Health Update

The Viral Triple Threat – What You Need to Know (Fall, 2023)

The Viral Triple Threat – What You Need to Know (Fall, 2023)

It’s time to think about your fall flu shot – but don’t stop there. The “Triple Threat” we’ve heard about has to do with the flu season beginning, the upswing in COVID cases and RSV (Respiratory Syncytial Virus) cases rising. Thankfully, we now have available vaccines for all three.

Bear in mind that the main goals of vaccines are to 1) prevent a disease or to 2) prevent severe disease, hospitalization, and death from the disease. Some vaccines have been shown to achieve goal number one quite effectively, such as rabies vaccine, where nearly 100% of the cases can be prevented. Goal number two is more realistic for Influenza, COVID, and RSV vaccines. A common misunderstanding or claim was that the Influenza and COVID vaccines would prevent disease; this was never the expectation among medical professionals. Both vaccines have been shown to be highly effective in accomplishing the intent of goal number two.


This virus has not left us and, in all probability, will not be “disappearing into the sunset.” While the prevalence has gone from epidemic to endemic, COVID will continue to be in the community with occasional mutation flare-ups and with immunity decreases in some people. Since the beginning of the pandemic, 6.3 million people have been hospitalized and over 1.2 million people have died as a result of COVID. Unfortunately, those numbers are likely to increase.

One thing we have learned is that immunity to COVID, despite having had an infection, being vaccinated or a combination of both, is not long-lasting. The disease is now less severe, particularly in people under 50 years of age, but those older, with chronic disease and immune system impairments, are still at risk for critical illness and hospitalization. Based upon recent evidence submitted to the FDA, the updated vaccines have been effective in those higher risk individuals. A question that remains is how often should one be getting newly formulated preparations? We do not know the answer.

The recently approved COVID vaccines, often erroneously called boosters, are different from previous ones. They are referred to as XBB1.5 monovalent COVID vaccines because they have been designed to deliver the spike protein of the XBB family whose variants/mutations are currently circulating. Preliminary data from Moderna and BioNTech/Pfizer (manufacturers of two of the newly approved agents) show that the currently circulating strains are neutralized by the antibodies these vaccines cause to be produced (please see the blog, How the Immune System Works to Respond to a Vaccine in our library). The question that remains: “Should everyone get the updated vaccine?” If you are at high risk, yes, get one! There is no controversy about it.

Bear in mind that if you are the caregiver of an at-risk individual or work with a vulnerable population, then, although you may only have a mild or minimally symptomatic case, you are able to transmit the virus to others. Your personal choice may have consequences for more than just you!

Remember, if you are at risk for complications from COVID (age 50 or greater or have a chronic disease), even with what may seem like a mild case, you should contact your healthcare provider about Paxlovid. This oral medication has been clearly demonstrated to prevent complications.

Finally, we still do not fully understand all the risk factors for Long COVID, nor do we know all the short-term and long-term sequalae; consequently, anyone who gets infected is at risk for this syndrome.


Everyone over age 60 should get the new RSV vaccine. RSV is an RNA virus that has been the cause of a sometimes-severe respiratory infection in young children and infants, leading to thousands of hospitalizations each year. Infections typically start in the fall and peak in the winter months. Transmitted by coughing, sneezing, or coming into contact with contaminated surfaces, the typical symptoms are cold-like and last 5-6 days. However, people over 60, as well as infants and toddlers, can be at risk for more serious disease, such as a pneumonia that often requires hospitalization. Other risk factors for severe infection in an older adult are lung, heart, and kidney diseases, and chronic diseases.

Aided by more precise and available diagnostic testing, doctors have found RSV to be behind hospitalization for non-bacterial pneumonia. It’s not that the virus has mutated and now infects older adults (anyone can be infected with it); rather, we now have RSV testing that is part of our panel used when seeing someone with a more severe respiratory infection. We now know that in those 60 and older, RSV accounts for 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths yearly.

Fortunately, there are now two recently approved, one-dose RSV vaccines recommended by the CDC for adults 60 and above. Both are highly efficacious (close to ~85%) in preventing hospitalization and severe disease. As with most vaccines, side effects can be fatigue, injection site pain, headache, and mild muscle aches within the first 24 hours. Cases of RSV have already been reported in the American south where it typically begins and then moves northward, so plan to get your vaccine if you are at risk. Because it is beyond the scope of this blog, please discuss with your healthcare provider the vaccine options available for infants and toddlers, and one soon to come for pregnant women.


With a relaxing of COVID restrictions, Influenza deaths rose from approximately 5,000 to 14,000 in the 21-22 season to 19,000-58,000 in the 22-23 season! More likely than not, the toll was much higher since the flu can cause other chronic diseases to worsen to a life-threatening level. (See: What are the benefits of flu vaccination?.)

Over the last several years, Type A flu strains have been predominate. (For a more detailed explanation of Influenza viruses, please see Flu Facts and Symptoms in our library). The current vaccines contain four different antigens – two type A and two Type B. (For a more detailed explanation of what an antigen is, see How the Immune System Works to Respond to a Vaccine in our library.)

Typically, Influenza epidemics begin in the Southern Hemisphere during its winter months and work their way up to our hemisphere in our fall and winter months. The chosen 2023-2024 season vaccine appears to be a good match to the circulating viruses and has reduced the risk for Influenza-related hospitalization by 52% (a very good figure).

Flu vaccination is now recommended for everyone 6 months of age or older, including pregnant women (a high-risk group for complications). If you are age 65 or older, you should get the “high dose” flu shot because as we age, our immune systems require a little more of the Influenza antigen for optimal response. Recommendations regarding egg allergy and the flu shot have also changed, and your healthcare provider can discuss this with you. There are multiple options/formulations available and few reasons to not get your fall flu shot.

Mitigating the triple threat

So, if you are age 60 or older, you need to consider getting your RSV, COVID and Influenza vaccines this season. Both the COVID and Influenza vaccines can be given at the same time with no reported decrease in the immune system’s response. Since the RSV vaccine is new, we don’t have enough data to make a clear recommendation as to whether it can be given with other immunizations. If you are younger, consider getting your Influenza and “reformulated” COVID vaccines.

Note: The CDC recommends that most people get their flu shot by the end of October or sooner if waiting is not feasible.

Remember, Truesdale Health is here to help you with your medical needs!

Henry R. Vaillancourt MD MPH FAAFP
A Truesdale Health member and specialist in Public Health and Prevention

The opinions expressed in this blog are those of the author and do not necessarily reflect those of your healthcare provider. As always, you should consult your healthcare provider for any specific questions or health concerns that you may have.

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