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COVID-19, flu and RSV in Colorado: Who should get which vaccine and when this fall?

There's a slight risk of stroke in older adults if updated COVID-19, flu vaccines are taken at the same time, CDC says
Tripledemic? How to prepare for a mix of COVID, RSV, and flu this fall
Posted at 2:42 PM, Sep 18, 2023

Editor's note on Oct. 31, 2023 at 4 p.m.: This article has been modified to include information about the updated Novavax vaccine, which was not yet available to the general public when this article was originally published on Sept. 18, 2023, and includes information from the CDC and the FDA released on Oct. 25, 2023, about the potential risk of stroke in older adults if the updated COVID-19 vaccines and this year's flu vaccine are taken at the same time, as well as an updated statement from the CDPHE regarding the aforementioned risk.

DENVER – Viral respiratory season is set to ramp up in the coming weeks and already, the U.S. Centers for Disease Control and Prevention (CDC) is projecting this year will be a repeat of last.

While health officials still don’t know what this season is going to look like, the CDC is projecting that the triple threat of COVID-19, flu and RSV could place a significant strain on the nation’s healthcare system during the colder months.

Since the beginning of August, Colorado has seen an increase in the number of cases and hospitalizations for COVID-19, and state health officials can’t say for sure whether that’s going to level out and decline before we see another winter increase, or if we’re just going to continue to see a gradual increase into the winter season.

Last year, COVID-19 sent 8,231 Coloradans to the hospital, compared with 3,076 hospitalizations for the flu, according to the Colorado Department of Public Health and Environment (CDPHE). Data from across five Denver metro area counties shows 2,630 people were hospitalized for RSV, with 80.6% of hospitalizations occurring among children. Statewide data for RSV wasn’t previously available, but a spokesperson for the CDPHE told Denver7 last week the state has started tracking RSV hospitalizations as of June 18.

covid flu and rsv hospitalizations 2022.png
COVID-19, RSV and influenza hospitalization rates in the 5-county metro area (Adams, Arapahoe, Denver, Douglas and Jefferson counties).

“As with last year, the total number of hospitalizations this year is expected to be higher than what we as a nation experienced prior to the COVID-19 pandemic,” CDC officials wrote in their Sept. 14 forecast, as they outlined two potential scenarios for the triple viral whammy in the fall and winter.

While the thought of getting multiple vaccines every fall might seem like a drag, “I think it does remind us that now is a great time… to think about getting those vaccines and we're talking about, of course, the COVID vaccine, but also vaccines for protection against influenza and RSV for individuals where it might be relevant,” said state epidemiologist Dr. Rachel Herlihy.


Let’s start with the most complex recommendations for this respiratory season and work our way down from there.

Anyone aged 6 or older is recommended to get the updated COVID-19 vaccine from either Pfizer or Moderna if it’s been at least 2 months since you last got vaccinated, regardless of whether you had previous doses of an outdated COVID-19 vaccine or no doses at all.

Anyone 12 years or older can also now get the updated, protein-based Novavax COVID-19 vaccine. A single dose is recommended for those who have been previously vaccinated with an mRNA vaccine from either Pfizer or Moderna, but who haven't gotten the updated shot from either of those vaccine makers. If you're unvaccinated, you will need two doses of the updated Novavax vaccine, taken three weeks apart.

Children 4 years and younger who have never been vaccinated, as well as the immunocompromised, may need two doses of the updated COVID-19 vaccine, though parents and adults who fit these categories should talk to their healthcare provider first to make that determination, Herlihy said.

Those who have been recently infected with COVID-19 within the past 2 or 3 months should talk with their healthcare provider to determine the timing of their next COVID-19 vaccine.

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When it comes to RSV, the U.S. Food and Drug Administration (FDA) recently approved two vaccines against RSV – one for older adults and one for pregnant women near the end of their third trimester.

The single-dose vaccines – Arexvy and Abrysvo, the former developed GSK and the latter by Pfizer – use similar technology to that of the flu vaccine by introducing a small amount of an inactivated RSV virus into the body so that once a person encounters the virus during the season, the immune system will be able to recognize it and mount its defenses to protect against severe disease.

Both vaccines are available for adults 60 years or older, but it’s recommended that people talk to their doctors or a healthcare provider beforehand to determine if vaccination is right for them.

The Abrysvo vaccine is also available for pregnant women between week 32 and week 36 of pregnancy, but expectant mothers should consult with their doctors to determine if the vaccine makes sense for them.

The reason why the RSV vaccines were approved but not strongly recommended to the targeted group by the CDC’s advisory panel earlier this summer was because clinical trial data showed some people went on to develop Guillain-Barré syndrome (a rare disorder that causes muscle weakness and sometimes paralysis) and atrial fibrillation (an arrhythmia that can lead to blood clots in the heart) days after vaccination, according to Yale Medicine.

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Herlihy also said it’s not only important for Coloradans to talk with their doctors about potentially getting these RSV vaccines, but also their health insurance provider, as these are newer vaccines that may not be covered just yet.

A monoclonal antibody treatment called Beyfortus was also approved this summer by the FDA and will be available very soon in Colorado, according to Herlihy. The monoclonal antibody treatment – which are laboratory-made proteins to help the body fight off infections – is recommended for infants up to the age of 8 months old during their first RSV season, and for babies up to the age of 19 months old who may be at increased risk for severe disease due to RSV.

Lastly, the flu shot is recommended for anyone 6 months of age or older, though Herlihy said there are specific flu vaccines aimed at older age groups that have demonstrated to have increased effectiveness, “so we recommend that individuals ask for those.”

“But of course, if that particular vaccine isn't available at your time of your appointment, or when you go to a pharmacy, it’s okay to get the other (flu) vaccines,” she said.


Most health insurers cover the flu shot every year, but it gets trickier with the other two vaccines.

Unlike previous years, the updated COVID-19 vaccine won’t be paid for by the federal government this time around, but those with healthcare insurance will be able to get them through their healthcare provider and at pharmacies, Herlihy said.

Uninsured adults will still be able to get vaccinated against COVID-19 through local pharmacies from the U.S. Department of Health and Human Services’ (HHS) Bridge Access Program for COVID-19 Vaccines and Treatments.

Government-run programs like Medicaid and Medicare are also expected to cover the updated shots, and kids enrolled in the Children’s Health Insurance Program and the Vaccines for Children Program will still be able to get updated COVID-19 vaccines through the end of September 2024, according to health officials.

Health First Colorado, the state’s Medicaid program, and Child Health Plan Plus (CHP+) will also continue to cover COVID-19 vaccines at no charge for members.

The RSV vaccines will be covered by Medicare Part D, according to Yale Medicine, but Herlihy highly recommended people speak to their insurance provider to determine if they’ll cover those vaccines this fall, as some people are being charged over $300 out-of-pocket for these new shots.


Herlihy told Denver7 at the time this article was published that while it was unclear if older Coloradans and pregnant women could get the RSV vaccines at the same time as the flu and COVID-19 vaccines, data from the last several years showed that it was okay to receive both the influenza and the COVID-19 vaccine at the same time.

New information from the CDC released on Oct. 25, however, shows that taking the updated COVID-19 vaccine together with the flu shot may slightly increase the risk of strokes caused by blood clots in the brains of older adults.

“Certainly talk to your healthcare provider – it’s likely you’ll receive one in each arm, I think that’s been a common strategy,” she said at the time. “I think that's a great idea of people who are seeking these vaccines to get them at the same time and get them both taken care of when you're at your pharmacy or at your doctor's office.”

In an updated statement, the CDPHE directed Denver7 to a CDC presentation about COVID-19 vaccine safety during their latest Advisory Committee on Immunization Practices meeting, which took place on Oct. 25.

"According to their report, there is no clear and consistent evidence of a safety problem for ischemic stroke with bivalent mRNA COVID-19 vaccines when given alone or with influenza vaccines," a CDPHE spokeswoman said. "CDC also notes that 'any real or theoretical risks of vaccine adverse events need to be placed in the context of the known benefits of COVID-19 and influenza vaccination in preventing COVID-19 and influenza disease and their potentially serious complications, including stroke.'"


While it would make sense to wait a few weeks into the viral respiratory season to get these shots as their efficacy is short-lived (about 3-6 months for the COVID-19 vaccine and about 4-5 months for the flu vaccine), it’s probably a good idea to get these vaccines now, Herlihy said.

“Now is a good time to bring that protection on board and have that protection as we're heading into the fall,” she said. “We want people to be protected sooner rather than later.”

For the flu, state health officials recommend Coloradans get their shot by the end of October. For COVID-19, Herlihy said if you’re more than two months out since your last vaccine, “it’s probably a good idea to go ahead and get that vaccine now.”

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Older Coloradans and pregnant women looking to get the RSV vaccine should first talk with their doctors. The former should also consult with their physicians before deciding whether they should take the updated COVID-19 vaccine together with this year's flu shot.

While it is still too soon to know how much the updated COVID-19 vaccine will stunt the spread of newer variants, the CDC said at the end of last month the updated COVID-19 vaccine “will likely be effective at reducing severe disease and hospitalization,” against several of the now-dominant SARS-CoV-2 variants.

Effectiveness for the RSV vaccine ranged from 67.2% over two seasons to 89% for the first season against respiratory disease in clinical trials.

Health experts also still don't know which strains of influenza will circulate in the next coming months, but this year’s flu vaccine — which was matched to the strains that circulated in the Southern Hemisphere earlier this year — was found to cut the risk of hospitalization by a little more than half, according to the CDC.

Coloradans looking to get any of these vaccines should contact their healthcare provider, pharmacy, or doctor’s office to make sure it’s available before heading out the door.


Besides taking care of yourself by eating well, getting enough sleep, staying active and avoiding stress as much as possible, there are other things you can do to stay ahead of a potential infection.

“Vaccines are obviously an incredibly important strategy and are really our first line of defense in protecting ourselves against these respiratory viruses, but there's also a lot of other things that we've learned in the last couple of years and new strategies or tools that we have now,” Herlihy told Denver7 last week.

Seeking out treatment and staying home if sick are “really important strategies going forward,” she said, as are wearing a high-quality mask like an N95, KN95 or KF94 in poorly ventilated indoor settings, avoiding large gatherings, moving gatherings outside wherever possible, ventilating indoor spaces if gathering inside, practicing proper hand hygiene, and following CDC quarantine guidance if you've been exposed or test positive for the virus. Taken together, all of these things can help Coloradans reduce their chances of becoming infected and from passing these viruses on to other people in the community, health experts say.

Experts say it's time to start guarding against respiratory diseases

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