Public Health

Flu season 2023: CDC guidelines for COVID, RSV and flu vaccines with Demetre Daskalakis, MD [Podcast]


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AMA Update

Flu season 2023: CDC guidelines for COVID, RSV and flu vaccines with Demetre Daskalakis, MD

Oct 2, 2023

Everything patients need to know about the flu season and vaccine this year from Demetre Daskalakis, MD, MPH, acting director of CDC’s National Center for Immunization and Respiratory Disease. Dr. Daskalakis shares who should get the flu vaccine, when the ideal timing is and how vaccination protects individuals and their loved ones. Dr. Daskalakis also provides an overview of the new vaccines for RSV and COVID and debunks common misconceptions about them and the flu vaccine. AMA Chief Experience Officer Todd Unger hosts.


  • Demetre Daskalakis, MD, MPH, acting director, CDC’s National Center for Immunization and Respiratory Disease

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about this year's flu vaccine campaign and what physicians and patients need to know about the upcoming flu season. Here to discuss this is Dr. Demetre Daskalakis, acting director of the CDC's National Center for Immunization and Respiratory Diseases in Atlanta. I'm Todd Unger, AMA's chief experience officer, in Chicago. Dr. Daskalakis, thanks so much for joining us today.

Dr. Daskalakis: Thank you so much, Todd. It's a pleasure to be here and really excited to talk about what Americans can do to protect themselves and their loved ones against flu and other respiratory viruses, which are likely to spread this fall and winter. So really happy to be here with you.

Unger: Well, before we get into the details of this year's flu season, why don't we start out by talking about last year's flu season? How did it play out, and was it more typical of flu seasons that we saw prior to the pandemic?

Dr. Daskalakis: So, Todd, the last flu season was actually the most severe we've had since the start of the COVID-19 pandemic. So it started earlier than usual. So when we think about the flu, it usually peaks in February. But last year, we actually had a surge in October. And we peaked in early December. And that really resulted in flu hospitalization rates that were the highest that we've seen in at least a decade.

So according to our preliminary estimates for that '22-'23 season, there are about 300,000 flu hospitalizations. And that's about three times higher than the previous year and 19,000 deaths. That's nearly four times higher than the previous year. But when you look at that in comparison to the seasons we've seen prior to the pandemic, it actually ranked as a moderate flu season.

Unger: That's interesting because October is coming up here pretty fast. From what I've read so far, flu activity is still relatively low at this time. I know you don't have a crystal ball here. And it's hard to predict with 100% certainty. But do we have any idea how this season might play out? How do you tell that?

Dr. Daskalakis: So, Todd, you're right. At the moment, the season's flu activity that we're seeing so far is low. But we definitely know that it's early. And we do expect flu activity to increase in the coming weeks. You're also right that it's really hard to predict flu.

So you probably heard the expression that if you've seen one flu season, you just see one flu season. So the timing, intensity and the severity of the upcoming season can't really be predicted. But we at CDC expect flu to spread this fall and winter. We know it's coming. And it's going to be coupled with its other viruses that like to circulate now around the same time, RSV and COVID-19.

So last fall and winter when we had all of these spreading simultaneously, that took a pretty significant toll on our health care system. And it ended up that at that time some hospitals didn't have enough beds, especially for children who are sick. So one of the important priorities that we have for this season is to prepare Americans as we head into another potentially busy fall and winter respiratory season.

So that actually includes taking advantage of what we know we've got, which are safe and effective immunization for some of the viruses, proven treatments and just the common sense precautions that we can use to protect ourselves as well as our loved ones against flu, COVID-19 and RSV. They're going to circulate at the same time.

Unger: Yes, as you mentioned, again, that word tripledemic entered our lexicon a few years ago. And as you point out, we've got tools to help us deal with that. And one way that that's handled is, of course, that the flu vaccine formulation changes every year based on what strains we predict are going to circulate. Do we expect it to be a good match this year?

Dr. Daskalakis: So you're right. Flu vaccines are updated every year based on the flu viruses that we are most likely to encounter in the upcoming season. So that is now a very routine piece of what we do for influenza. So we do that by looking at the flu viruses that are circulating in the Southern Hemisphere and the vaccine effectiveness measured against those viruses.

So this year, the vaccine protects against four strains, including flu A, H1N1. So flu vaccines have been shown to reduce the risk of having to visit the doctor by 40 to 60% and are estimated to prevent tens of thousands of hospitalizations each year even when we don't necessarily prevent the flu infection itself. CDC has deployed a digital campaign to seize it. If you haven't seen it, it's great. It's called Wild to Mild, which shows how flu vaccination contain flu symptoms, so, again, thinking about the wild animal like a grizzly bear to a mild teddy bear.

It was really well received by our consumer message testing participants who said that they really heard that flu vaccines could actually lessen symptoms and severity, that they appreciate how it helped change their expectations of what the vaccine can do. So like I said, we're going down our normal path. We're going to know more about vaccine effectiveness in the U.S. as we go forward. We know what's happened in the Southern Hemisphere. And we know that you can use vaccine to tame flu from wild to wild. So those I think are the core messages this year.

Unger: I love that messaging. Speaking to a marketer, I love from Wild to Mild. I totally get that message. Why don't we start talking a little bit about looking forward here. Can you review the current recommendations, especially the ideal time frame to get a flu vaccine and any changes that physicians out there should be aware of?

Dr. Daskalakis: Great question, Todd, Thank you. So CDC recommends that everyone six months and older with very rare exceptions gets a flu vaccine every season. Children who are six months through eight years of age may need two doses during a flu season. Everyone else, they only need one dose.

So flu vaccine, like I said, has a lot of important benefits. So it's that wild to mild idea, which I think if we can get that into the minds of providers, that's going to be really important. It can reduce flu illness, visits to doctor's offices, and missed work and school due to flu, as well as importantly making people feel not as bad, so symptoms become less severe and also cut back on the visits that people have to emergency departments, hospitalizations and then also ultimately the most severe outcome of flu, which is death.

So it's important to remember that even healthy children adults can get sick from flu. When you look back at last season, there were 174 pediatric deaths reported to CDC. 80% of those children, that's 8-0, were not vaccinated against flu. So these are really heartbreaking outcomes and things that we could prevent. So that Wild to Mild message it's really important regardless of people's underlying conditions or their age.

Flu vaccine works to tame the flu virus. So as for the timing, another great question, the best thing is to be vaccinated before the end of October. But we're going to keep drumming that drumbeat with vaccination as long as flu virus is circulating. So even if you're not able to get the vaccine until December or even later, it's never too late. Vaccine is still recommended as long as flu activity is being seen. And that often continues into May.

Unger: It sounds like it's about time for my annual email to my team encouraging them to get their flu shots. Again, I think a lot of people underestimate the seriousness of the flu. And again, why not tame that, again, from wild to mild? When we think about folks that are at serious, even more serious risk of complications from the flu, talk to us a little bit about that group. And why is it so important for physicians to make special efforts to reach them as well as marginalized groups?

Dr. Daskalakis: It's such an important piece and really like the centerpiece of the work that we do at CDC around respiratory seasons and vaccines. So these vaccinations are important for everyone, but they're especially important for people who are at higher risk of developing serious flu complications. So that includes infants, kids who are younger than five years of age, folks who are 65 years and older, pregnant people, people who have certain health conditions or if they have a weakened immune system or immunocompromised.

So folks in those groups are more likely to get more severe flu symptoms as well as those other complications. So it's more likely that the flu is going to be wild for them, so even more important to tame it to mild. So it's really important for physicians to use that tool and reach these populations.

Also, we know that some of the fault lines that we see in equity in the country with so many other interventions, racial and ethnic minority groups, including Black, Hispanic, American Indian and Alaska Native Americans are actually at the highest risk for being hospitalized with flu but are also less likely to get vaccinated. So everyone who cares for populations needs to have this in their mind to really promote strategies that help improve health equity and then also make sure that as we prioritize vaccine for everybody, we really prioritize it for people who are at the highest risk.

Unger: So important. Well, that brings us to this year's AMA, CDC and Ad Council flu vaccine campaign, which launched with a media tour on September 19. Talk to us a little bit about the goal of the campaign.

Dr. Daskalakis: So it's really exciting. The Ad Council, AMA and CDC launched their annual Get My Flu Shot campaign with really broad messaging, but also really having that equity focus on mind, focused on Black and Hispanic audiences especially to try to increase their vaccine coverage, which begins with increasing their vaccine confidence and trust in the vaccine and the system, as well as to reduce some of the historical disparities that we've seen in those populations. Remember just a second ago, I told you that we see disparities in who gets the vaccine. And that is also reflected in disparities in terms of who gets sick.

So AMA, CDC the Ad Council have a really rich history of collaboration on public health campaigns, really trying to combine clinical and public health expertise with media and advertising to really inspire folks to go from maybe I'll have a flu vaccine or should I have a flu vaccine to actually doing it. So this public service announcement is going to run nationwide in English and Spanish across multiple platforms.

And, again, that's actually in time and also space donated by media throughout this flu season. So all hands on deck. And so I think messaging in all of those directions with that focus on equity and that get it from Wild to Mild strategy is going to be so important this year.

Unger: Well, in addition to the campaign, how can physicians help get the word out? And what are some of the top line messages they should be communicating to their patients about getting a flu vaccine, particularly this year? I love already from Wild to Mild. I'm sure that's on your list. What else?

Dr. Daskalakis: So first of all, let's just make sure everyone knows physicians are so important in getting people to get vaccine. So it's important that physicians are really our frontline, our first defense, the tip of our spear as it were to get the word out to Americans. So we really need to do a better job, all of us together, at getting people to roll up their sleeves to get a flu vaccine.

And like I said, medical providers, physicians are at the lead. So as you know, people are very receptive to getting a vaccine when they hear it from a physician or a medical professional. So physicians are amongst the highest esteem, trusted messengers. And they really play an important role in encouraging vaccination. I'll say that the other thing that's important is if you fail once, try, try again. Sometimes people need to hear it over and over again.

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So it's a no at visit one. Maybe it'll be a yes at visit two. Just have to keep it on your list.

With misinformation and disinformation really driving people to have lower confidence in vaccination, it's really critical and critical now that physicians have really honest conversations with patients and as a credible voice share really credible information recommendations. So if you don't offer flu vaccine at your facility, it's really important to make a referral, know where people can go, and also put that on your list for follow-up to see if patients actually got their vaccine, got their appointment and got vaccinated. And I always say if you can, spread the wealth. Think about all the other people working with you in your practice to put that on their radar as well so they make sure that they remind folks as well.

So what's the top line for flu? Get an annual flu shot because it's the best way to reduce your risk from flu and its serious complications, Wild to Mild. Getting a flu shot is something we can all do to help slow the spread of flu and keep ourselves, our families and communities protected. And again, Wild to Mild, part 2, a flu vaccine won't always keep someone from getting sick. But, again, it can tame the most severe symptoms, reducing the risk of serious illness, and then ultimately hospitalization and potentially death.

So whenever in doubt, there's a little mnemonic that we have here at CDC. It's called SHARE. So Share the reasons—that's the S—why the flu vaccine is right for the person in front of you. Highlight or H positive experiences with flu vaccines, whether it's your own or in practice to really reinforce and strengthen confidence in the vaccine. People listen to stories, especially if it's yours.

A, Address patient questions and concerns about the flu vaccine. And that also means not shying away about talking about side effects and vaccine effectiveness. The R in SHARE is Remind. And that's remind patients that flu vaccines protect them and their loved ones from serious illness and complications.

And then, finally, Explain, just, again, transparency. Explain the costs and consequences of getting a flu shot. So health care providers, we are also important in giving folks other information about the sort of common sense strategies that may prevent flu like washing your hands, covering your cough and your sneezes the way that we all learn during COVID, and really importantly, if you're not feeling good, it's a good time to stay home. Also, it's prioritize and remind your folks who may be at higher risk for flu complications to make sure that they come on in to get their shot early.

Unger: Well, I think one question that folks will have too is about the different vaccines that are all available now going back to the tripledemic idea. We've got updated COVID vaccines that were just authorized last month. And for the first time this year, we also have vaccines for RSV.

So in some cases, people could be eligible for all three. And most of us are eligible for at least two, which can seem like a lot, especially for people that might be getting weary of vaccines. What's your advice to physicians about giving these vaccines all at once? What's the ideal timing, and how do they communicate that to patients?

Dr. Daskalakis: Thanks, Todd. So I'll say that my first thing I want to say is that we as physicians, we have to be the cheerleaders here. So I think that there are so many things that people are weary about in prevention, whether it's diet change or all of the other things that we do. But if we cheerlead and make a priority, I think that we're going to see that we're going to be able to move some of the weary into a zone of action.

So you're right. What's really exciting this year for the first time ever, we have immunizations available in the U.S. that are active against all three of these major respiratory diseases. It's great news. So I mean, it's been a year of breakthrough in preventing RSV.

CDC recommends a new long-acting monoclonal antibody called nirsevimab for all infants younger than eight months born during or entering their first RSV season and also for a smaller group of children between the ages of 8 and 19 who may be at increased risk of RSV disease. And that includes kids who are severely immunocompromised. So for them, a dose is also recommended in their second season.

So we also have new RSV vaccine recommended for use in pregnant people to protect their newborns from severe RSV after birth. So CDC recommends, and this just happened recently, a single dose of this vaccine. And it's really focused on people who are weeks 32 through 36 week of their pregnancy. And that's seasonally administered, so right around when RSV hits. And in most of the United States, that's really going to mean September through January.

So most infants are going to likely only need protection from either the RSV vaccine for pregnant people or the RSV antibody or nirsevimab for babies, not necessarily both. So we're going to leave the kids and talk about adults for a moment. For adults 60 years and older, CDC recommends that they could receive a single dose of one of two RSV vaccines. And that's a conversation that they need to have with their provider. It's a shared clinical decision-making discussion to see if that RSV vaccination is right for them.

So as for COVID, CDC is recommending an updated vaccine for everyone six months and older. And we've already talked about flu very similar guidance. So we believe that this new COVID vaccine will provide better protection against hospitalization and death from the variants that are currently circulating and will also help reduce the chances of some of the longer complications that we see with COVID.

And I'm specifically referring to long COVID. So immunity from infection and also previous vaccine weakens over time. So this is a little reminder for your immune system as well as a little introduction of some new immunity to some of the circulating strains so that it helps us restore and add additional depth and breadth to the immune protection that we have against COVID-19.

So on to the idea of can I get them all at the same time, co-administration of these vaccines is really a best practice for patients that you don't see very frequently. You can also give RSV vaccine at the same time in older adults, but it's worth thinking about if it makes sense for them. So just thinking about do we have to put this third one in here at this time or not or is it better to cycle it? But big picture, if you have someone in front of you, really consider that a best practice to give the vaccines that they're due for.

Unger: Excellent. Well, last question. You mentioned earlier about misinformation, disinformation. Are there any common misconceptions about any of these vaccines that pose barriers to uptake that are important for physicians to address?

Dr. Daskalakis: So, again, the physicians are the tip of that spear to increase confidence. And we know that misconceptions impact vaccine uptake. And so what we can say to our patients can go a long way in debunking that misinformation. So some people, as an example, think that they don't need a new COVID-19 updated vaccine because activity is lower than we saw in past years, but there's still thousands of hospitalizations and hundreds of deaths from COVID-19 that happened each week. And that includes children and adults with no underlying conditions.

So the updated COVID-19 vaccine will help protect people against serious illness this fall and winter. So that's one for sure. Some folks also think that they don't want a flu shot because it also gives them the flu. I think this is one that we're used to talking about a lot.

So it's important to continue that drumbeat of combating this age old myth and reinforce that flu vaccines cannot cause flu illness. But clarify that they can trigger an immune response. And sometimes that means that you may have some mild symptoms. That's not the flu.

Also, remember that sometimes flu circulates around the same time that people get the vaccine. So important to let them know that it's too too and unrelated if they do get the flu after the vaccine. But side effects from the vaccine, like aching muscles or low-grade fever, we should just make folks expect that that could happen so that they better understand.

Also, we'd like to remind physicians that they have the most influence over whether a patient chooses to get vaccinated, whether it's for COVID-19, flu or RSV if eligible. So it goes back to that tip of the spear conversation. So we really encourage docs to have a conversation with their patients over the next several months so they can protect our patients. Thank you.

Unger: Dr. Daskalakis, this has been an excellent overview. Really appreciate you coming here and sharing all this information. I know it must be a busy time for you. That wraps up today's episode. We've got links to helpful resources in the description of this episode.

And once again, for more information on this year's flu vaccine campaign, visit Make sure you know how to tame that flu virus and turn it from Wild to Mild. 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 today. Please take care.

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