Influenza (flu) and COVID-19 are both highly contagious respiratory illnesses. COVID-19 is caused by infection with a coronavirus (SARS-CoV-2), and flu is caused by infection with an influenza virus. The best way to protect yourself from either of these illnesses is to get vaccinated. Updated vaccines for both influenza and COVID-19 are now available. In this Q&A, Dr. Robert Jacobson, medical director for Mayo Clinic's Primary Care Immunization Program, answers some common questions he gets about influenza and COVID-19 seasons, vaccines and prevention.

Watch: Dr. Robert Jacobson answers questions about influenza and COVID-19.

Journalists: Broadcast-quality video is available in the downloads at the end of the post. Please courtesy: Mayo Clinic News Network. Name super/CG: Robert Jacobson, M.D./ Primary Care Immunization Program/Mayo Clinic.

What is expected from the 2024-25 influenza season?

Dr. Jacobson says you can expect this upcoming flu season to be "more typical" than what everyone saw in the early days of the COVID-19 pandemic.

"That means all of us need to get our flu vaccines — even babies born now, when they turn 6 months, are going to need that protection because the season starts in fall and goes through winter, often peaking somewhere between December and March. But we can continue to see outbreaks plaguing schools, long-term care facilities and hospitals, unfortunately, all the way through May and June," says Dr. Jacobson.

When is the best time of year to get a flu shot?

Dr. Jacobson recommends everyone 6 months and older get vaccinated for the flu as soon as possible.

"It takes two to four weeks for the vaccine to work, and you want to get the vaccine before you start seeing the virus. It does no good once you've been exposed," he says.

For most people, the ideal time to get vaccinated is September and October, before the number of flu cases becomes significant.

Guidelines for certain populations:

• Those 65 years and older should take advantage of one of three vaccines especially designed for their age group that can help protect them from the flu and help them avoid hospitalization. Older adults should not get their flu shots in July or August.
• Pregnant people in their third trimester should be vaccinated for the flu as early as possible, even July or August, so the immunity can be passed on to their babies through the placenta and provide protection for the first six months of their lives.
• Children 6 months and older who are getting the flu shot for the first time will need two doses of the vaccine, 28 days apart. They also should get their first doses in July or August, if possible.

New this year are recommendations for those 18 and older who recently had a solid organ transplant and are on immunocompromising medicine to receive the more potent vaccination, designed for those 65 and older.

What are some medical reasons why someone may refrain from getting a flu shot?

"There's really only one major one, and that is if you've had a serious allergic reaction, that is anaphylaxis, and not just hives. If you have had anaphylaxis to a previous flu vaccine or to one of the components in the flu vaccine (other than eggs), you should not get that vaccine again."

Can someone get a flu shot if they are allergic to eggs?

"If you have egg allergy, even a serious egg allergy, you can get the flu vaccine, even if that flu vaccine was made in part with hen's eggs," says Dr. Jacobson.

What about those who have had Guillain-Barre syndrome?

"You should have a discussion with your clinician if you've had Guillain-Barre syndrome, or GBS, within six weeks of a previous flu vaccine. The flu vaccine is not off the table, your clinician and you will consider the risk you're in for flu and consider whether or not you should go ahead and get the flu vaccine," says Dr. Jacobson.

Injected form vs. FluMist

The injected form of the flu vaccine is inactive. However, there is a live, attenuated vaccine known as FluMist, which is a nasal spray.

For certain populations, Dr. Jacobson says they should get the inactivated influenza vaccine and not the FluMist. Those include:

• Those who are pregnant.
• Those with chronic diseases that put them at higher risk for getting the flu.
• Those who are immunocompromised.

At-home nasal spray vaccine option

The Food and Drug Administration recently approved the first at-home nasal spray flu vaccine that does not need to be administered by a health care professional. FluMist is sprayed into the nose and has been used safely and effectively for many years. Dr. Jacobson says this could be a great option, especially for parents of young kids.

"I'm excited about it. I love the idea of recognizing that the nasal spray vaccine is a great vaccine for those who are eligible for it. And why not get it at home? Why not, as a parent, administer it rather than have to make a special trip to the doctor's office?" says Dr. Jacobson.

He says the at-home nasal spray flu vaccine is just as safe and effective as those administered in a doctor's office or pharmacy. He adds that it also could be an option for healthy individuals between 2 and 49 years old.

"If you're healthy and you're between 2 and 49 years of age, it's a great alternative. And it's a great workplace and school place vaccine because there's not as many sharps around. I want to decrease as many needles, needle pain and needle accidents as possible, and the nasal spray vaccine is one way to do that. By the way, it's an incredibly safe vaccine to be mailed and received at home," says Dr. Jacobson.

Who should not receive the at-home nasal spray vaccine option?

Because it's a live virus and hasn't been studied enough for use in certain populations, he says those who are immunocompromised, pregnant or have a chronic condition should not use the nasal spray.  

Why do young, healthy individuals still need to get the influenza vaccination?

Everyone is at risk of getting influenza. And every year, about 10%-20% of people will get sick with the flu.

"A great study done in the Twin Cities in Minnesota showed healthy young adults who are vaccinated against flu have, on average, each year, less sick days from work and less outpatient clinic visits.”

Will there be a rise in COVID-19 infections this fall/winter?

While COVID-19 isn't seasonal in the same way influenza is, cases are expected to increase during the winter months as more people congregate indoors.

"We believe that as people are drawn together for school, as more people go into the office to work in the office setting, as more events take place inside rather than outside, we're going to see increased number of cases of COVID," says Dr. Jacobson.

Just like the influenza vaccine, Dr. Jacobson recommends everyone eligible also should receive the updated COVID-19 vaccine.

"This (vaccine) is designed for the circulating strains of COVID-19. It's been shown to be safe, effective and, based on what's circulating, needed and without good alternatives. It's your way of protecting you and your loved ones from another respiratory infection," he says.

Who is at risk for getting infected with COVID-19?

"People who talk to other people, people who are in a room with other people. Oh, that's all of us. So there's no one group that says, 'Oh, I'm more likely to get COVID.' We're all more likely," says Dr. Jacobson.

Who is at higher risk of complications?

"The older you are, the more at risk; 65 years and older — that's where we're seeing the hospitalizations and deaths. Though we did see a significant number of deaths in children similar to the numbers we saw with flu last year," says Dr. Jacobson. "We do also worry about our patients who are immunocompromised, and we have special variations on vaccination."

If someone received the COVID-19 vaccine this summer, do they still need one this fall?

"This is a different vaccine, and groups like Mayo actually purposely stopped vaccinating at the end of July, knowing that this new vaccine was coming out. Those who somehow got the vaccine in August need to wait eight weeks before they get this new vaccine, so their body really sees it and responds to it," says Dr. Jacobson.

Is it safe to get the flu and COVID-19 vaccinations at the same time?

Not only is it safe, it is safe to get with other vaccines. Dr. Jacobson recommends getting your flu and COVID-19 vaccinations in the same visit. He says, other than the possibility of sore arms, there are no disadvantages.

What do you say to those on the fence about getting updated COVID-19 and influenza vaccinations?

"It's a powerful tool to allow your body to make good immunity to the disease without you having to get the disease," says Dr. Jacobson.

"And it's a broader immunity. You get a bout of the flu, you're only immune to that strain. When you get the flu vaccine, you're immune to three to four strains, and you weren't contagious. You get the vaccine, you are immune. You're stopping it from spreading in your household and your work and your play community, and you didn't get anyone else sick either."

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