Cooler weather is on our doorstep and it's bringing some very unwanted house guests — their names are COVID, influenza and RSV.
Some experts are predicting a particularly bad flu season and there's concern vaccine uptake will remain low and, in turn, hospitalisations will increase.
There's also talk of the dreaded "flurona".
Past experience shows infections will ramp up soon, usually around late April. Some vaccine guidelines have also recently changed.
Let's unpack the latest advice.
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Influenza
The 2023 flu season was particularly long, but the 2024 season could be even worse, says Michael Clements, vice president and rural chair of the Royal Australian College of GPs.
"We've been isolated in the past [during the pandemic] so there isn't a lot of herd immunity.
"International travel is full steam ahead and we typically import our influenza from the northern hemisphere."
However, he says a higher rate of infections can also reflect the fact people can now buy at-home testing kits and find out if they have influenza or RSV.
"So in the past we may never have even known they had influenza."
Christopher Blyth, a paediatric infectious diseases professor with the University of Western Australia, says every influenza season is different so it's hard to make many predictions.
"But what I will say is a significant number of children will be hospitalised with influenza this year, like every year."
Last year, children between the ages of five and nine had the highest influenza notification rates, and the number of deaths in children under 16 was higher than in many pre-COVID pandemic years.
"The bulk of children hospitalised are in good health, they just aren't vaccinated," says Professor Blyth, who's the director of the Wesfarmers Centre of Vaccines and Infectious Diseases at the Telethon Kids Institute.
According to the latest government data, influenza cases are higher than expected for this time of year (around 1.7 times greater than the same time last year).
Your immunisation guide:
Annual influenza vaccination is recommended for everyone over six months of age.
The following groups can receive their vaccine for free under the National Immunisation Program (NIP):
- children aged between six months and five years
- those over 65
- Aboriginal and Torres Strait Islander people
- anyone pregnant
- those with medical conditions that increase their risk of severe influenza
The Queensland government also recently announced it would pay the cost of the flu vaccine for all residents not covered by the NIP.
Dr Clements says pharmacies are starting to see vaccines trickle in, but the government stock is not due until around early April.
"I know some people are really keen but we actually want to tell them it's OK to wait, as it takes a month or so to get peak effect from the vaccine and it does taper off at between four to six months."
Professor Blyth says getting a vaccine in April will mean you're protected when infections start ramping up in May and still be covered for the peak, which is typically in August.
Vaccination coverage last year was low, with around 32 per cent of the population vaccinated.
Dr Clements says it's "heartbreaking" to see people suffer from something preventable and he particularly wants to see more pregnant women and young children vaccinated this year.
He says the higher the vaccine uptake, the lower the peak of infections. This will make the entire community safer, including those who aren't vaccinated.
"Because there's always people who can't get the vaccine or have it but it doesn't work."
The vaccine's effectiveness rate is between 40 to 60 per cent.
RSV
Respiratory syncytial virus (RSV) infections are common and can be very disruptive.
"Most parents can give a really good history of being awake at night worried about the wet cough their child has," Dr Clements says.
"For the elderly, it's often RSV that triggers the pneumonia that kills them."
The virus can infect the lungs and breathing passages and is the leading cause of hospitalisations in infants nationwide.
RSV is so common partly because individuals lose their immunity to it relatively quickly. Reinfection can occur just two months after the last infection.
"In the next couple of weeks to months we will have plenty of RSV. It's one of the major causes of bed block in paediatric hospitals," Professor Blyth says.
RSV normally surges around May to July in the southern states, while case numbers in the tropics can be more consistent throughout the year.
Your immunisation guide:
For years, Australians have suffered through RSV without the option of immunisation.
But this autumn, for the first time, that's no longer the case for some people.
The Therapeutic Goods Administration (TGA) last year approved a drug called Nirsevimab, which is a long-acting antibody that's been shown to reduce infections by about 75 per cent for up to five months.
While Nirsevimab is not currently part of the National Immunisation Program (NIP), some states have free immunisation programs for infants and children.
Earlier this month, the Western Australian government announced it will provide free access to Nirsevimab from April for all babies under eight months (or up to 19 months for those at increased risk of severe RSV).
This week, the Queensland and New South Wales governments followed suit and announced their own free RSV immunisation programs.
In Queensland, newborn infants, Aboriginal and Torres Strait Islander infants less than eight months of age and certain infants with complex medical conditions are eligible.
In New South Wales, premature babies born after October 31, 2023, all Aboriginal and Torres Strait Islander babies born after October 31, 2023 and certain vulnerable infants are covered.
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In a separate development, Australians over the age of 60 may have access to a free RSV vaccine in the future.
The TGA recently approved AREXVY which is a protein-based vaccine for the prevention of lower respiratory tract disease caused by RSV.
It is currently only available on private prescription (which means the consumer pays the full cost) as it's not funded through the NIP.
However the manufacturer of AREXVY has applied for the vaccine to be made available for free through the NIP, and Dr Clements believes this could happen next year.
COVID-19
COVID-19 transmission is low at the moment, Professor Blyth says, but cases are expected to rise around the same time as the influenza and RSV peaks.
"We're concerned COVID will just piggyback onto another cough or cold so if someone has RSV they might then happen to get COVID and have dual infections and be even sicker," Dr Clements says.
"It's known as flu-rona".
Professor Blyth says those who will be most at risk will be older Australians and those who are immunocompromised.
Your immunisation guide:
Last month the government updated its COVID-19 vaccination guidelines.
Six-monthly boosters are now only recommended for those over the age of 75.
Anyone over 18 is advised to just have an annual booster.
But if you're 65 to 74 or severely immunocompromised you can have a six-monthly booster. Talk to your doctor about the risks and benefits.
A 2024 booster is not recommended for those between the ages of five and 17, unless they're severely immunocompromised.
Children under five are not advised to have a booster this year.
Anything else?
Both Dr Clements and Professor Blyth urge all Australians to check with their GP about whether they're up to date with routine vaccinations.
This includes the shingles vaccination, which is free under the National Immunisation Program (NIP) for those most at risk, including anyone over the age of 65 or under 18 who is immunocompromised.
The pneumococcal vaccine is another important one.
Pneumococcal disease can cause a variety of diseases, like pneumonia and meningitis, and young children and the elderly are most at risk.
It is free under the NIP for certain groups including children, adults aged 70 and over and Aboriginal and Torres Strait Islanders aged 50 and over.
"It's not just about protecting yourself against the seasonal viruses but it's about keeping up to date with the routine stuff too," Professor Blyth says.
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