Should Long COVID Patients Get the Flu, RSV, and New Booster Shots?

Tinker Ready

September 11, 2023

The first thing up on the Dartmouth Hitchcock Medical Center website in late August was a question: Are you up to date with your vaccines?

For people living with long COVID and other chronic conditions, the answer may not be so clear.

Three shots are coming on line this fall, including a new vaccine for respiratory syncytial virus (RSV). With flu season approaching, as well a pending update to the COVID-19 shot, people with long COVID will have to make some choices.

The Centers for Disease Control and Prevention (CDC) advises everyone to get the COVID vaccine and a flu shot. The RSV vaccine is recommended for those over 60 and with weakened immune systems, and federal health experts suggest younger individuals, pregnant women, parents, and others talk to their doctors about the pros and cons of receiving the RSV vaccine.

But the CDC is not specifically saying whether long COVID patients should get the new COVID boosters, flu shots, or RSV vaccines. A CDC spokesperson said the agency could make no one available to discuss whether long COVID patients should get a COVID vaccine, and the Food and Drug Administration (FDA) referred similar questions to the CDC.

Last fall, federal health officials urged people to get their COVID booster and flu shot at the same time — but in separate arms.

In terms of vaccine guidelines, some professional medical groups, like the American Academy of Family Physicians, defer to the CDC. The FDA’s label for the RSV vaccine makes no mention of long COVID. Long COVID is not on the CDC’s list of vaccine contraindications.

Despite the lack of clear guidelines from the CDC, some experts and healthcare organizations say people with long COVID should get the new COVID booster and the flu shot, and should talk with their doctors about whether the RSV vaccine is right for them.

At Oregon Health and Science University (OHSU), Portland, for instance, researchers have created a guide to educate primary care doctors on how to recognize and treat long COVID. Eric Herman, MD, who helped set up the OHSU long COVID program in 2021, recommends the flu, COVID, and RSV vaccines to individuals with long COVID.

Paul Sax, MD, clinical director of the infectious disease clinic at Brigham and Women’s Hospital in Boston, Massachusetts, acknowledged an absence of clinical trial data on vaccines for people with long COVID. But he said the COVID and flu shots may benefit people with the condition.

"People with long COVID may be susceptible to postinfectious, prolonged fatigue illnesses, and these are more likely with the severity of the illness," he said in an email. "Since the vaccines reduce disease severity (and initially prevent infection), anything that mitigates disease severity would be beneficial to them."

On the RSV vaccine, he agrees with the (FDA) that this is a shot that benefits "shared decision making" — a doctor and a patient weighing risks and benefits before proceeding. He would only recommend RSV to "people at the extremes of older age, immunocompromised, or with multiple other medical problems," he wrote.

Jeffrey Parsonnet, MD, co-director of Dartmouth Hitchcock’s Post-Acute COVID Syndrome Clinic in Lebanon, New Hampshire, said nothing in the medical literature raises concerns about vaccines for people with long COVID. However, he said it is reasonable for some people to be cautious and to talk to their doctors about the pros and cons before making a decision.

Parsonnet said he's not getting many questions about the flu or RSV vaccines from his patients with long COVID, as neither one has rolled out yet. But he gets a lot of questions about the COIVD boosters. He added that many of his patients who contracted long COVID did so after a second infection.

He tells those already vaccinated to skip the current boosters if they had a bad reaction in the past. The vaccines are great at preventing death and hospitalization, he said. "I’ve had every vaccine right on time and I’ve had it twice," he said.

If the new vaccine booster due this month proves effective, he said, he would be likely to recommend the shot.

The fall COVID-19 vaccines are an improvement on the exiting vaccine, but the virus is mutating quickly. In late August, President Joe Biden called for another update.

For anyone who is vaccine hesitant, Parsonnet advises a wait-and-see approach on RSV. Until recently, RSV was considered a childhood disease, he said, but a growing death rate among older adults led to a vaccine. He said he qualifies by age and will be getting it.

His general advice: "I think doctors should follow the recommendations of our public health authorities," he said. "That’s what I would do."

Advocates for people with long COVID and other chronic health conditions have complained that there is little research into how vaccines impact their health. For years, people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is common among people with long COVID, have been reporting both improvement and declines after vaccines or infections.

A recent Mayo Clinic study of about 500 patients found that vaccination lowered the risk for long COVID and reduced the severity when it did occur. Vaccinated patients are less likely to report loss of smell, chest pain, dizziness, numbness, shortness of breath, and weakening.

Herman, with Oregon Health and Science University, noted that most people get their vaccines from primary care doctors, which is why OHSU’s long COVID program created a guide for primary care doctors who need help treating a new condition.

"The OHSU Long COVID-19 Program generally recommends that patients experiencing chronic COVID-19 symptoms obtain all preventative vaccinations (including flu, COVID, and RSV) for which they are eligible, while also recommending that patients directly discuss any questions or concerns they may have about vaccination with their health care provider," he said.

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