Cystic Fibrosis and Seasonal Respiratory Illnesses: Flu, COVID-19, and RSV

The flu, COVID-19, and RSV are highly contagious viruses that can cause significant illness. When people with cystic fibrosis get one of these viruses, they may get sicker than people without CF because of their lung disease.

Common respiratory illnesses include the flu (influenza), COVID-19, and RSV (respiratory syncytial virus). They are caused by viruses, are highly contagious, and occur most frequently during the late fall and winter months in the U.S. They can be spread by direct and indirect contact and through the air, such as when someone sneezes.

The flu, COVID-19, and RSV can make people with cystic fibrosis of any age very sick because of their lung disease, but they can be especially problematic for those with weakened immune systems and the very young and old. People with CF who have had a lung or other organ transplant may be particularly vulnerable to serious illness from respiratory viruses, because they take medications that suppress their immune systems to prevent organ rejection. People with autoimmune diseases who take these medications are also at risk.

People whose immune systems are suppressed should avoid the live, attenuated influenza vaccine (LAIV) nasal spray due to safety concerns.

"Because I am immunocompromised after having a lung transplant, I still take extra precautions with COVID-19." — Katherine, adult with CF, from the CF Community Blog

Reducing the Risk: Vaccines and Medication

To reduce the risk of getting and spreading these viruses, it is important for you and everyone around you to follow infection prevention and control practices such as wearing masks when sick or around others who are sick, washing your hands, and getting vaccinated. In addition, antiviral medication that is often given to treat the flu can also be used to prevent the flu in people who have been exposed.

There are safe and effective vaccines for the flu and COVID-19, as well as vaccines and preventive treatments for RSV. All approved vaccines and treatments have been shown to be safe and effective, especially at preventing severe illness, hospitalizations, and death. Side effects have been rare and minor for most people. 

Who Should Get Vaccinated?

Flu

The annual flu vaccination is recommended for everyone 6 months and older unless they have a medical reason for not getting the vaccine (called a contraindication). This recommendation includes people with CF, their families, and those who have frequent close contact with people with CF.

It is best to get the flu shot in September or October because flu cases usually start increasing in October. It can take around two weeks after vaccination for the body to be protected against the flu virus. If you cannot get vaccinated by October, getting the flu vaccine later is still helpful as flu season can last until spring. Likewise, even if you’ve had the flu, it still is a good idea to get the vaccine during the same flu season as being sick with one strain does not protect you from others.

It is important to get the flu shot every year because flu viruses are always changing. The flu vaccine cannot prevent all types of the flu virus, but it remains the best way to reduce the risk of getting the flu viruses that are most likely to make you sick during the current flu season.

People with CF can usually get their flu shot at a Cystic Fibrosis Foundation-accredited care center, through primary care providers, or retail pharmacies. Talk with your CF care team to find out whether vaccines are available at clinic visits. 

Children ages 6 months through 8 years may need two shots of the flu vaccine to fully protect them against the flu. Experts generally recommend four weeks between the two shots. Ask your doctor if your child needs one or two flu shots and how far apart they should be given.

COVID-19 

The CF Foundation encourages COVID-19 vaccination for all people with CF, their families, and those who have frequent close contact with people with CF. COVID-19 vaccines are updated yearly to address the latest strains. All approved vaccines have been shown to be safe and effective, especially at preventing hospitalizations and death. 

People with CF who have had a lung or any organ transplant may be particularly vulnerable to serious illness from COVID-19 because of medications that suppress their immune systems to prevent organ rejection. Discuss vaccine recommendations with your care or transplant team. 

Getting A COVID-19 Vaccine

It is a good idea to request a prescription for the COVID-19 vaccine from your doctor or care team. Contact your pharmacy or health care provider prior to making an appointment to ask about vaccine availability and requirements.

RSV

To prevent severe RSV in infants, it is recommended that pregnant individuals receive an RSV vaccine during their third trimester or infants can be given long-acting RSV antibodies. Talk with your doctor or care team about the benefits and risks of receiving the RSV vaccine during pregnancy and learn more. 

Long-acting antibodies are available to prevent RSV infections in infants, including infants with CF during their first year of life. Some infants with CF can receive a second dose of RSV antibody to protect them during their second year of life. 

For adults with CF ages 50 years and older who have not previously received an RSV vaccine, it is recommended to receive a single dose of an RSV vaccine in late summer or early fall before RSV typically starts to spread in the community. Talk to your care team about RSV immunization recommendations. A prescription may be necessary.

People Who Live With Individuals With CF

People who live in the same household as someone with CF or have close contact with someone with CF — especially a person who has had a transplant or whose immune system is suppressed — should also be fully vaccinated against flu and COVID-19 and take precautions to reduce the risk of spreading these viruses. It is a good idea to request a prescription for the COVID-19 vaccine and RSV vaccine from your doctor or care team. Contact your pharmacy or health care provider prior to making an appointment to ask about vaccine availability and requirements.

The more people in your circle who have received vaccinations, the better the chances of creating what is called “herd immunity” in your community. When a large percentage of people get vaccinated, it makes it more difficult for the illness to spread, offering some protection for most people.

For questions about vaccine access, coverage, in-network vaccine locations, call CF Foundation Compass. Compass case managers can help find locations that provide in-network vaccines as well as address other vaccine access or cost concerns. Compass's hours of operation are:

• Monday through Thursday, 9 a.m. until 7 p.m. ET

• Friday, 9 a.m. until 5 p.m. 

  
  

What Are the Side Effects?

The vaccines for flu, COVID-19, and RSV immunization have been found to be safe and effective. Side effects for most have been rare and mild. Serious side effects are possible in rare cases, however, and you should discuss any concerns you have about side effects with your care team or doctor. The most common reported side effects include:

• Soreness at the injection site

• Fatigue

• Headache

• Muscle and joint aches

• Fever

• Nausea

If you have any of these, they should go away in a few days. Discuss any concerns you have about side effects with your care team or doctor.

What If You Get a Respiratory Illness?

If you have a respiratory illness, you should stay home and away from others until your symptoms get better and your fever is gone. The fever should be gone without using a fever-reducing medicine, such as acetaminophen (Tylenol) or ibuprofen (for example, Advil). 

Contact your CF care center or doctor's office as soon as you feel symptoms. Flu and COVID-19 home test kits are available, or testing can be performed at urgent care facilities.

Antiviral medications used to treat people for the flu are most effective if taken within 1–2 days of the start of symptoms. Antiviral medication for flu may also be used to prevent infection in the case of close contact with someone with active flu. 

Antiviral medications used to treat people for COVID-19 are most effective if taken within 5–7 days of the start of symptoms. These antiviral medications may help lessen your symptoms or how long you are ill but are not a substitution for the annual flu vaccine. Because the antiviral medication Paxlovid can interact with CFTR modulators, your modulator dose will need to be adjusted while you are taking Paxlovid. Discuss the necessary dose adjustments with your CF care team.

Reducing the Risk: Other Best Practices

In addition to getting vaccines, the following recommendations are intended to help people with CF reduce the risk of getting and spreading germs:

• Clean your hands: Use soap and water to wash your hands or clean them with an alcohol-based hand gel (especially after coughing or sneezing). This will help protect you and others around you.

• Cover your cough: Use a tissue when you cough or sneeze. Throw the tissue away immediately, then wash your hands with soap and water or clean them with an alcohol-based hand gel. If you don't have a tissue, cough or sneeze into your inner elbow. If you cough or sneeze into your hands, wash them immediately afterward.

• Keep a safe distance: Try to stay at least 6 feet away from anyone who has a cold, the flu, or an infection both outdoors and — especially — indoors, such as in school or at work. If you do get sick, staying home will allow you to get rest and recover. It will also help prevent the spread of respiratory viruses to others.

• Wear a mask when in a hospital or clinic, when you’re sick, or around others who may be sick.

• Practice other good health habits: Get plenty of sleep, drink plenty of fluids, eat nutritious food, be physically active, and manage your stress.