CDC guidelines on new COVID vaccines and when to get the flu shot with Andrea Garcia, JD, MPH


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Who should get the latest COVID, flu and RSV vaccines and when they should get them. AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, also discusses the potential for a fall tripledemic and how to prepare. Plus, rising COVID-19 cases, new CDC data on drug overdose deaths and the blood supply shortage. AMA Chief Experience Officer Todd Unger hosts.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

Respiratory virus season: AMA & CDC Fireside Chat

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Good to see you, Andrea.

Garcia: Good to see you, too. Thanks for having me back.

Unger: Well, Andrea, let's start off, as we have in recent weeks, by talking about COVID. There have been a lot of developments lately, with the rise in cases, and of course, the news of updated vaccines. Andrea, how have the numbers been trending since we last talked?

Garcia: Well, Todd, according to the latest data from the CDC, for the week ending September 2, almost 19,000 people were admitted to the hospital with COVID in the U.S. That's about a 8.7% increase from the previous week. I think with that being said, the week before that, we had been seeing about a 16% increase in hospitalizations. So hopefully, this is a sign that these increases are beginning to slow down.

The good news, as you noted, is we do have updated COVID vaccines that we know are starting to be administered. I also know you talked to Dr. Fryhofer, who is our AMA liaison to the CDC's Advisory Committee on Immunization Practices. And she talked all about the updated vaccines, so we'll include a link to that interview in the description for this episode. And I really encourage everyone to check that out.

Unger: It was a great episode. Again, watch that one with Dr. Sandra Fryhofer. Let's talk about that word that we used last fall—tripledemic—COVID, flu and RSV. Andrea, is this something that we should start expecting to see every year at this point?

Garcia: Well, you noted that the tripledemic is something that we need to be aware of this year, just like last year. Whether or not this is going to be an every year thing around this time, I think it's too early to tell. We've talked about, often here, the fact that there are two new RSV vaccines for older adults and that new monoclonal antibody injection to protect infants. We know that's certainly going to be helpful with RSV cases.

As for COVID, even though it's been, I think, such a huge part of our lives over the past few years, we're still relatively early in our understanding of it. So we don't really know the full long-term impacts on our health and we can't really predict how that virus is going to evolve in the future. I think a level of caution, especially during fall and winter, is certainly warranted.

The CDC did put out a respiratory virus season outlook. That indicated that they're expecting this respiratory disease season to be similar to last year's in terms of the number of hospitalizations. But new COVID variants could certainly change that prediction, and the CDC is encouraging people to get vaccinated. We know it's the best way to protect yourself against those serious outcomes for COVID, RSV and flu.

Unger: Well, thankfully, as you pointed out, this year, we've got new vaccines for all of those respiratory diseases, but patients have lots of questions about which ones they should get. Can you give us more of the details about what patients need to know?

Garcia: Yeah, absolutely. I think, let's start by talking about flu and COVID vaccines, which we know CDC recommends for everyone six months and older. With the flu vaccine, it's typically a single vaccine for most people. There are some kids between the ages of 6 months and 8 years who may need two doses, and your physician will certainly be able to advise on that.

With COVID, it's different, a little bit, depending on your age and your previous vaccination status. Again, your physician or local pharmacy can guide you through that. But here are a few differences to be aware of.

If you're five or older, you'll be receiving one dose of that updated COVID vaccine at least two months after your last dose. If you're six months to four years of age and you've already received a COVID vaccine, you may receive one or two doses of the new updated vaccine. And that's going to depend on the previous COVID vaccine that you received. And then, those children who are six months to four years old, who haven't received any COVID vaccines, can receive three doses of the updated Pfizer vaccine or two doses of the new Moderna vaccine.

Unger: Well, thank you very much for that overview. That is really helpful. Let's move and shift our attention here now for the RSV vaccine.

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Garcia: Yeah, so when it comes to RSV, the two new vaccines that are available are for adults aged 60 and older. We've discussed before they were not universally recommended by the CDC, like flu and COVID. Instead, patients may choose to get the RSV vaccine in consultation with their physician.

Infants are another group that we know are at high risk for RSV. For them, the CDC recommends the new monoclonal antibody injection, which we know protects infants less than eight months old as well as some children between 8 to 19 months that are at risk for severe illness. There is also an RSV vaccine for pregnant people that's given in those last few weeks of pregnancy to protect infants up to six months of age against RSV.

That vaccine for pregnant people is still pending review by ACIP and CDC sign-off. I think, overall, if you're an older adult, a pregnant person or if you have an infant, be sure to talk about RSV with your physician. They can definitely advise you on the best course of action.

Unger: All right, Andrea. Patients are also wondering when they should get each of these shots. What can you tell us about that?

Garcia: Yeah, timing is definitely one of the questions we hear the most often. I know it's often, if you can get the flu and COVID vaccine at the same time, the answer to that is yes. And the advantage is that you can get it taken care of in a single appointment.

The goal is generally to get vaccinated before the virus is spreading in your community. So for example, if we were to talk about COVID circulating at the moment, as evidenced by those increase in hospitalizations that we talked about earlier, it's best to get that COVID vaccine as soon as possible, depending, of course, on the timing of your last vaccine or any prior infection.

In general, September and October are really good times to get the flu vaccine. Some people do choose to wait until later in the month of October to get their flu vaccine, and I think the rationale there is you know those antibodies wane over time, and you want to ensure you're protected when the virus is expected to be the most prevalent. But generally, September, October—getting it before October is—end of October is ideal.

And then, with RSV, because that vaccine is so new, we simply don't have a lot of data yet on co-administration. The CDC does say that co-administration with other adult vaccines is acceptable, but we know that research is still ongoing to inform guidance on that co-administration. So older adults who decide to get the RSV vaccine after talking to their physician should also discuss timing for that vaccine based on their individual circumstances.

Unger: All right. Andrea, again, thanks for walking us through all of that. We're going to switch it up here. COVID has not been the only public health issue that's been making recent headlines. Last week, the CDC released new data on drug overdose deaths in the U.S. Andrea, tell us more about that.

Garcia: Yeah, so the CDC shared data that show drug overdose deaths reached another record-high in the spring. We know that over 111,000 people died from a drug overdose over that 12-month period, ending in April of 2023. That's about 1,000 more lives lost in the past 12 months than were lost in the prior year.

We saw overdose deaths surge during the pandemic, and I think it's concerning that we're still continuing to see these numbers increase. I know you recently spoke to Dr. Mukkamala on Overdose Awareness Day, and the data he shared from the FDA tells a similar story. Overdose deaths continue to increase, and that's largely due, we know, to synthetic opioids like illicit fentanyl.

The FDA has approved two naloxone products for over-the-counter sale. It's too early to tell, though, what the impact is going to be on overdose deaths with this greater access to naloxone. We do know that's an important step in the right direction, as is increased access to evidence-based treatment.

Unger: Absolutely. And we'll be sure to include a link to that episode with Dr. Mukkamala in the episode description as well. Lastly, Andrea, there was a big announcement from the Red Cross, which declared a national blood supply emergency. Tell us more about that.

Garcia: Yeah, that's right. The Red Cross announced that the blood supply has fallen to critically low levels, and they're calling on more people to donate blood and platelets. Specifically, the blood supply has dropped nearly 25% since early August. That's significant because we know the Red Cross distributes about 40% of our nation's blood donations.

According to the Red Cross, climate disasters, which we know we've seen a lot of them this summer, are in part driving this shortage. And that's in part because disasters put a greater demand on our blood supply, but they also impact donations, because it makes it harder for people to get to donation centers and blood drives. The Red Cross also noted that August was an unusually busy travel season, which has resulted in a decline in donations.

Unger: So Andrea, how does this shortage translate to hospitals and physicians?

Garcia: Yeah, so the Red Cross says it needs to collect about 12,500 blood donations every day to meet the demands of hospitals and transfusion centers nationwide. We know that there are already hospitals at critical levels, and even one traumatic event could really deplete the blood supply in many parts of the country. There's no easy way to make up the shortage besides getting the word out and encouraging more people to donate blood.

In May of this year, we did see the FDA issue new guidance that removed those categorical restrictions on blood donations from men who have sex with men—something the AMA has long advocated for. This definitely broadened the pool of donors by determining the eligibility based on science and individual risk. And in fact, we just saw AMA President Dr. Jesse Ehrenfeld donate blood last week with his husband, Judd, marking that first time that they were eligible to donate blood since that FDA rule change.

We know 62% of the population is eligible to donate blood. Only about 2% to 4% of the population actually does. If you can donate blood, please consider it, and ideally, get into the habit and make doing it part of your regular routine.

Unger: Oh, that's such an important reminder for everyone, especially right now. We'll be sure to keep an eye on this issue. Andrea, thanks so much for joining us today and keeping us up to date. That wraps up today's episode and we'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.