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  • A new virus variant and lagging vaccinations may mean the US is in for a severe flu season

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    The United States may be heading into its second severe flu season in a row, driven by a mutated strain called subclade K that’s behind early surges in the United Kingdom, Canada and Japan.Last winter’s season was extreme, too. The U.S. had its highest rates of flu hospitalizations in nearly 15 years. At least 280 children died of influenza, the highest number since pediatric death numbers were required to be shared in 2004.Now, with a new variant in the mix, experts say we’re on track for a repeat. And with flu vaccinations down and holiday travel on the way, they worry that things may look much worse in the weeks ahead.The good news: Early analysis shows that this season’s flu shots offer some protection against being hospitalized with this variant, especially for kids. The bad news is that many Americans appear to be skipping their flu vaccines this year. New data from prescription data company IQVIA shows that vaccinations are down compared to where they usually are at this point in the year.A new playerFlu activity is low but rising quickly in the United States, according to the latest FluView report from the U.S. Centers for Disease Control and Prevention.Most of the flu viruses identified this season have been an A strain called H3N2, and half of those have come from subclade K, a variant that was responsible for a rougher-than-normal flu season this summer in the Southern Hemisphere.That variant wasn’t a major player when scientists decided which strains should be in the annual flu shots, so the vaccines cover a related but slightly different group of viruses.”It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case,” said Dr. Richard Webby, director of the World Health Organization Collaborating Center for studies on the ecology of influenza in animals and birds at St. Jude Children’s Research Hospital.Early analysis by the U.K. Health Security Agency shows that subclade K has seven gene changes on a key segment of the virus. Those mutations change the shape of this region, making it harder for the body’s defenses to recognize.”That’s the predominant thing that our immune system targets with antibodies, and that’s also pretty much what’s in the vaccine,” said Dr. Adam Lauring, chief of the Division of Infectious Diseases at the University of Michigan Medical School.UKHSA scientists found that the current flu vaccines are still providing decent protection against subclade K viruses. Vaccination cut the odds of an emergency department visit or hospitalization for the flu by almost 75% in children. The effectiveness for adults, even those over 65, was lower, about 30% to 40% against needing to visit the hospital or ER.But the scientists offer a caveat: These results are from early in the season, before the protection from seasonal flu vaccines has had time to wane or wear off. The findings are posted in a recent preprint study, which means it was published ahead of scrutiny from outside experts.Still, some protection is better than no protection, and while subclade K is expected to dominate the season, it won’t be the only flu strain circulating. No one gets to pick what they’re exposed to. Lauring said his daughter has just recovered from the flu, but it was a B-type strain.At the same time this new variant has emerged, flu vaccinations appear to be down in the U.S. According to IQVIA, about 64% of all flu vaccinations were administered at retail pharmacies, which administered roughly 26.5 million flu shots between August and the end of October. That’s more than 2 million fewer shots than the 28.7 million given over the same time frame in 2024.”I’m not surprised,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University’s School of Public Health. Vaccine skepticism expressed by leaders of the US Department of Health and Human Services has “injected chaos into the whole vaccination system,” she said.”There’s been a lot of attention on really non-issues,” like vaccine ingredients and separating shots, that she thinks “at the best, left people confused but possibly at the worst have left people worried about getting vaccinated,” she added.Flu vaccinations have also fallen in Australia, where subclade K was the predominant virus this year. As a result, flu hit a record, with more than 443,000 cases. Flu season in the Southern Hemisphere typically runs from May to July, so infectious disease experts often look to those countries for a preview of what might be on the way to North America.”What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming,” said Dr. Earl Rubin, director of the infectious disease division at the Montreal Children’s Hospital in Canada.’This is the time we start to see the rise’It’s difficult to say whether subclade K actually makes a person sicker than other flu strains, but if it drives more cases, it will certainly drive hospitalizations too, Rubin said.”When you look at severity, the more cases you have, if the same percentage get hospitalized, obviously you’re going to have more hospitalization if you have more cases. So it sometimes will look like the severity is also worse,” he said.Lab testing data has begun to show an uptick in flu cases.”This is the time we start to see the rise,” said Dr. Allison McMullen, a clinical microbiologist at BioMerieux, which makes the BioFire test, a popular diagnostic tool for respiratory pathogens.The company anonymously compiles its test results into a syndromic surveillance tool, which can offer a glimpse of what bugs are making people sick at any given time. At the beginning of the month, less than 1% of tests were positive for type A flu. Now it’s 2.4% – still low numbers but going up briskly, which aligns with the CDC trend.”We’re going to start seeing heavy holiday travel before we know it,” McMullen added. “With the rising cases that we’re seeing the U.K. and Japan, it can definitely be a bellwether for what we’re going to see in North America.”Signals are also rising in wastewater, said Dr. Marlene Wolfe, an assistant professor of environmental health at Emory University. In October, 18% of samples in the WastewaterSCAN network — an academically led wastewater monitoring program based at Stanford University, in partnership with Emory — were positive for type A flu, Wolfe said. In November, that number had risen to 40%.”Flu is something where, when it’s not in season, we don’t detect it very frequently in wastewater,” Wolfe said. COVID, on the other hand, can be detected pretty much all the time, which makes it challenging to know if it’s going up or down, she said.The scientists can set a threshold for when they can declare that a specific area is in flu season, Wolfe says. So far, just four of the 147 sites they monitor in 40 states have reached that threshold. Those sites are in the Northeast — in Maine and Vermont — in Iowa and in Hawaii.”I am concerned, I guess, that we could have a big flu season this year based on what we’re seeing in other parts of the world, and particularly Europe and elsewhere,” Michigan’s Lauring said.”It’s not too late. Go and get your flu shot,” Lauring advised. “And be alert that it’s out there.”

    The United States may be heading into its second severe flu season in a row, driven by a mutated strain called subclade K that’s behind early surges in the United Kingdom, Canada and Japan.

    Last winter’s season was extreme, too. The U.S. had its highest rates of flu hospitalizations in nearly 15 years. At least 280 children died of influenza, the highest number since pediatric death numbers were required to be shared in 2004.

    Now, with a new variant in the mix, experts say we’re on track for a repeat. And with flu vaccinations down and holiday travel on the way, they worry that things may look much worse in the weeks ahead.

    The good news: Early analysis shows that this season’s flu shots offer some protection against being hospitalized with this variant, especially for kids. The bad news is that many Americans appear to be skipping their flu vaccines this year. New data from prescription data company IQVIA shows that vaccinations are down compared to where they usually are at this point in the year.

    A new player

    Flu activity is low but rising quickly in the United States, according to the latest FluView report from the U.S. Centers for Disease Control and Prevention.

    Most of the flu viruses identified this season have been an A strain called H3N2, and half of those have come from subclade K, a variant that was responsible for a rougher-than-normal flu season this summer in the Southern Hemisphere.

    That variant wasn’t a major player when scientists decided which strains should be in the annual flu shots, so the vaccines cover a related but slightly different group of viruses.

    “It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case,” said Dr. Richard Webby, director of the World Health Organization Collaborating Center for studies on the ecology of influenza in animals and birds at St. Jude Children’s Research Hospital.

    Early analysis by the U.K. Health Security Agency shows that subclade K has seven gene changes on a key segment of the virus. Those mutations change the shape of this region, making it harder for the body’s defenses to recognize.

    “That’s the predominant thing that our immune system targets with antibodies, and that’s also pretty much what’s in the vaccine,” said Dr. Adam Lauring, chief of the Division of Infectious Diseases at the University of Michigan Medical School.

    UKHSA scientists found that the current flu vaccines are still providing decent protection against subclade K viruses. Vaccination cut the odds of an emergency department visit or hospitalization for the flu by almost 75% in children. The effectiveness for adults, even those over 65, was lower, about 30% to 40% against needing to visit the hospital or ER.

    But the scientists offer a caveat: These results are from early in the season, before the protection from seasonal flu vaccines has had time to wane or wear off. The findings are posted in a recent preprint study, which means it was published ahead of scrutiny from outside experts.

    Still, some protection is better than no protection, and while subclade K is expected to dominate the season, it won’t be the only flu strain circulating. No one gets to pick what they’re exposed to. Lauring said his daughter has just recovered from the flu, but it was a B-type strain.

    At the same time this new variant has emerged, flu vaccinations appear to be down in the U.S. According to IQVIA, about 64% of all flu vaccinations were administered at retail pharmacies, which administered roughly 26.5 million flu shots between August and the end of October. That’s more than 2 million fewer shots than the 28.7 million given over the same time frame in 2024.

    “I’m not surprised,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University’s School of Public Health. Vaccine skepticism expressed by leaders of the US Department of Health and Human Services has “injected chaos into the whole vaccination system,” she said.

    “There’s been a lot of attention on really non-issues,” like vaccine ingredients and separating shots, that she thinks “at the best, left people confused but possibly at the worst have left people worried about getting vaccinated,” she added.

    Flu vaccinations have also fallen in Australia, where subclade K was the predominant virus this year. As a result, flu hit a record, with more than 443,000 cases. Flu season in the Southern Hemisphere typically runs from May to July, so infectious disease experts often look to those countries for a preview of what might be on the way to North America.

    “What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming,” said Dr. Earl Rubin, director of the infectious disease division at the Montreal Children’s Hospital in Canada.

    ‘This is the time we start to see the rise’

    It’s difficult to say whether subclade K actually makes a person sicker than other flu strains, but if it drives more cases, it will certainly drive hospitalizations too, Rubin said.

    “When you look at severity, the more cases you have, if the same percentage get hospitalized, obviously you’re going to have more hospitalization if you have more cases. So it sometimes will look like the severity is also worse,” he said.

    Lab testing data has begun to show an uptick in flu cases.

    “This is the time we start to see the rise,” said Dr. Allison McMullen, a clinical microbiologist at BioMerieux, which makes the BioFire test, a popular diagnostic tool for respiratory pathogens.

    The company anonymously compiles its test results into a syndromic surveillance tool, which can offer a glimpse of what bugs are making people sick at any given time. At the beginning of the month, less than 1% of tests were positive for type A flu. Now it’s 2.4% – still low numbers but going up briskly, which aligns with the CDC trend.

    “We’re going to start seeing heavy holiday travel before we know it,” McMullen added. “With the rising cases that we’re seeing the U.K. and Japan, it can definitely be a bellwether for what we’re going to see in North America.”

    Signals are also rising in wastewater, said Dr. Marlene Wolfe, an assistant professor of environmental health at Emory University. In October, 18% of samples in the WastewaterSCAN network — an academically led wastewater monitoring program based at Stanford University, in partnership with Emory — were positive for type A flu, Wolfe said. In November, that number had risen to 40%.

    “Flu is something where, when it’s not in season, we don’t detect it very frequently in wastewater,” Wolfe said. COVID, on the other hand, can be detected pretty much all the time, which makes it challenging to know if it’s going up or down, she said.

    The scientists can set a threshold for when they can declare that a specific area is in flu season, Wolfe says. So far, just four of the 147 sites they monitor in 40 states have reached that threshold. Those sites are in the Northeast — in Maine and Vermont — in Iowa and in Hawaii.

    “I am concerned, I guess, that we could have a big flu season this year based on what we’re seeing in other parts of the world, and particularly Europe and elsewhere,” Michigan’s Lauring said.

    “It’s not too late. Go and get your flu shot,” Lauring advised. “And be alert that it’s out there.”

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  • COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

    COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

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    With a triple pandemic of COVID, flu, and Respiratory syncytial virus (RSV) hitting the U.S. hard this winter and resulting in an explosion of cases, business executives need to take the lead on promoting the newly updated, Omicron-specific boosters. Doing so will help reduce the number of sick days taken by their workers, minimize COVID outbreaks and superspreader events in their companies, reduce employee fears about returning to the office, and position executives as trustworthy participants in stakeholder capitalism.

    Research shows that the new boosters from Pfizer and Moderna, which are bivalent (they target both Omicron and the original COVID strain) are very safe, like current vaccines. They are also more effective than previous vaccines against the Omicron variants, which are prevalent in the U.S. and around the globe.

    The boosters are widely available and price is not an issue: the federal government purchased plenty of doses to give away for free to anyone approved to get one. They’re authorized for Americans aged 12 or older. The Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky stated “there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it.”

    Unfortunately, these recommendations are largely falling on deaf ears. Only 7.6 million Americans received the new booster in September, the first month it became widely available.

    Missing booster shots could have dire consequences

    The reason for low uptake stems from vaccine hesitancy and a lack of awareness. According to a Kaiser Family Foundation survey, less than a third of the targeted population intend to get the new boosters.

    This low number is not surprising, given an Ipsos poll showing that 65% believe there is a small or no risk in returning to their normal, pre-COVID life. That belief would not be a problem if we didn’t have hundreds of COVID-related deaths per day right now, and many additional deaths from flu and RSV as part of the triple pandemic. Moreover, the University of Washington’s Institute for Health Metrics and Evaluation projects a new wave of COVID in the winter that could more than quadruple the current infection rate, which aligns with projections of a major winter wave by the FDA.

    The consequences for executives and their teams can be dire. We knew since early 2022 that, according to a CDC study, the original vaccine’s effectiveness against Omicron fades quickly. Those who received two doses of Moderna or Pfizer have 71% less likelihood of being hospitalized with COVID compared to non-vaccinated people within the first month of getting the shots. However, that effectiveness fades relatively quickly to 58% after four months and continues falling off after that. Someone who received the original two doses and then a booster gets a protection of 91% against hospitalization immediately. Effectiveness falls to 78% after four months.

    By now, it’s been many months since most Americans received the original vaccine series and the booster shots. That makes us seriously vulnerable to COVID, especially the most experienced, senior staff at companies, whose age puts them in a high-risk category.

    The immediate danger of staff members being out for several weeks in a hospital, or even dying, is just part of the problem. We can’t forget about the threat of long COVID, meaning long-term symptoms of COVID infection. These symptoms can range from fatigue and brain fog to sudden heart failure and strokes in otherwise healthy young and middle-aged people.

    A CDC survey from June 2022 shows that 7.5% of Americans report having long COVID symptoms, defined as symptoms lasting three or more months after first contracting the virus. A study by the University of Southern California finds that 23% of those who get sick with COVID are likely to get long COVID symptoms.

    Per a study published in The Lancet, 22% of those who had long COVID symptoms were unable to work, and another 45% needed reduced hours. The Brookings Institution evaluated these numbers to find that long COVID is keeping anywhere from 2 to 4 million Americans out of the labor force. No wonder we’re experiencing such labor shortages!

    Nobody wants their staff–or themselves–to become part of these statistics. Yet what are executives doing about it? Not much. That’s despite serious recent outbreaks at major companies that mandated office returns, such as Google or CalPERS, the $441.9 billion California Public Employees’ Retirement System.

    By failing to take action, business leaders are falling into the omission bias. This term refers to a dangerous judgment error–a cognitive bias that downplays the costs of inaction in our minds.

    In fact, some companies are taking steps in the opposite direction in their desperation to drive staff to the office. For example, Goldman Sachs lifted vaccination requirements everywhere except in areas that have government vaccine mandates for being in the office.

    What should managers do?

    What executives should be thinking about is the long-term consequences of failing to encourage new booster shots. Given the data, we can confidently state that the more employees get shots, the fewer sick days they will take. It will also lower the chance of staff having to permanently reduce their hours or even withdraw from the labor force.

    Similarly, advocating for boosters will minimize COVID outbreaks in a company. Doing so avoids the bad PR from such outbreaks, as well as the decreased morale afflicting staff at a time when companies are trying to have their staff return to the office, as Google, CalPERS, and others have discovered.

    On a related note, to reduce employee fears about returning to the office, encouraging everyone to get the new booster is an excellent strategy. Whether a company pursues a flexible, team-led model in returning to the office as I encourage my clients to do, or a more rigid, top-down approach, many employees have fears about COVID. An internal survey my company just completed for a Fortune 500 SaaS company showed that 64% of respondents felt somewhat concerned about COVID in the office. That aligns with broader surveys, such as one by Ipsos in September showing that 57% of those surveyed feel somewhat concerned about COVID.

    Last, but far from least, comes the crucial role of executives to serve as trustworthy exemplars of what the Business Roundtable calls the new purpose of companies: stakeholder capitalism. A critical aspect of stakeholder capitalism involves “supporting the communities in which we work.”

    There’s little doubt that reducing COVID among company employees supports broader community health and well-being. According to Edelman’s trust barometer, business leaders are trusted more than the government, nonprofits, and the media. Some 86% of respondents to the trust barometer expect CEOs to speak out on issues such as pandemic impact. This makes it only more urgent for executives who wish to be on the front line of stakeholder capitalism to speak out in favor of the new boosters.

    Mandates are certainly not the right way to go about promoting new boosters, given that we are transitioning from the emergency of the pandemic into a more endemic stage of learning to live with the virus. A much better approach is creating appropriate norms and nudging employees to engage in win-win behaviors by using behavioral science-based approaches.

    To create appropriate norms, executives need to both publicly advocate for the new boosters and get the shot themselves. The CEO at one of my client organizations wrote up a blog post for an internal company newsletter about the benefit of getting the bivalent booster, accompanied by a photo of himself getting the jab. She also strongly encouraged her C-suite and mid-level managers to get the booster and discuss doing so with their team members. The company also brought in a well-respected epidemiologist to talk about the benefits of getting a bivalent vaccine booster, who answered questions and addressed concerns among staff.

    To nudge employees, this company offered paid time off for getting the shot, along with sick leave for any side effects. It also created a competition between different teams within the organization. Team members could submit anonymized proof of their shots, and the first three teams to have all their members get shots got treated to an all-expense-paid weekend getaway. The company offered the same prize through a lottery for five employees across the organization who got the booster within the first three months it became available.

    Other companies I work with have adopted similar techniques to developing norms and nudging employees, customized to their own needs. These approaches help create a context that encourages employees to protect everyone’s health without forcing them to get the shot. Doing so benefits the bottom line by reducing sick days, addressing worker resistance to coming to the office, minimizing PR fiascos, and helping executives be at the forefront of stakeholder capitalism.

    Gleb Tsipursky, Ph.D., is the CEO of the boutique future-of-work consultancy Disaster Avoidance Experts. He is the best-selling author of seven books, including Never Go With Your Gut: How Pioneering Leaders Make the Best Decisions and Avoid Business Disasters and Leading Hybrid and Remote Teams: A Manual on Benchmarking to Best Practices for Competitive Advantage. His expertise comes from over 20 years of consulting for Fortune 500 companies from Aflac to Xerox and over 15 years in academia as a behavioral scientist at UNC-Chapel Hill and Ohio State.

    The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

    More must-read commentary published by Fortune:

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    Gleb Tsipursky

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  • FDA OKs Novavax COVID Vaccine as First Booster Shot

    FDA OKs Novavax COVID Vaccine as First Booster Shot

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    By Cara Murez 

    HealthDay Reporter

    THURSDAY, Oct. 20, 2022 (HealthDay News) – Americans will now have another choice if they want a COVID booster shot.

    On Wednesday, the U.S. Food and Drug Administration approved Novavax Inc.’s protein-based vaccine as a first booster dose. Until now, it had only been approved as a two-dose primary series.

    “The U.S. now has access to the Novavax COVID-19 Vaccine, adjuvanted, the first protein-based option, as a booster,” Novavax President and CEO Stanley Erck said in a news release. “According to CDC data, almost 50 percent of adults who received their primary series have yet to receive their first booster dose. Offering another vaccine choice may help increase COVID-19 booster vaccination rates for these adults.”

    The Novavax booster could be used by adults who can’t find or are not able to use an mRNA boosters from Pfizer or Moderna. It’s also available to people who prefer this vaccine for a booster over the mRNA options. The Novavax booster can be given at least six months after the primary series.

    The Novavax vaccine uses a more traditional approach to fighting the virus, teaching the immune system to recognize modified fragments of the coronavirus spike protein.

    Scientists created the vaccine from a genetic sequence of the original strain of the virus. Vaccines that fight hepatitis B and pertussis are also made in this way.

    Public health officials are encouraging people to get their boosters. About 68% of U.S. residents have had an initial COVID vaccine series, but only 33.5% have received boosters, CDC data shows. Novavax’s vaccine is one of four options available in the United States now.

    More information

    The U.S. Centers for Disease Control and Prevention has more on COVID-19 vaccines.

     

     

    SOURCE: CNN

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  • Should Your Flu and COVID Shots Go in Different Arms?

    Should Your Flu and COVID Shots Go in Different Arms?

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    At a press briefing earlier this month, Ashish Jha, the White House’s COVID czar, laid out some pretty lofty expectations for America’s immunity this fall. “Millions” of Americans, he said, would be flocking to pharmacies for the newest version of the COVID vaccine in September and October, at the same appointment where they’d get their yearly flu shot. “It’s actually a good idea,” he told the press. “I really believe this is why God gave us two arms.”

    That’s how I got immunized last week at my local CVS: COVID shot on the left, flu shot on the right. I spent the next day or so nursing not one but two achy upper arms. Reaching high shelves was hard; putting on deodorant was worse. And it did make me wonder what would have happened if I’d ignored Jha’s teleological advice and gotten both jabs in the same arm. Maybe my annoyance would have been lessened. Or perhaps the same-side shots would have made the soreness in my left arm way worse. When I posed this puzzle to immunologists, vaccinologists, and pharmacists, I got back a lot of hems and haws. For the millions of Americans who will be getting two-shot appointments by fall’s end, they told me, the choice really does come down to personal preference in the absence of clear data: You’ve just gotta pick a side. Or, you know, two.

    On the one hand (sorry), there are the vaccine double-downers. Sallie Permar, a pediatrician at Weill Cornell Medicine, and Stephanie Langel, an immunologist at Duke University, both said they’d probably get both shots in the same shoulder; so would Rishi Goel, an immunologist at the University of Pennsylvania. “Personally, I’d rather have one arm that’s slightly uncomfortable than both,” Goel told me.

    On the other hand, we’ve got Team Divide-and-Conquer. Several experts said they’d follow the White House protocol of splitting shots left and right. Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he’d prefer to have two slightly sore arms to one totally dead one. Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, says she generally recommends that her patients get the vaccines on separate sides “for comfort.” Last year, she opted to get the flu shot and a COVID booster within a few inches of each other, and “I wanted to chop my arm off,” she told me. “Never again.”

    Read: America’s fall booster plan has a fatal paradox

    The deciding logic here should be pretty intuitive, Permar told me. Two shots on one side might be expected to double how sore that arm will get, though the experience of each vaccine recipient will depend on a bevy of factors, including the ingredients in the shots and that person’s infection and vaccination history, as well as their immune-system health. Also, for people like my husband—who’s prone to very heavy vaccine side effects—the choice may not matter at all. He was so knocked out by the fever and chills that came with his COVID-flu-shot combo, he couldn’t have cared less which arms got the shots.

    I dug around for studies examining the consequences of the one-versus-two-arm choice and found only one: a Canadian trial from 2003, which vaccinated a few hundred sixth-graders at two dozen middle schools against group C meningitis and hepatitis B at the same time. Roughly half the kids got both shots in the same arm; the others received one on each side. (Some kids in the latter group requested that their shots be administered by a pair of nurses who could plunge both syringes at the same time.) Among students in the same-arm group, 18 percent ended up with tenderness at the injection site that they rated “moderate or severe.” But those kids fared better than the ones in the two-arm group, 28 percent of whom experienced moderate or severe tenderness in at least one arm, and 8 percent of whom had it in both arms at the same time.

    But those results apply only to that group of kids in that setting, with those two specific vaccines; there’s no telling whether the same trends would be seen with flu shots and COVID shots when given to children or adults. Michela Locci, an immunologist at the University of Pennsylvania, told me she suspects that combining flu and COVID inoculations in the same arm could actually drive extra side effects: “The overall inflammation might be higher,” she said.

    Many pediatricians, who often have to administer four or five shots to a baby at once, are habitual splitters. “If there’s more than one vaccine syringe to give to a baby, generally, two legs are used,” Permar told me. (Kids usually upgrade to arm shots sometime in toddlerhood—it’s all about finding a muscle that’s big enough for the needle to hit its mark.) Doctors also have a nerdy reason to split shots between arms or legs. “If there’s a local reaction to the vaccine,” Permar said, “you can identify which vaccine it was if you separate them by space.” (For the record, I had a more painful reaction in my left arm, where I got the COVID shot. Others I’ve spoken with have reported the same disparity.)

    Read: Families are going rogue with rapid tests

    The CDC advocates for separating vaccination shots by at least one inch of space. Per the agency, if a COVID shot is being given at the same time as a vaccine “that might be more likely to cause a local injection site reaction,” the shots should be dosed into “different limbs, if possible.” Two types of flu shots cleared for use in people 65 years and older—the high-dose vaccine and the adjuvanted one—fall into that category. But the different-limb advice doesn’t seem to apply to other flu shots, including those cleared for use in younger adults and kids.

    However someone ends up taking simultaneous flu and COVID shots, the placement is unlikely to affect how much protection the vaccines provide. There could be an argument for letting “each side focus on its own thing,” says Gabriel Victora, an immunologist at Rockefeller University. “But it probably doesn’t make a whole lot of difference.” Children routinely get combo vaccines, such as DTaP and MMR, each of which combines multiple disease-fighting ingredients in a single syringe. The triple-threat formulas work just as well as injecting their individual parts. The immune system is used to multitasking: It spends all day being bombarded by microbes, so there’s good reason to believe that with vaccines, too, our body will see simultaneous shots “as independent events,” Goel told me.

    Which arm gets picked for which shot, though, will affect where the jab’s contents end up. After a vaccine is injected, its immunity-inducing ingredients meander to the nearest lymph node, such as the ones in the armpits. There, hordes of immune cells fight over the vaccine’s bits, and the fittest and fiercest among them are selected to leave the lymph node and fight. Here, again, doubling up on one arm shouldn’t be an issue, Goel said: The immune-cell boot camps in these lymph nodes have “a good amount of real estate.”

    It might even be a good idea to stick the same limb—and thereby, the same lymph node—every time you get another dose of a particular vaccine. After immune cells in a lymph node spot a particular bit of pathogen, some of them march off into battle, but others may hang around like reserve troops, mulling over what they’ve learned. A couple of recent studies, one of them in mice, hint that repeated delivery of the same ingredients to those veteran learners could give the body a slight edge—though the extent of that advantage “might be marginal,” Victora told me. Still, Langel, of Duke, told me jokingly that because she usually gets all of her vaccines in her “non-writing” arm, the lymph node beneath it could now be especially superpowered—a “nice bonus” for her defenses on the whole.

    That said, no one should stress too much about getting a shot in the “wrong” arm. “It’s not like you’re immune on the left side and not on the right side,” Goel told me. Immune cells travel throughout the body; there is no midline DMZ. Permar even points out that getting the newly formulated COVID vaccine, which includes new ingredients tailored to fight Omicron subvariants, on the opposite side from the previous rounds could help its ingredients reach a fresher slate of cells. “I think you could convince yourself either way,” she told me. Which, honestly, leaves me totally at peace with my choice. Apart from arm achiness, I had no other side effects—and in a way, I preferred the symmetry of the one-on-each-side injections.

    With all that said, it’s worth briefly acknowledging a third option: Splitting the flu and COVID vaccines into separate visits. I was, before my most recent COVID shot, some 10 months out from my previous dose. But it felt awfully early for my flu shot, which might be better timed for peak protection if taken later in the season. Still, the allure of getting it all over with was too tantalizing, especially because I happen to have a lot of travel up ahead. In the grand scheme of things, the bigger, more important choice was opting into the shots at all.

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    Katherine J. Wu

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