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Advisory: Need to Increase Immunization Coverage, Use of Therapeutics for Respiratory Illnesses

Health Alerts Posted on December 15, 2023

Health Advisory: Urgent Need to Increase Immunization Coverage and Use of Therapeutics for Respiratory Illnesses

December 15, 2023

Action Requested 


  • Be aware that CDC has issued an advisory regarding the urgent need to increase immunization coverage for influenza, COVID-19, and RSV and use of authorized/approved therapeutics in the setting of increased respiratory disease activity during the 2023-24 winter season.
    • Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks. 
    • In addition, a recent increase in cases of multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection in the United States has been reported.
  • Providers should leverage all available tools to increase immunizations against influenza, COVID-19, and RSV. CDC has developed communication tools including a conversation guide and immunization call-back message template to aid provider efforts in increasing immunizations in their patient populations. Additional tools can be found at CDC’s Healthcare Provider Toolkit: Preparing Your Patients for the Fall and Winter Virus Season.
  • Healthcare providers should administer influenza, COVID-19, and RSV immunizations now to all patients, if recommended.
    • Everyone 6 months and older should receive a 2023–2024 seasonal influenza vaccine. Most people need only one dose for the season. Some children ages 6 months–8 years need two doses spaced 4 weeks apart. Adults ages 65 years and older should receive high-dose, adjuvanted, or recombinant influenza vaccine, if available.
    • Everyone 6 months and older should receive at least one dose of an updated 2023-2024 COVID-19 vaccine. More than one dose may be needed for children 6 months through 4 years, immunocompromised patients, and unvaccinated persons 12 years and older who choose to receive the Novavax vaccine.
    • Adults 60 years and older may receive one dose of RSV vaccine using shared clinical decision-making. Both Pfizer Abrsyvo and GSK Arexvy are approved for use in adults 60 and older. Individuals and their providers should consider the patient’s risk for severe RSV disease. Older adults at highest risk of severe disease due to RSV include those with cardiopulmonary disease and those living in long-term care facilities.
    • There are two options to protect infants against RSV-associated lower respiratory tract disease: RSV vaccine for pregnant people and nirsevimab for infants.
      • Pregnant people 32 through 36 weeks gestation should receive RSV vaccination. Only the Pfizer RSV vaccine (Abrysvo) is recommended pregnant people . GSK Arexvy is not recommended for use in pregnant people.
      • Nirsevimab is recommended for infants <8 months, as well as some infants aged 8 through 19 months at increased risk. Because RSV activity is surging across all continental U.S. regions, providers should use available nirsevimab doses expeditiously rather than reserving nirsevimab doses for infants born later in the season. In settings with limited nirsevimab availability during 2023–2024, please see the recent CDC HAN Health Advisory about limited availability of nirsevimab in the United States for further guidance. Neither Pfizer Abrysvo nor GSK Arexvy is approved for infants or children.
      • Either RSV vaccination of pregnant people (Pfizer Abrysvo) or nirsevimab immunization for infants is recommended to prevent RSV-associated lower respiratory tract disease in infants; administration of both products is not needed for most infants.
  • For MIS-C, a new CSTE/CDC MIS-C case definition went into effect in January 2023 and updated MIS-C treatment guidelines were released in July 2023. Providers are encouraged to report cases of MIS-C to their jurisdictional health department. Call 425-339-3503 to reach the Snohomish County Health Department Communicable Disease program by phone.
  • Antiviral medications are currently underutilized but are important to treat patients, especially persons at high-risk of progression to severe disease with influenza or COVID-19, including older adults and people with certain underlying medical conditions.  
  • Healthcare providers should counsel patients about other everyday preventive actions they can do to protect themselves against respiratory diseases including testing, covering coughs and sneezes, washing hands wearing a well-fitting mask if a patient chooses to wear a mask, and improving ventilation in home and work environments. 

Background

Reports of increased respiratory disease have been described in multiple countries recently. CDC is tracking increased respiratory disease activity in the United States for several respiratory pathogens, including influenza viruses, SARS-CoV-2, and RSV, across multiple indicators such as laboratory test positivity, emergency department visits, wastewater, and hospitalizations. Currently, the highest respiratory disease activity in the United States is occurring across the southern half of the country, with increasing activity in northern states.

In the past 4 weeks, hospitalizations among all age groups increased by 200% for influenza, 51% for COVID-19, and 60% for RSV. As of December 1, 2023, the weekly percentages of pediatric emergency department visits for pneumonia due to multiple etiologies were increasing since September in children, but remains consistent with prior fall and winter respiratory activity. To date, 12 pediatric influenza deaths have been reported during the 2023–2024 season. From September 1 through December 10, 2023, CDC received 30 reports of MIS-C, a rare complication that typically occurs 1 month after SARS-CoV-2 infection, with illness onset among cases occurring from August 6 to November 9, 2023, a relative increase compared with previous months. High RSV activity is also occurring across much of the United States.

Influenza, COVID-19, and RSV can result in severe disease, especially among unvaccinated persons. Infants, older adults, pregnant people, and people with certain underlying medical conditions remain at increased risk of severe COVID-19 and influenza disease. Infants and older adults remain at highest risk of severe RSV disease; it is the leading cause of infant hospitalization in the United States.

Vaccination for influenza, COVID-19, and RSV reduces the risk of severe disease, including pneumonia, hospitalization, and death. Vaccination for COVID-19 can also reduce the risk of MIS-C and post-COVID conditions.

See full CDC HAN Advisory for additional information

Additional Resources


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  2. 3020 Rucker Avenue
    Everett, WA  98201
    Phone: 425-339-5200

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