Adult Flu, COVID-19 and RSV Vaccination Early in the 2023–24 Season

Influenza, SARS-CoV-2 and respiratory syncytial virus (RSV) usually circulate in the United States from fall into early spring, though flu and RSV patterns shifted during the COVID-19 pandemic. Older adults, people with chronic conditions and racial and ethnic minority groups have borne a disproportionate share of illness and death from all three. CDC tracks vaccination against them during the season so health programs can plan.

What was recommended for 2023–24

• Flu: a yearly vaccine for everyone aged 6 months and older without contraindications, recommended by the Advisory Committee on Immunization Practices (ACIP) since 2010.
• COVID-19: on September 12, 2023, ACIP recommended the updated 2023–2024 vaccine for everyone aged 6 months and older, to protect against circulating variants.
• RSV: in June 2023 ACIP said adults aged 60 and older may receive a single dose, through shared clinical decision-making with their provider — the first recommended vaccine against RSV disease. RSV vaccination was also recommended during pregnancy, which this report does not cover.

How coverage was measured

The National Immunization Survey-Adult COVID Module calls randomly dialed cell phones of adults in all 50 states, the District of Columbia and some local areas and territories, and weights the results to represent adults outside institutions. It asks whether people have had each vaccine since July 1, 2023, and when, and whether they intend to. Anyone who reported a COVID-19 shot since September 14, 2023, counted as having the updated vaccine, since it was the only one authorized after that date. This analysis covers interviews from September 24 to December 9, 2023.

Coverage by December 9, 2023

By mid-November, flu coverage was about 2.5 percentage points lower than at the same point in the 2022–23 season. RSV coverage was low even among people with chronic conditions — lung, heart, kidney or liver disease, diabetes or a weakened immune system — who are most at risk of severe disease.

Weekly flu, updated COVID-19 and RSV vaccination status and intent among adults, September 24–December 9, 2023. CDC, MMWR.

Many were still open to it

As coverage rose over the fall, the share of unvaccinated adults who said they definitely would get vaccinated fell — from 33.2% to 9.4% for flu, from 28.2% to 14.1% for COVID-19, and less steeply, from 20.9% to 14.1%, for RSV. RSV had the smallest share saying they probably or definitely would not get it, and the largest share saying probably or unsure.

Altogether, about 27% of adults for flu, 41% for COVID-19 and 53% of adults 60 and older for RSV were unvaccinated but said they definitely or probably would get vaccinated, or were unsure.

Who was vaccinated

• Insurance: coverage for every vaccine was lowest among people without health insurance.
• Age and place: coverage and intent rose with age and were higher in urban and suburban areas than in rural ones.
• Race and ethnicity: flu coverage was higher among White and Asian adults than most other groups, and COVID-19 and RSV coverage higher among White adults. Yet White adults were more likely than Black or Hispanic adults to say they probably or definitely would not get a COVID-19 vaccine (43.2% vs. 31.3% and 34.7%) or an RSV vaccine (32.5% vs. 15.3% and 19.3%); for flu, the share was the same for White and Black adults (32.2%) and lower for Hispanic adults (24.0%). Counting those open to vaccination, the coverage Hispanic, Black and Asian adults could reach is similar to or higher than White adults'.
• Jurisdiction: coverage ranged from 15.6% to 54.8% for flu, 2.4% to 35.6% for updated COVID-19 vaccine and 1.9% to 32.4% for RSV.

Flu, updated COVID-19 and RSV vaccination status and intent among adults by demographic group, December 3–9, 2023. CDC, MMWR.

Raising coverage

A health care provider's recommendation and offer of vaccination are strongly linked to people getting vaccinated. An earlier report found that unvaccinated adults open to the bivalent COVID-19 vaccine hadn't gotten it mainly because of worries about side effects, being too busy, or simply not getting around to it. Offering vaccines at convenient places and times — provider offices, pharmacies, workplaces — alongside a strong recommendation could help, especially for RSV. Measures that narrowed gaps during the first COVID-19 vaccine rollout, such as free vaccines, trusted messengers and vaccination in libraries, barbershops and restaurants, could help here too.

CDC works with community organizations and providers through its Partnering for Vaccine Equity program; its Bridge Access Program provided COVID-19 vaccines to adults without insurance or whose insurance did not cover the full cost, with locations listed at vaccines.gov. Campaigns such as "Wild to Mild," "Get My Flu Shot" and "Everything" promoted vaccination, and provider toolkits support recommending it. Vaccination is recommended as long as the viruses are circulating.

Limitations

• Fewer than 25% of those contacted responded; weighting reduces but may not remove bias.
• Vaccination was self-reported, which could overstate coverage.
• People in prisons or long-term care facilities may not be represented.

Sources

• Black CL, Kriss JL, Razzaghi H, et al. "Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2023." MMWR 72(51). CDC.