extensively, and once again having vacations, going to restaurants and religious services, and back to school and to the office, there are more opportunities for the [flu] virus to circulate,” says William Schaffner, medical director of the National Foundation for Infectious Diseases and a professor of infectious diseases at the Vanderbilt University Medical Center in Nashville, Tennessee.
Americans also have less natural immunity to influenza because so few people were infected in 2020 and 2021, Pekosz says.
In typical years, “a good percentage of the population gets infected with influenza, and their immunity after infection lasts longer than what we get from vaccination,” Pekosz notes. “What we’re seeing is a couple of years where we didn’t see infection. So more people may be susceptible to influenza in this coming season.”
He says an early season is usually a sign of more susceptible people in a population. That would explain what happened in Australia — and possibly predict an early season here.
Schedule your flu shot
The Centers for Disease Control and Prevention (CDC) recommends getting your flu shot in September or October. “Ideally, everyone should be vaccinated by the end of October,” the agency says. (But it’s better to get it late than not at all.)
Since an early influenza season is possible this year, some experts say you should aim to get the vaccine earlier, in September instead of October.
“You need to be vaccinated one month before influenza comes, because it takes about a month to get the antibodies you want for protection,” says Adolfo Garcia-Sastre, director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai in New York City.
“What we have seen in Australia would be the equivalent of [the flu season] starting in October here,” he adds.
If the virus doesn’t follow Australia’s path and peaks in February instead, as it has in other years, your immunity, if you got the shot in September, may be somewhat weakened by then, Garcia-Sastre says. That has prompted discussion among health experts about whether to recommend an influenza booster for high-risk groups, he adds. At this point, however, there is no recommendation for a second shot.
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Older adults should get the high-dose or adjuvanted vaccine
All of the approved influenza vaccines this year are quadrivalent, meaning that they contain four different strains of the virus. So far, it looks like the shot is well matched to circulating strains.
“Even in years where there is not a very good match between the vaccine and circulating virus, there is always some protection from the vaccine,” Schaffner says.
Adults 65 and older should get the higher-dose or adjuvanted flu vaccine, the CDC says; both have been shown to evoke a stronger immune response in older adults and can offer greater protection against illness.
“People age 65 and older account for over 85 percent of the hospitalizations and deaths from the flu, so we need all the help we can get,” Schaffner adds.
Influenza caused about 380,000 hospitalizations and 20,000 deaths in the 2019–2020 flu season, according to CDC data. Previous flu seasons have been more severe: In the 2017–2018 season, for example, an estimated 710,000 Americans were hospitalized and 52,000 Americans died of the disease, according to the CDC.
Still, about one-third of older adults skipped out on the flu vaccine last year, federal data shows.
One shot in each arm?
There’s a new batch of COVID-19 boosters out from Pfizer-BioNTech and Moderna that have been tweaked to better target omicron and its subvariants, and health officials are recommending that all fully vaccinated adults get one this fall. (People 12 and up can get the updated Pfizer vaccine; adults 18 and older can opt for Moderna’s.) And a good time to get the new booster, experts say, is when you go in for your flu shot.
“Get the flu vaccine in one arm and the COVID vaccine in the other,” Schaffner suggests.
White House COVID-19 Response Coordinator Ashish Jha even said, “I really believe this is why God gave us two arms — one for the flu shot and the other one for the COVID shot.”
Health officials acknowledge that Americans feeling “vaccine fatigue” may be tempted to forgo one or both shots, but they warn that doing so could put you at significant risk of hospitalization or death.
“My worry is, we haven’t seen very good uptake of the COVID booster shot, particularly in vulnerable populations,” Pekosz says. “The same population at high risk of severe COVID are the ones at high risk of severe influenza. Now is the time to be cognizant of that and do something about it. We do know that vaccines are the best protection.”
Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation’s top consumer publications. Her work has appeared in Reader’s Digest, Real Simple, Prevention, The Washington Post and The New York Times.