The new year is bringing a significant rise in respiratory virus activity across the U.S. Many are experiencing coughs, fever and congestion — some of the telltale signs of COVID-19 and influenza. Dr. Nipunie Rajapakse, a Mayo Clinic pediatric infectious diseases expert, explains why this surge is happening, what still may be to come, and how to protect you and your family.

"We have seen increasing rates of COVID-19 and influenza. Influenza season has not yet peaked, we expect that to happen sometime in the coming weeks. But we are seeing kind of increase in cases and hospitalizations related to both of these viruses," says Dr. Rajapakse.

Watch: Dr. Nipunie Rajapakse discusses increasing levels of respiratory infections

Journalists: Broadcast-quality sound bites with Dr. Rajapakse are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Nipunie Rajapakse, M.D./Pediatric Infectious Diseases/Mayo Clinic.

Influenza

As the U.S. approaches the peak of the flu season, Dr. Rajapakse says it's not too late to get vaccinated, and she encourages everyone 6 months and older to get this season's flu shot, which she says could help keep you out of the hospital with the flu this season.

A recent report from The Center for Disease Control and Prevention shows seal flu activity continues to be elevated in most parts of the country. Dr. Rajapakse says the trend is concerning.

"We have already this year seen about 20 children who have unfortunately died from influenza already, and the reports coming out are that many of these children and children who are being hospitalized with influenza are those who have not been vaccinated yet," says Dr. Rajapakse.

The influenza strains that are circulating so far this season appear to be well matched to those included in this year's formulation of the vaccine.

COVID-19

"The current predominant variant of COVID-19 circulating in the United States is called JN.1. This variant has some mutations that allow it to escape immunity a bit better — immunity from either vaccination or other prior infection," says Dr. Rajapakse.

She says, thus far, JN.1 doesn't seem to be causing more severe illness, but people who haven't had a recent infection or didn't get the updated COVID-19 vaccine are tending to get sick with this new variant.

"The updated COVID-19 vaccine is providing some protection against this JN.1 variant. It is a descendant of the omicron variant. And so, therefore, there is some cross-protection that would be conferred from that vaccine."

Low vaccination rates could make for more severe flu season

The Centers for Disease Control and Prevention (CDC) warns about low vaccination rates amid rising cases of illness. Seven million fewer flu vaccines were administered to adults in 2023 compared with 2022. Only 16% of adults have gotten the updated COVID-19 vaccine. The new RSV vaccine for adults 60 and over only has an uptake rate of 15%–16%, according to CDC data.

"Because the last few flu seasons especially have been relatively mild, as people were adhering to precautions around COVID-19, really immunity in the population as a whole is dependent on people getting vaccinated because we just don't have that kind of natural immunity that comes from having a recent influenza infection," says Dr. Rajapakse. "The fact that influenza vaccination rates are extremely low this year really kind of sets us up for a situation where we can see a lot of people getting sick with flu infection."

Related posts:

• Mayo Clinic Minute: Why do more people get sick with viruses in the winter?
• Mayo Clinic Minute: Update adult vaccinations for a new year

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Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:10) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"It's a really interesting phenomenon that we see with respiratory viruses like COVID-19 and influenza, where we see almost annually this surge of infections during the cooler months in the Northern Hemisphere. It usually happens anywhere between November and the end of February," says Dr. Binnicker. "Most people think that it's just due to more people being indoors, which I think plays some role in it."

Dr. Binnicker says another factor is humidity.

"In the warmer months, there's more humidity," he says. "And when we speak, when we cough, when we sneeze, the larger amounts of moisture in the air causes whatever droplets we release from a cough, sneeze or talking to be bigger. Those droplets are larger in size, and they fall to the ground, they fall to the floor faster."

But, in the winter, when the air is drier, those droplets that may contain a virus can hang in the air for longer periods of time and can spread further.

It also turns out that a person's immunity is not functioning as well in the winter months. That's because cilia, which are small, hairlike projections in the upper respiratory tract that usually move foreign objects out of your nose, don't function as well during the cooler temperatures and lower humidity.

"So a virus is able to persist in our upper respiratory tract for longer periods of time," says Dr. Binnicker.

Besides taking precautions like getting vaccinated and practicing good hand hygiene, Dr. Binnicker says humidifiers may help prevent the transmission of these viruses.

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In this Mayo Clinic Minute, Dr. Matthew Binnicker, director of the Clinical Microbiology Molecular Lab and co-director of the Clinical Virology Lab at Mayo Clinic, explains the multipronged approach he recommends for preventing and reducing viral infections during the holiday season.

Watch: The Mayo Clinic Minute

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"Getting vaccinated is the first and foremost best step that we can take to help prevent ourselves from being infected with influenza, COVID-19 and, in certain groups, RSV," says Dr. Matthew Binnicker.

If you do feel sick, it's better to have a case of FOMO, or fear of missing out, than risk exposing others to your illness.

"It's really hard to do during the holidays because you want to get together with family and friends. But if you feel sick, whether that be a gastrointestinal illness or a respiratory illness, what you need to do is stay home," says Dr. Matthew Binnicker.

Another strategy to consider is testing for COVID-19, the flu and RSV before traveling or attending gatherings.

"If you're going to be getting together with a group where there might be someone who is at higher risk for severe disease, so if there's really young children who are going to be present, or if there's an elderly individual or anyone who is immunocompromised, taking a test the day of or right before the event can help catch whether someone unknowingly has a high amount of the virus," says Dr. Binnicker.

Finally, don't forget to wash your hands before and after getting together with people, especially when food is involved.

Additional resources:

• Mayo Clinic Minute: You’re washing your hands all wrong
• Fight off the flu with immune-boosting nutrients

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DEAR MAYO CLINIC: The Food and Drug Administration recently approved two new COVID-19 vaccines from Pfizer and Moderna. What are the recommendations for who should get it?

ANSWER: The Centers for Disease Control and Prevention has recommended the 2023-2024 COVID-19 (mRNA) vaccine for everyone 6 months or older. The COVID-19 vaccine is strongly recommended for people who face the highest risk of experiencing complications from the virus. This group includes older people, those with compromised immune systems and chronic medical conditions such as diabetes and heart disease, and very young children. If you're young and healthy, the vaccine may not benefit you as much, but you still should consider getting it if you live with someone in one of these categories or want to reduce the risk of a COVID-19 infection.

Overall, there is little to no harm in getting the vaccine for protection. For most of the population, the risks from the vaccine are much less significant than the risks from COVID-19 itself. While getting the vaccine does not prevent all COVID-19 cases, the latest vaccines aim to reduce the number of hospitalizations, severe illnesses and deaths from the virus.

Even if you have had COVID-19 previously or have been vaccinated, it is important to get the updated COVID-19 vaccine because the immunity from previous vaccines and infections decreases over time. Another benefit has to do with immune innovation — when the virus changes, it can escape the antibodies you’ve formed in reaction to the previous versions of the vaccine. By getting the updated vaccine, you are protecting yourself against the strains that are currently circulating.

The 2023-2024 COVID-19 vaccines produced by Moderna and Pfizer target a different strain of COVID-19 than was in the original vaccine. Think influenza vaccines — they are all flu vaccines, but the strains they protect against change year after year.

The updated vaccine targets the XBB.1.5 strain that has been circulating throughout the U.S. and most parts of the world since the start of 2023. The World Health Organization has labeled XBB.1.5 as the most transmissible omicron strain to date.

The updated 2023-2024 COVID-19 vaccine is the only COVID-19 vaccine currently available. Essentially, with the approval of the new vaccine, the older vaccines have lost their approval.

Other methods to protect yourself from COVID-19 include getting enough sleep and exercise. Avoid highly crowded indoor spaces and consider wearing a mask when you cannot avoid those situations. If you become sick, wear a mask to protect those around you and stay home to avoid exposing people at your workplace and elsewhere.

The COVID-19 vaccine and the influenza vaccine can be given at the same time. Keep in mind that there is no way to tell the difference between flu, cold, respiratory syncytial virus (RSV) or COVID-19 symptoms besides testing.

Visit Vaccines.gov to find vaccination providers near you. Information may be limited in some states. Text your ZIP code to 438829 or call 800-232-0233 to find vaccine locations near you in the U.S. — Dr. Priya Sampathkumar, Infectious Diseases and Occupational Medicine, Rochester, Minnesota

________________________

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The post Mayo Clinic Q and A: Who should get the latest COVID-19 vaccine? appeared first on Mayo Clinic News Network.

Those symptoms include:

• Fever
• Cough
• Sore throat
• Runny nose
• Body aches

Matthew Binnicker, Ph.D., director of the Clinical Virology Laboratory at Mayo Clinic, says it is possible for people to contract more than one virus at the same time.

Watch: Dr. Matthew Binnicker discusses COVID-19 and influenza.

Journalists: Broadcast-quality sound bites are available in the downloads at the bottom of the posts. Name super/CG: Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic

"We've seen patients that are unfortunate enough to contract COVID-19 and influenza," says Dr. Binnicker. "There are patients who have COVID-19 and other viruses as well, that are not infected with influenza. They typically have similar symptoms. Some of the cases have been more severe because they're infected with multiple viruses. It’s not a high occurrence, but it does happen."

If someone were to develop flu-like symptoms, the first step Dr. Binnicker recommends is getting tested for COVID-19. Your healthcare provider also can order a test for influenza and RSV.

"We have lab-based PCR tests that test for influenza and respiratory syncytial virus, or RSV, at the same time, and some of the tests that we have in our laboratories will also include COVID-19," says Dr. Binnicker.

Prevention is key

"Prevention is key, and there are a number of ways that we can help to do that. The first and foremost way to prevent influenza, COVID-19, and even RSV for select groups, is vaccination," says Dr. Binnicker.

It is safe to receive the COVID-19 and flu vaccines at the same time. The Food and Drug Administration (FDA) recently approved updated COVID-19 vaccines that are targeting the most current circulating strains of the virus.

"I'd encourage everyone to go out and get both their influenza and updated COVID-19 vaccine as soon as possible. And then recently, this year, there are new vaccines available for RSV," says Dr. Binnicker.

This year, the FDA approved the first RSV vaccine for adults over the age of 60. There are also approved RSV vaccines for infants and expecting mothers between week 32 and week 36 of pregnancy.

Back to the basics

Along with getting recommended vaccinations, Dr. Binnicker says basic prevention measures can help keep you and your family healthy.

"Then you get to the basics, good hand hygiene. If you're sick, stay home. If you have to get out, wear a mask if you have any symptoms. Then testing so that we know what we're dealing with, and we can take good steps to prevent transmission to other people," says Dr. Binnicker.

Related posts:

• What to expect for the flu, RSV and COVID-19 respiratory season
• Mayo Clinic Minute: Strategies to stay healthy during respiratory virus season

The post Can you get COVID-19 and the flu at the same time? A Mayo Clinic expert weighs in appeared first on Mayo Clinic News Network.

If you haven't had the flu in a few years, there's a reason. As Dr. Nipunie Rajapakse, a pediatric infectious diseases physician with the Mayo Clinic Children's Center, shares, all the more reason to ensure you and your family are vaccinated this year.

The Centers for Disease Control and Prevention recommends that everyone 6 months and older get a flu shot. And make it a goal to be vaccinated by the end of October.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (0:58) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"We know that our population-level immunity to influenza is lower than usual because we've had lower rates during the COVID times," says Dr. Rajapakse.

Public health measures during the pandemic — wearing masks, washing hands and social distancing — not only help reduce COVID-19 transmission but also lowered the spread of the flu.

"Fewer people have had influenza infection and illness. They don't have the antibodies from that experience. We're all the more dependent on the antibodies from vaccination to protect us in that situation," she says.

Why get a flu shot

Dr. Rajapakse says getting vaccinated is an important way to build immunity and prevent infection.

The recommendations still remain that anyone over six months of age should get an influenza vaccine this year," she says.

"And so the recommendations still remain that anyone over 6 months of age should get an influenza vaccine this year.”

Especially young children, older adults and those with weakened immune systems who are at higher risk of severe illness due to the flu. 

"People's protection is going to come from vaccination rather than recent infection. And that makes it all the more important to get the vaccine," says Dr. Rajapakse.

Who should get flu shot

Everyone aged 6 months and older should get a yearly flu vaccine. It's especially important for those at a higher risk of severe flu complications.

Those at higher risk of complications from flu include:

• Young children under age 2.
• Adults older than age 65.
• Residents of nursing homes and other long-term care facilities.
• People who are pregnant or plan to be pregnant during flu season.
• People with weakened immune systems.
• American Indians or Alaska Natives.
• People with chronic illnesses, such as asthma, heart disease, kidney disease, liver disease and diabetes.

Getting the flu shot has important benefits. It reduces flu cases, doctor visits, missed work and school days due to flu, and lessens symptom severity, lowering flu-related hospitalizations and deaths.

Along with vaccination, practicing good hand hygiene and avoiding people who are ill are ways to prevent transmission and illness.

Related posts:

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• Mayo Clinic Q and A: Flu shots are important for young people, too
• Fight off the flu with immune-boosting nutrients

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In this Mayo Clinic Minute, Dr. Priya Sampathkumar, an infectious diseases expert, outlines some strategies you can use to keep you and your family healthy during respiratory virus season.

Watch: The Mayo Clinic Minute

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"Each year we have what we call viral respiratory season where people seem to get colds, and some people get worse infections, including pneumonia," says Dr. Sampathkumar.

The viruses responsible for causing most infections in the fall and winter are influenza, COVID-19 and respiratory syncytial virus (RSV).

One of the best strategies to provide protection against these viruses is vaccination. Annual flu shots are recommended for everyone 6 months and older.

"The flu vaccine, as you know, has been around for many, many years and is a very safe vaccine," says Dr. Sampathkumar. "It does do a good job in preventing the most serious complications of flu, which are hospitalization and death."

Updated COVID-19 vaccines are also recommended this year, along with a newly approved RSV vaccine for adults ages 60 and older with risk factors for RSV such as weakened immune systems, frailty or chronic heart or lung disease.

Dr. Sampathkumar says along with getting recommended vaccinations, avoiding crowded areas, considering masking to protect yourself in crowded indoor spaces, and frequent hand-washing, are other ways to help get you through respiratory virus season.

"Then, if you do become sick, make sure that at that point, you do wear a mask to protect those around you. Staying home and not exposing a lot of people at your workplace or elsewhere."

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• What to expect for the flu, RSV and COVID-19 seasonal respiratory season
• Mayo Clinic expert answers questions about the new COVID-19 vaccine

The post Mayo Clinic Minute: Strategies to stay healthy during respiratory virus season appeared first on Mayo Clinic News Network.

Influenza, respiratory syncytial virus (RSV), and COVID-19 are all part of the seasonal respiratory virus lineup. According to the Centers for Disease Control and Prevention (CDC), the upcoming fall and winter are expected to have a similar number of hospitalizations for respiratory diseases as last year. However, they say it's important to note that these hospitalization numbers are higher than before the COVID-19 pandemic when the leading causes were the flu and RSV.

Matthew Binnicker, Ph.D., director of the Clinical Virology Laboratory at Mayo Clinic, says researchers in the Northern Hemisphere look to the trends in the Southern Hemisphere, where winter is ending, to help forecast the upcoming respiratory season.

Watch: Dr. Matthew Binnicker talks about the upcoming 2023-2024 respiratory season

Journalists: Broadcast-quality soundbites are available in the downloads at the bottom of the posts. Please courtesy: "Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic."

"We saw in Australia that they had a typical to, in some areas, more severe influenza season. And that's what I expect this year is more of what we saw pre-pandemic," says Dr. Binnicker.

"Whether it's an average year or a more severe year will be based on a few factors: how well people abide by all the lessons we learned about staying home when you're sick, masking if you're sick, getting your influenza vaccination, but also the type of virus that's circulating," he says.

The CDC says the 2023 Southern Hemisphere flu vaccine reduced hospitalizations by 52%. If similar influenza virus strains spread in the Northern Hemisphere, the 2023-24 vaccine might provide equal protection.

Strains of influenza

Dr. Binnicker says there has been a predominance of a few different strains of influenza over the last few years.

"One is called H3N2 influenza A virus, a common influenza A virus that circulated for years. And then, in some areas, the pandemic strain from 2009, the H1N1 influenza strain, has also been in circulation. We typically see those influenza A strains anywhere from November to February or March here in the U.S.," says Dr. Binnicker.

"We also see a strain of influenza called influenza B, which usually causes a little bit less severe disease, and that typically comes up toward the tail end of the influenza season, in the February, March and April timeframe," he adds.

Preventing illness during respiratory season

There are some unknowns in the outlook, including the timing, the specific virus strains and what new COVID-19 variant might emerge. That's why prevention is critical, says Dr. Binnicker.

The good news is that there are vaccines for these three seasonal illnesses, including updated COVID-19 vaccines and new vaccines for the prevention of RSV in those 60 and older, infants and those who are pregnant.

"It's an exciting time in terms of prevention strategies for these viruses," says Dr. Binnicker. "Then you get to the basics: good hand hygiene. If you're sick, stay home. If you have to get out, wear a mask if you have any of these symptoms. And then testing so we know what we're dealing with and can take good steps to prevent transmission to other people.”

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The post What to expect for the flu, RSV and COVID-19 respiratory season appeared first on Mayo Clinic News Network.

At-home COVID-19 tests allow you to collect your sample and detect active COVID-19 infections. 

But what if you have at-home COVID-19 tests nearing expiration or expired on your shelf?

Matthew Binnicker, Ph.D., director of the Clinical Virology Laboratory at Mayo Clinic, says companies set the original test dates arbitrarily due to these diagnostic at-home tests being developed rapidly. So, check your boxes before you toss them.

“Now that we are 3 1/2 years into the pandemic, those manufacturers have had the opportunity to go back and assess the test performance over prolonged periods of time. And they've updated the expiration dates in many cases,” says Dr. Binnicker.

His first recommendation if you have tests at home is to search the Food and Drug Administration (FDA)  website for information on updated expiration dates. 

"If you take a test that is beyond the expiration date, and the test is positive, that's likely a reliable result, especially if you have a respiratory illness. If you get a negative result from a test that is beyond the expiration date, I'd recommend making sure the test doesn't have an extended expiration date. And if it's beyond that, then definitely go out and get another test or go in and have a healthcare provider collect a swab for a lab-based test before you rule out COVID-19," Dr. Binnicker says.

Watch: Dr. Matthew Binnicker talks about at-home COVID-19 tests

Journalists: Broadcast-quality soundbites are available in the downloads at the bottom of the posts. Please courtesy: "Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic."

Can at-home tests detect current strains of COVID-19?

"Yes, they should detect the currently circulating strains of COVID-19. The good news is that most of the changes in the virus with these new variants are in the spike protein, which is the part of the virus that binds to the cells. And the protein these antigen tests are looking for is a different protein where not as many mutations occur. So that allows us to confidently say that these tests should pick up the circulating strains," says Dr. Binnicker. 

Testing positive

Are you contagious if you test positive for COVID-19?  Most likely, says Dr. Binnicker.

"When an at-home antigen test is positive, it means that that person is still shedding or excreting a high amount of viral protein. In most cases, that means that the person is shedding a high amount of virus, and likely a high amount of virus that could be spread from one person to another," he says.

He says if you get a positive at-home antigen test, consider yourself at risk of spreading the virus to others. 

Testing negative

Dr. Binnicker says testing at home is recommended if you experience COVID-19 symptoms. If it comes back positive, you likely have a COVID-19 infection. But what if you have symptoms and the test comes back negative? 

"If your test comes back negative at home, and you still have those typical symptoms of COVID-19 — sore throat, cough, fever, body aches — that's when I'm recommending that people go in to see their healthcare provider, get a swab collected that can be sent to a lab for a PCR-based test. That will give us the most reliable information on whether you truly have, or don’t have, COVID-19," says Dr. Binnicker.

When should you test for COVID-19?

Dr. Binnicker says there are few instances recommended for testing.

• If you develop symptoms such as fever, cough, sore throat, runny nose or body aches.
• If you've spent time with someone with a confirmed diagnosis of COVID-19. 
• If you plan on visiting a person at high risk of severe illness. That includes a person with cancer, an older adult or someone taking medications that suppress their immune system.

He says if you've been exposed to the virus, don't test immediately.

"My recommendation is to wait a few days, don't go right home and take a test because it won't have been enough time for the virus to reach levels that will trigger antigen tests to be positive. Typically, wait three days after an exposure and then take a test. If it's negative, consider taking another test the following day or 48 hours from then; typically, by day five after exposure, you're likely in the clear if you test negative over that timeframe," he says.

Temperatures and at-home COVID-19 tests

With the many fluctuating temperatures across geographic areas, can these tests be affected by high heat or cold temperatures? The information packets that come with at-home antigen tests should offer storage condition information as determined by the FDA. That's where reading the fine print can help.

"If you're in an area that has experienced subzero weather or temperatures well above 100, like many parts of the country have during the summer months, it is always a good idea to check the packet that comes with a test to look for the acceptable storage conditions," says Dr. Binnicker.

Related post:

• Mayo Clinic expert answers questions about the new COVID-19 vaccine

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Ahead of the fall respiratory virus season, the Food and Drug Administration has approved two updated COVID-19 vaccines. The new messenger RNA, or mRNA, vaccines from Moderna and Pfizer/BioNTech are formulated to better target variants that are currently circulating and will replace outdated vaccines.

Watch: Mayo Clinic expert answers questions about the new COVID-19 vaccine

Journalists: Broadcast-quality soundbites are available in the downloads at the end of the post. Please courtesy: Mayo Clinic News Network Name super/CG: Priya Sampathkumar, M.D./Infectious Diseases/Mayo Clinic.

"The new vaccine that was just approved by the FDA is essentially a COVID vaccine targeting a different strain of the COVID virus than was in the original vaccine or in the bivalent vaccines that came out last year. It's still a COVID vaccine, but it's now targeting the XBB.1.5 strain, which has been the omicron-type virus that's been circulating throughout the U.S. and most parts of the world since the beginning of this year," says Dr. Priya Sampathkumar, a Mayo Clinic infectious diseases expert.

Is it considered a booster?

"It's not exactly a booster. I would liken it to the updated influenza vaccine that comes out each year. The influenza vaccine is updated each year as the strains that they protect against change year from year," says Dr. Sampathkumar.

Who should receive the 2023-2024 COVID-19 vaccine?

The Centers for Disease Control and Prevention panel of vaccine experts voted to recommend the new 2023-2024 COVID-19 vaccine to all Americans 6 months of age and older.

"The COVID vaccine definitely should be taken by those at highest risk of complications from COVID, and that includes older people, people with weakened immune systems, very young children. These are the people that we are seeing have significant complications from COVID," says Dr. Sampathkumar.

Health experts also are urging people to get vaccinated for influenza. Experts say it is safe to get both the COVID-19 and flu vaccines at the same time. Both vaccines have been shown to prevent the most serious complications of COVID-19 and the flu, which include hospitalization and death.

"The (flu) vaccine is recommended for everyone who is 6 months and older, and the groups that benefit the most from the vaccine, again, are the same kind of people who benefit from the COVID vaccine — older individuals, people who have underlying immune deficiencies, people with underlying heart, lung, liver kidney disease — because they don't tolerate influenza as well as others," says Dr. Sampathkumar.

Mayo Clinic will offer influenza and 2023-2024 COVID-19 vaccines once they are available. You may find getting the new 2023-2024 COVID-19 vaccine at another location more convenient since some pharmacies may already have supplies. You can text your ZIP code to "438829" or call 800-232-0233 to find a vaccination location near you.

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