Health & Lifestyle

Doctors urge elderly adults to get triple-whammy of Covid, flu and RSV vaccines this winter despite ‘miniscule’ risk of strokes flagged by FDA

  • Minor stroke risk with combining Covid and flu shots shouldn’t dissaude people
  • Getting three jabs at once is fine but doctors say adults can space them out
  • READ MORE:  FDA links Covid shot to slightly higher risk of strokes and seizures

Doctors have urged older adults to roll up their sleeves for three different vaccines this fall – calling the tenuous links to higher stroke risk ‘minuscule’.

The advice comes on the heels of a Food and Drug Administration analysis out this week that found there was a slightly elevated risk of stroke in over-85s who received the new Covid-19 vaccine and the flu shot formulated for seniors at the same time.

It was the second analysis by health officials to flag a possible association between strokes and seniors after getting the combination of seasonal vaccines.

But experts in heart health and infectious diseases told DailyMail.com that the risk associated with getting both flu and Covid vaccines, as well as the new RSV vaccine at once, is so small that people can still be comfortable with getting them done all in one sitting.

For those who want to be extremely cautious and don’t mind having ‘two sore arms’, it is also OK to space their vaccinations out. 

Infectious disease experts and cardiologists said the minute risk between stroke and receiving the Covid and flu shots together should not discourage older adults from getting flu, Covid, and RSV shots in one sitting

Infectious disease experts and cardiologists said the minute risk between stroke and receiving the Covid and flu shots together should not discourage older adults from getting flu, Covid, and RSV shots in one sitting

Dr Lili Barouch, a cardiologist at Johns Hopkins University told DailyMail.com: ¿That amount of risk is tiny. It¿s miniscule. I wouldn¿t let that stop anybody from getting vaccines'

Dr Stuart Ray, an immunologist at Johns Hopkins University School of Medicine, said: ¿I think it's reasonable to consider spacing these out'

Dr Lili Barouch (left), a cardiologist at Johns Hopkins University told DailyMail.com: ‘That amount of risk is tiny. It’s miniscule. I wouldn’t let that stop anybody from getting vaccines.’ Dr Stuart Ray (right), an immunologist at Johns Hopkins University School of Medicine, said: ‘I think it’s reasonable to consider spacing these out’

There were roughly three strokes or stroke-like events called transient ischemic attacks for every 100,000 doses of both Covid and flu vaccines given at the same time between August 31 and November 6 last year.

For comparison, in 2022 the death rate from Covid in over-85s was 1,224 per 100,000.

This will be the first year that adults 60 and older will have access to a vaccine for respiratory syncytial virus, which kills between 6,000 and 10,000 seniors every year.

Seniors will also have three updated high-dose flu shot options containing three to four times as much flu virus antigen to protect older people. 

The FDA’s analysis reported a 20 to 35 percent increased stroke risk in older adults who received either the Moderna or Pfizer vaccine with the influenza vaccine in the same visit compared to seniors who only got the Covid bivalent shot. 

Dr William Schaffner, a preventive medicine and infectious diseases at Vanderbilt University School of Medicine studied the analysis closely before it was published.

Dr Schaffner, a member of the Centers for Disease Control and Prevention’s panel of vaccine experts, told DailyMail.com: ‘The short answer is no, this should not dissuade people from getting [Covid and flu shots] done simultaneously. I got the Covid and flu in the same arm simultaneously.

‘The data are very small and inconsistent in other databases – England, France, and Israel have done similar look-back studies and have not found similar risks. This is likely a statistical fluke or a very, very low increased risk compared to the risk of stroke following either Covid or influenza.’

In absolute terms, there were an additional 3.1 strokes per 100,000 doses following the Pfizer and flu shots and 3.3 strokes per 100,000 doses of the flu and Moderna shots.

Dr Lili Barouch, a cardiologist at Johns Hopkins University told DailyMail.com: ‘That amount of risk is tiny. It’s miniscule. I wouldn’t let that stop anybody from getting vaccines.

‘If people are concerned about spreading them out by a couple of weeks, that’s fine. People should get all the vaccines, so if they can do that all at once that’s great but I wouldn’t let this small risk make them not get vaccinated.’

The Centers for Disease Control and Prevention, which issues nationwide vaccination recommendations for different age groups, has not taken a firm stance on whether it’s best to get all three shots administered at once or to space them out by a couple of weeks.

When asked for comment by DailyMail.com, the CDC provided the same recommendations as those published on its website.

Dr Barouch, who is also the director of the sports cardiology program at Hopkins, said: ‘Personally I’m planning on getting them all at the same time and I usually get them in the same arm, so I don’t have two sore arms.

Pfizer’s Covid booster & flu shot on same day ‘raises risk of STROKE’ 

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She added: ‘We don’t want to read too much into that small amount of information.’

More apprehensive adults may want to space out each vaccine by a week or two, a method that has not been shown to change the effectiveness of the vaccines.

 There is no recommended waiting time between getting the Covid and flu shots, according to the CDC.

Dr William Schaffner, a preventive medicine and infectious diseases at Vanderbilt University School of Medicine told DailyMail.com that spacing shots out by two weeks is ideal. 

For instance, getting a flu and Covid shot on one Saturday and the RSV shot two Saturdays after that would provide the same protection as getting all three at once.

Whether an older adult will end up receiving the shots simultaneously or over a few weeks will come down to conversations between them and their doctors.

Dr Stuart Ray, an immunologist at Johns Hopkins University School of Medicine, said: ‘It’s wise to have a discussion with one’s care providers about that person’s individual risk. But I think it’s reasonable to consider spacing these out.

‘Some people are at more risk for vascular events than others. I think it also depends on whether that person is, from a respiratory point of view, very fragile, if they have chronic lung issues an infection like RSV could cause precipitous illness.’

Someone who just recently recovered from Covid likely will not need a vaccine for a while because they have residual immunity from recovery, according to Dr Ray. Meanwhile, if a senior is frequently around children who can carry and transmit RSV easily, doctors may strongly recommend they get the shot for added protection.


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