COVID-19, Influenza & RSV – IDSA

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This page undergoes regular review and was last comprehensively reviewed on November 28, 2022. Some sections may reflect more recent updates.
Multiple respiratory viruses are currently co-circulating in the United States, including SARS-CoV-2, influenza and respiratory syncytial virus. This page includes key influenza and RSV resources for clinicians in the context of COVID-19 and will be updated as the winter 2022-2023 season progresses.

CDC recommends that everyone 6 months and older get a flu vaccine to help protect against flu and its potentially severe complications. Influenza vaccination is a critical tool to prevent potential severe complications. However, flu vaccine claims data suggest that uptake may be down so far this year compared with the same time last season.
In terms of influenza vaccine and COVID-19 vaccine coadministration, CDC guidance states that routine administration of all age-appropriate doses of vaccines simultaneously is recommended for children, adolescents and adults for whom no specific contraindications exist at the time of the healthcare visit.
For individuals who are influenza-positive, evidence suggests that the administration of an influenza antiviral, such as oseltamivir or zanamivir, could help reduce the severity of symptoms and the length of symptoms. However, influenza antivirals are more effective if given as soon as possible after illness onset (up to 48 hours after illness onset) (Liu, August 2021).
CDC Weekly U.S. Influenza Surveillance Report
Dashboard monitoring key metrics including outpatient influenza-like illness, hospitalizations and mortality.
CDC Seasonal Influenza Vaccination Resources for Health Professionals
Central CDC hub for clinical resources, public health information and epidemiological updates.
ACIP 2022-2023 Influenza Vaccine Recommendations Summary
Current clinical advice and guidance from CDC’s Advisory Committee on Immunization Practices.

Source: CDC FluView data accessed December 9, 2022. Data updates weekly on Fridays.
Pediatric hospitals across the country are experiencing a rise in the number of patients admitted with RSV. Infections due to RSV have shown a sharp increase and are appearing earlier than usual this year, according to CDC. Health care providers should consider RSV in patients with respiratory illness, particularly during the RSV season, and particularly among young children (under 5 years) and older adults (65 years and older).
Because RSV and influenza are both respiratory viruses that usually circulate during the winter and generally affect younger children and older adults with increased severity, there are substantial similarities in illness presentation, symptoms, populations affected and seasonality. This can make it challenging to differentiate between influenza and RSV without laboratory testing. However, wheezing is more common in children with RSV, compared to children with influenza infection, whereas high fever (>103 F) may be more common among individuals of all ages with influenza infections, compared to RSV infections.
Most RSV infections go away on their own in a week or two, and there is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals. Healthy adults and infants infected with RSV do not usually need to be hospitalized. But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalized if they are having trouble breathing or are dehydrated.
CDC RSV Surveillance Reports
Central CDC hub tracking national, state and regional RSV trends.
CDC Guidance for Health Care Professionals: RSV
Guidance for clinicians on RSV in children and adults including information about case definition, management, testing and pre-exposure prophylaxis.
Updated American Academy of Pediatrics Guidance: Use of Palivizumab Prophylaxis to Prevent Hospitalization from Severe Respiratory Syncytial Virus Infection During the 2022-2023 RSV Season
With the shift in seasonality noted in 2021 and the current regional variability in interseason RSV cases, the AAP continues to support the use of palivizumab in eligible infants in any region experiencing rates of RSV activity at any time in 2022 similar to a typical fall-winter season.
During the 2021–22 influenza season, 6% of hospitalized pediatric influenza patients had SARS-CoV-2 coinfection; among influenza-associated pediatric deaths, 16% had SARS-CoV-2 coinfection, according to this CDC MMWR.
RSV is spreading rapidly and much earlier than normal this year. Dr. Parga-Belinkie offers reassurance and practical guidance for parents in this AAP YouTube video.
Video recording featuring government officials and clinicians discussing developments in the “tridemic” of influenza, RSV and COVID-19, as well as an update on the Ebola virus.
Experts discuss clinical observations and other issues related to the current outbreaks of RSV, influenza and COVID-19.
A news briefing by CDC’s National Center for Immunization and Respiratory Diseases and HHS’s Assistant Secretary for Preparedness and Response about current U.S. respiratory disease burden, prevention strategies and resources.
Bivalent booster doses provided additional protection against COVID-19–associated emergency department/urgent care encounters and hospitalizations, according to this CDC MMWR.
CDC and the Council of State and Territorial Epidemiologists have established an updated MIS-C surveillance case definition that can be used for voluntary reporting starting January 1.
The federal government is offering an additional round of 4 free at-home COVID-19 tests to all U.S. households upon request.
During last winter’s influenza season, 6% of hospitalized pediatric influenza patients had SARS-CoV-2 coinfection; among influenza-associated pediatric deaths, 16% had SARS-CoV-2 coinfection, according to this CDC MMWR.
The age-adjusted death rate for long COVID was 6.3 per 1 million population for the 12-month period ending in June 2022, according to this CDC Vital Statistics Rapid Release.
This CDC hub includes updated COVID-19 immunization schedule reference documents designed for health care professionals.
This resource center was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000574). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.
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