This coming winter could be the worst flu season in years since last winter we had one of the lowest incidences of flu cases and deaths because of the isolation techniques, mask wearing and hand washing so many people used to try to prevent COVID-19 (JAMA, published online August 25, 2021). Since very few people will have natural immunity from getting the flu last winter, we can expect a marked increase in flu cases and deaths this year. Most winters, 75 to 150 children die of influenza in the U.S. Last winter we had only one recorded child death from flu.

You need to get the flu vaccine each year because last year’s vaccine offers little protection in the current year. Flu viruses mutate frequently and each year’s strain has a different structure than the virus that appeared the previous year. However, all flu viruses do share some of the same surface proteins, so infection or vaccination with one flu virus can help reduce the severity of infection with a different strain of flu.

Everyone over six months of age should be immunized for the flu, with few exceptions. You are at increased risk for complications of flu if you have other serious conditions such as high blood pressure, obesity, diabetes, heart disease, lung disease or organ damage, or are over age 65.
• All presently available flu vaccines will contain four different flu viruses.
• Special high-dose flu vaccines are available for people over 65.
• Flucelvax Quadrivalent is now approved for people over age two.
• Flu vaccines and COVID-19 vaccines can be given at the same time.
• It takes at least two weeks for the flu vaccine to protect you.

Where to Get a Flu Vaccination
You can get a flu vaccine at your doctor’s office, health department, pharmacies, drive-through immunization services, curbside clinics, mobile outreach units, or home health visits.

Who Should Not Get a Flu Vaccination?
• Infants younger than six months of age are too young to get a flu shot.
• People with severe, life-threatening allergies to any ingredient in a flu vaccine should not get that vaccine.
• People who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. If you have had a severe allergic reaction to an influenza vaccine in the past, talk to your health care provider.
• If you have ever had Guillain-Barré Syndrome (GBS), check with your health care provider.
• If you are not feeling well, postpone your flu vaccination until you have recovered.
• Do not get a flu vaccine if you think you currently may be infected with COVID-19.

Flu and COVID-19
• Get vaccinated for both flu and COVID-19, even if you have had COVID-19. Unvaccinated people who already had COVID-19 are more than twice as likely than fully vaccinated people to get COVID-19 again (MMWR Morb Mortal Wkly Rep, 2021;70:1081-1083).
• A flu shot will not protect an unvaccinated person from suffering COVID-19, but it may reduce your chances of developing severe COVID-19 disease (MedRxiv, June 2020, preprint).

My Recommendations
With few exceptions, I believe that most people should get both the flu and COVID-19 immunizations.