COVID Vaccine, Influenza, & RSV Resource Page

Updated: 9/19/23 
These resources will be updated as the respiratory viral season and product availability change in Chicago and across the United States.  
Reach out to adsp@nm.org for questions regarding this content.​

COVID-19, Influenza, and RSV Vaccine Frequently Asked Questions:

Co-administration of Vaccines: 

• Coadministration is acceptable for any combination of the following:
  • COVID-19, Influenza, and RSV (and other adult routine vaccines): ok to give simultaneously​
  • Pediatric RSV mAB (nirsevimab), routine childhood vaccines, COVID-19, and Influenza vaccines: ok to give simultaneously

Live flu vaccine considerations:

• COVID-19, RSV, and intramuscular influenza vaccines available at NM are all inactivated vaccines.
  • Inactivated vaccines can be given regardless of timing of any live or inactivated vaccine administration.
• Flumist intranasal (live vaccine), if used, should be administered simultaneously with other live vaccines or separate subsequent live vaccines by 4 weeks

​
​For patient facing information: See FDA Resources for Fall Respiratory Illness Season

Which vaccines and products are available: 

• COVID-19: for 2023-2024, the monovalent vaccine will be available, targeted against Omicron variant XBB.1.5. It also has demonstrated activity against circulating Omicron variants EG.5.1 and BA.2.86. The bivalent COVID-19 vaccines are no longer authorized.
• Influenza: seasonal vaccine products for NM are in drop down below.
• RSV: products below expected to be available to NM prior to the RSV season in October.
  • RSV vaccine for ≥60 years old. FDA approved for pregnant patients between 32-36 weeks gestational age
    • Also currently available at community pharmacies
  • Pediatric RSV monoclonal antibody (nirsevimab) for newborns and infants

​For vaccine locations: see the CDC vaccines.gov

Viral Vaccine Specific FAQ Continued:​

COVID-19 vACCINES

See CDC COVID Vaccine FAQ for further patient FAQs.
​Disclaimer: resource links are updated frequently
​

COVID-19 Vaccine Schedules Adult and Children ≥12 years old:

• Immunocompetent people should receive one of the following 2023-2024 monovalent COVID-19 vaccines:
  • Moderna (Spikevax): 0.5 mL IM dose x1
  • Pfizer-BioNTech (Comirnaty): 0.3 mL IM x1 dose
• Immunocompromised people: 
  • Previously vaccinated: should receive one updated monovalent vaccine and have the option to receive an additional updated vaccine 2 months after their 1st update vaccine
  • Not previously vaccinated:
    • Moderna (Spikevax): 3 doses of 0.5 mL IM; 4 weeks between each dose
    • Pfizer-BioNTech (Comirnaty): 3 doses of 0.3 mL IM; 3 weeks between dose 1 & 2, 4 weeks between dose 2 & 3

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Special populations and FAQ:

• People ages 65 years and older: have the option to receive an additional monovalent vaccine dose 4 months after the 2023-2024 monovalent dose
• Immunocompromised people: have the option to receive an additional monovalent vaccine dose 2 months after the last 2023-2024 monovalent dose
• Timing of COVID Vaccine after COVID illness recovery: may consider delaying vaccination for 3 months after symptom onset or positive test
• For patients who received the bivalent vaccine, administer 2023-2024 monovalent vaccines at least 2 months after the last dose
• See CDC Recommendations for people vaccinated outside of the United States
• Reimbursement / patient cost:
  • Medicare Part B: covered with no patient cost-sharing
  • Medicaid/CHIP: covered with no patient cost-sharing

​COVID-19 Vaccine Schedules for Children <12 years old:

• Children 5 to 11 years old: 
  • Moderna COVID-19 2023-2024 vaccine for emergency use: 0.25 mL IM x1
  • Pfizer COVID-19 2023-2024 vaccine for emergency use: 0.3 mL IM x1
• Children 6 months to 4 years old:
  • Moderna COVID-19 2023-2024 vaccine for emergency use: 
    • Not previously vaccinated: 2 doses of 0.25 mL 1 month apart
    • 1 or more previous COVID-19 vaccines: 1 dose of 0.25 mL
  • ​​Pfizer COVID-19 2023-2024 vaccine for emergency use:
    • ​Not previously vaccinated: 3 doses of 0.3 mL; week 0, week 3, and ≥8 weeks after dose 2
    • Previously received 1 COVID-19 vaccine: 2 doses of 0.3 mL; 3 weeks after previous dose and ≥8 weeks after dose 2
    • Previously received >1 COVID-19 vaccine: 0.3mL IM x1, ≥8 weeks after the last dose
• Immunocompromised children 6 months and older:
  • ​​Previously vaccinated: should receive one updated monovalent vaccine and have the option to receive an additional updated vaccine 2 months after their 1st update vaccine
  • ​Not previously vaccinated: ​3 doses of Pfizer-BioNTech or Moderna updated vaccine. See CDC recommendations for schedule

Influenza vACCINES

For comprehensive information, see CDC Flu Vaccine Site.

​Vaccine products available at NM:

• Regional Medical Group/Northwestern Medical Group: Fluzone (0.5 mL IM; ≥ 6 months old) and High-dose Fluzone (0.7 mL IM; ≥65 years old)
• Regional Medical Group, Northwestern Workforce, Non-Ambulatory: Fluarix (0.5 mL IM; ≥ 6 months old)
• Available at all sites: Flublok (0.5 mL IM; ≥18 years old) and Flumist (0.2 mL intranasal 2 to 49 years old)

​
Special population FAQ:

• Pregnancy/Chronic Medical Conditions/Immunocompromised: Avoid Flumist intranasal (live vaccine) 
• 6 months – 8 years: should receive two doses of the influenza vaccine for their first season
• Age 65+: high dose vaccine is recommended 
• Caregivers/Contacts of High risk patients who receive Flumist intranasal (live vaccine) should avoid severely immunocompromised patient for 7 days 
• Egg allergy: can receive any flu vaccine formulation 
• If previous severe allergic reaction to flu vaccine, avoid formulations that contain eggs 
• In patients recovering from moderate to severe infection related illness, no flu vaccine wait period beyond illness recovery
• Reimbursement / patient cost:
  • Medicare Part B: covered with no patient cost-sharing
  • Medicaid/CHIP: covered with no patient cost-sharing

Influenza vaccination after antivirals: inactivated vaccines are appropriate anytime.

• Avoid giving Live attenuated vaccine (Flumist intranasal vaccine) after the patient received: 
  • Oseltamivir/Zanamivir: 48 hours before or 2 weeks after
  • Peramivir: 5 days before or 2 weeks after
  • Baloxavir: 17 days before or 2 weeks after 

RSV VACCINE AND PEDIATRIC MONOCLONAL ANTIBODY

RSV Vaccines for ≥60 years old:

• ​Expected to be available at NM prior to RSV season in October: Abrysvo (Pfizer) 0.5 mL IM x1 dose
• Any patient ≥60 years old may receive an RSV vaccine with shared clinical decision making
• Risk factors for severe disease include: Chronic medical conditions (cardiopulmonary disease, kidney disorders, liver disorders, neurologic or neuromuscular conditions, hematologic disorders, diabetes, moderate to severe immunocompromise), frailty, advanced age, nursing home/long-term care facility residents
• Reimbursement / patient cost:
  • Medicare Part D: covered with no patient cost-sharing
    • Patients must have Part D for coverage. The patient may have to pay a vaccine administration fee at the time of service, but they can get reimbursed in full for this fee from their Part D plan
  • Medicaid/CHIP: covered with no patient cost-sharing

RSV Vaccines for pregnant patients:

• FDA approved in pregnancy during 32-26 weeks gestational age for the prevention of severe infant RSV infection. RSV vaccine use recommendations for pregnant patients are expected from the CDC fall of 2023.
• ​Expected to be available at NM prior to RSV season in October: Abrysvo (Pfizer) 0.5 mL IM x1 dose

RSV Pediatric mAB Product (nirsevimab):

• Expected to be available to NM patients in October
• Recommended by the CDC to be given to newborns within 1 week of birth (during RSV season)
  • Also recommended for children 8-19 months old who are at increased risk of severe RSV disease entering their second RSV season
• Pediatric RSV mAB (nirsevimab) + routine childhood vaccines: ok to give simultaneously​
• Use in infants whose mother received the RSV vaccine: the CDC is expected to provide clarity in the fall of 2023
• See AAP FAQ resource for more nirsevimab information
• See ACIP and AAP resource for additional information for patients post palivizumab (Synagis)
• For patients who received cardiopulmonary bypass, see Beyfortus package insert for dosing

Infants <8 months born during or entering 1st RSV season:

• < 5 kg: 50 mg IM x1 dose
• ≥ 5 kg: 100 mg IM x1 dose

Children 8-19 months old who are at increased risk of severe RSV disease entering their second RSV season:

• 200 mg x1 dose (2x 100 mg IM doses at once)

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Treatment and Post-Exposure Prophylaxis (PEP):

COVID-19

See the COVID-19 webpage for treatment

Influenza

See the CDC influenza Antiviral Medication Summary for more details

Oseltamivir
​Treatment:

• Adult dose: 75 mg twice daily for 5 days
• See Antimicrobial Dosing Page for dose adjustment for patients with renal dysfunction 
• Pediatric doses:
  • <1 year old: 3mg/kg/dose twice daily for 5 days
  • >1 year old and child's weight:
    • ≤15 kg: 30 mg twice daily for 5 days
    • >15 to 23 kg: 45 mg twice daily for 5 days
    • >23 to 40 kg: 60 mg twice daily for 5 days
    • >40 kg: 75 mg twice daily for 5 days

​Post-exposure prophylaxis:

• Adult dose: 75 mg daily for 7 days
• Pediatric doses: same doses above with once daily dosing for 7 days

​Baloxavir
Treatment and prophylaxis (regimen are the same):

• Adult dose: 
  • <80 kg: 40 mg x1
  • ≥80 kg: 80 mg x1
• Pediatric dose (for 5 years and older): 
  • <20 kg: 2 mg/kg oral suspension x1​
  • 20 to <80 kg: 40 mg x1
  • ≥80 kg: 80 mg x1

Avoid co-administration of baloxavir with calcium, iron, aluminum, zinc, and magnesium containing products

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Influenza post-exposure prophylaxis (PEP) considerations:

• ​Indications for PEP with oseltamivir: 
  • High risk of flu complications during first two weeks following vaccination with exposure 
  • High risk of flu complications who cannot receive vaccine with exposure 
  • Severe immune deficiencies or those who might not respond to vaccination with exposure 
• Patients receiving PEP should be educated to seek medical evaluation if they develop a febrile respiratory illness ​
• For hospitalized and LTC outbreak settings, oseltamivir should be given for at least two weeks and continuing up to one week after last known case

RSV

No routine antiviral treatment for RSV is recommended at this time.