Respiratory virus season has begun, and three viruses could affect its severity and timing: influenza, COVID-19 and respiratory syncytial virus, known as RSV. All three have the potential to cause significant loss of productivity from missed work and school, as well as hospitalization and death.
Influenza season in the U.S. usually begins in October and peaks between December and February. RSV season generally begins in October and peaks in December, but since the COVID-19 pandemic, RSV season has begun earlier and lasted longer, about 33 weeks. COVID-19 continues to circulate year-round, but seasonal spikes have been identified for November through April globally.
A similar number of hospitalizations is expected for the upcoming season as compared with last year, according to the annual forecast from the Centers for Disease Control and Prevention. The CDC notes that there could be more widespread illness and strain on the health care system if a new, more pervasive or severe COVID variant emerges, or if there are severe, coinciding waves or peaks of influenza, COVID or RSV.
Here’s a look at the coming respiratory virus season and actions states can take.
Respiratory Syncytial Virus
Respiratory syncytial virus is a common respiratory infection that usually causes cold-like symptoms. Although most people recover from RSV within a week or two, infants and older adults are at risk for developing severe complications. People in long-term care facilities and those who are immunocompromised or have chronic health conditions are also at increased risk for severe RSV.
RSV in the United States, by the Numbers
- 58,000-80,000: Number of children under 5 years of age who are hospitalized annually due to RSV.
- Up to 160,000: Number of adults 65 and older who are hospitalized annually from RSV; 6,000-10,000 of those patients die.
Source: Centers for Disease Control and Prevention
Vaccination for Older Adults
Two vaccines, recently approved by the Food and Drug Administration and recommended by the CDC, are now available to protect older adults against RSV: Arexvy, from GlaxoSmithKline, and Abrysvo, from Pfizer. The CDC recommends a single dose of either vaccine for people 60 and older, in consultation with a health care provider.
Protection for Infants
RSV is the primary cause of infant hospitalization in the U.S. To prevent severe illness, infants can now receive the FDA-approved monoclonal antibody treatment nirsevimab. The treatment, known by the brand name Beyfortus, reduces the risk of RSV-related respiratory tract infections in infants by 74.5%.
The CDC’s Advisory Committee on Immunization Practices recommends Beyfortus to protect newborns and infants under 8 months born during or entering into RSV season, and children under 20 months who remain vulnerable entering their second RSV season. Beyfortus is administered by an intramuscular injection like a vaccine.
Vaccination During Pregnancy
The FDA recently approved the Pfizer vaccine Abrysvo to be administered during pregnancy to protect infants from RSV during the first six months of life. The vaccine was shown to be effective at reducing the risk of severe lower respiratory tract disease from RSV by 82% within 90 days after birth and by nearly 70% within the first 180 days after birth.
The CDC recommends the RSV vaccine for pregnant people to protect their babies from severe RSV disease. Pregnant people should get a single dose of the Abrysvo vaccine during weeks 32 through 36 of pregnancy during September through January. Most infants will need protection from either the infant vaccine or maternal vaccine, but not both.
Influenza
The flu causes notable productivity loss every year and can lead to hospitalization and sometimes death. The CDC estimates that the flu has resulted in 140,000-710,000 hospitalizations and 12,000-52,000 deaths annually in the U.S. Although most people who get the flu recover without serious complications, older adults, very young children, pregnant people and those with certain chronic medical conditions are at risk of serious illness.
The CDC recommends annual flu vaccination for everyone 6 months and older who does not have contraindications (conditions that increase the risk for a serious adverse reaction), and strongly encourages it for people at high risk of serious flu complications. The ideal time for receiving a flu vaccine is September or October, but vaccination should continue throughout the season as long as the vaccine is available.
There are several flu vaccine products available. For people 65 years and older, the CDC recommends one of three vaccines. Studies indicate these vaccines may be more effective than standard flu vaccines for older adults.
COVID-19
COVID-19 has caused between 10,000-20,000 COVID-19 hospitalizations per week since March. The FDA recently approved and authorized for emergency use two updated COVID-19 vaccines manufactured by Moderna and Pfizer. The vaccines have been formulated to more closely target currently circulating variants and provide protection against serious consequences of the virus.
The CDC recommends that everyone 6 months and older get an updated COVID-19 vaccine to protect against potentially serious outcomes of COVID-19 this fall and winter. The recommended timing and number of doses varies with age and prior vaccination. The vaccines will be available at no cost to uninsured people through the federal Bridge Access Program through December 2024.
State Policy Options
States have explored many ways to help decrease the burden of respiratory viruses, including:
- Expanding scope of practice and authority for certain health care providers to administer respiratory virus vaccines for greater access and convenience.
- Enhancing access to childhood vaccines for low-income or uninsured populations through the Vaccines for Children Program.
- Exploring protections for vulnerable populations, such as residents in long-term care facilities and patients recently discharged from hospitals.
Expanding Scope of Practice
Several states have enacted bills in 2023 to expand the scope of practice of certain professions to include the administration of vaccines. For example, Illinois passed legislation that allows podiatrists with certain training to administer the flu, tetanus and COVID-19 vaccines to people 18 years and older. Nevada passed legislation that allows dentists, dental hygienists and therapists with a special endorsement to administer immunizations, and West Virginia allows dentists to administer vaccines during a declared public health emergency. New Hampshire now allows optometrists to administer the flu, COVID-19 and shingles vaccines.
Every state allows pharmacists to administer vaccines, but laws regarding vaccine authority for pharmacists vary in three major areas: which vaccines a pharmacist can administer; the ages of patients a pharmacist can administer to; and whether a patient needs a prescription from another health care provider.
At least 11 states enacted legislation this year regarding pharmacists’ authority to administer vaccines. New Hampshire now allows pharmacists to administer the new RSV vaccine to older adults. Connecticut allows pharmacists to administer any FDA-approved and CDC-recommended vaccine to patients 18 years and older. As of September, the CDC recommendations include the RSV vaccine, along with the flu and COVID-19 vaccines, for older adults and pregnant people.
Montana passed legislation that allows a pharmacist or pharmacy technician with a collaborative practice agreement to administer flu vaccine to anyone age 12 or older and to administer any CDC-recommended vaccine to those 7 and older. Kansas now allows pharmacists and pharmacy techs to administer flu vaccine to anyone older than 5 pursuant to certain protocols.
Vaccines for Children Program
Vaccines for Children, or VFC, is a federal program that provides vaccines at no cost for children whose families are unable to pay for them. The CDC purchases vaccines for distribution to registered VFC providers. Eligible children can receive CDC-recommended vaccines.
At least four states—Georgia, Illinois, Louisiana and Michigan—passed legislative resolutions in 2023 urging the CDC to add the new RSV technologies, including vaccines and monoclonal antibodies, in the VFC program. In August, the CDC’s immunization advisory committee voted unanimously to include Beyfortus in the program, and the CDC is currently working to add Beyfortus as well.
At least two states recently enacted measures to help to ensure eligible children can receive vaccines through VFC. Michigan now requires pharmacists who do not participate in VFC, and are administering a vaccine to someone younger than 19, to inform the family that they may qualify for the program and provide locations of local providers. Colorado recently passed a bill that allows pharmacists to receive reimbursement for the administration of vaccines to children through the medical assistance program if the pharmacist is enrolled in VFC.
Protections for Vulnerable Populations
A study of almost 3 million residents of long-term care facilities found that, from 2011-2017, about 11,000 cardiorespiratory hospitalizations were caused by influenza and RSV, for an estimated cost of $91 million. To minimize the financial burden, many states have taken measures to reduce the transmission of respiratory viruses in these facilities.
Thirty-two states have flu vaccination provisions for patients or residents of long-term care facilities. For example, New Jersey requires its facilities to document evidence of annual flu vaccination for each resident. Virginia requires certified nursing facilities to provide or arrange for flu shots for residents, and North Carolina requires flu vaccines for nursing home residents and employees. With the recent approval of RSV vaccines for older adults, states may consider creating programs like those for flu vaccination that would allow for convenient RSV vaccination in these facilities.
People recently discharged from the hospital also can be at risk of acquiring a severe respiratory virus. At least 16 states have passed laws that require hospitals to offer flu vaccination to patients. For example, Ohio requires hospitals to offer the vaccine to each admitted patient, and Georgia requires hospitals to offer flu shots to patients 50 and older prior to discharge.
For more information on vaccination policies, see NCSL’s State Public Health Legislation Database and the State Legislatures News story “Lawmakers Turn to Data Systems to Guide Vaccine Decision-Making.”
Shannon Kolman is a senior policy specialist and Claudia Meyer is an intern in NCSL’s Health Program.
This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $250,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.