Every week this time of year, someone in my exam room asks some version of the same question: “Do I really need all three?” They have seen the pharmacy signs for the flu shot, the COVID booster and the RSV vaccine, and they are not sure which ones apply to them. If you are an adult in Northborough, Marlborough or Hudson trying to sort this out, here is how I answer it in the office.
The flu shot: nearly every adult, and it is not too late
The CDC’s standing recommendation is that everyone six months and older get a flu vaccine every season, with rare exceptions. The ideal window is September or October, but vaccination continues as long as flu is circulating, and in Massachusetts the peak usually comes in January or February. Getting it in November still puts protection in place before the worst weeks.
If you are 65 or older, ask for the stronger version. CDC guidance for this season says adults 65 and older should preferentially receive a high-dose, recombinant or adjuvanted flu vaccine when one is available, because the standard dose produces a weaker immune response as we age. Egg allergy is no longer a reason to skip it or to pick a special product.
The COVID vaccine: the 2026–2027 formula is recommended for all adults
This is the one that confuses people most, because the advice has shifted over the past few years. As of its September 2026 update, the CDC’s clinical guidance states that a 2026–2027 COVID-19 vaccine is recommended for all adults 18 and older; the shared decision-making language applies to children, not adults.
In practice, I put the most weight on it for patients over 65, anyone with heart, lung, kidney disease or diabetes, anyone who is immunocompromised, and anyone who lives with or cares for someone in those groups. For a healthy 35-year-old the absolute benefit is smaller, but the recommendation still stands, and the main cost is a sore arm for a day. The flu and COVID vaccines can be given at the same visit, one in each arm.
RSV: a one-time vaccine, and the age cutoffs matter
RSV is the one most adults have never thought about, because for decades it was treated as a childhood illness. In older adults it causes a meaningful number of winter hospitalizations for pneumonia and worsening heart failure or COPD. The CDC recommends the RSV vaccine for everyone 75 and older, and for adults 50 to 74 at increased risk of severe RSV illness, which includes chronic heart or lung disease, a weakened immune system, certain other conditions and nursing-home residence.
Two things set it apart. It is a single dose, not an annual one; current CDC guidance is that one dose protects for at least two years, and people who have already had it should not get another right now. And if you are 50 to 74 and healthy, it is not routinely recommended.
When to talk to us rather than keep reading: if you are 50 to 74 and unsure whether a condition you have counts as “increased risk,” if you have ever had Guillain-Barré syndrome, or if you had a serious reaction to a previous vaccine.
How we handle this at our practice
Courtney Laperriere, PA-C, Diana Kisel, FNP-C and I share one chart, so whichever of us you see, we can check your vaccine history and tell you in the visit what you are due for. If you got a shot at a pharmacy in Hudson or Marlborough, or at a previous practice, the record often shows up through Care Everywhere; if not, bring the card or pharmacy printout and we will enter it.
We offer same-day sick visits most weekdays for established patients, with labs and an EKG on site, which matters in winter because a cough and a fever can be the flu, COVID, RSV or something else, and the right treatment depends on which. Established patients in Massachusetts can also use telehealth to talk through symptoms before deciding whether to come in.
On cost: these vaccines are covered as preventive care by the plans we accept, including Blue Cross Blue Shield, Harvard Pilgrim, Mass General Brigham Health Plan, Tufts Medicare Preferred HMO, Aetna, Cigna, UnitedHealthcare and Wellpoint. Some plans route vaccines through the pharmacy benefit, so check where yours prefers you receive them.
The short version
Flu shot: every adult, every year, stronger version at 65 and older. COVID vaccine: the 2026–2027 formula for all adults. RSV: one dose if you are 75 or older, or 50 to 74 with a qualifying condition. The details are on the CDC’s pages on flu vaccines, 2026–2027 COVID-19 vaccination and RSV vaccines for adults.
Interested in joining our practice? Reserve your spot with the short form on our new-patient page or call (508) 770-6701 — our team will call you within one business day to confirm your details and save your place, and patients on our list get first choice of appointment times. Current patients: our office is at 162 Main Street, Northborough.
Gunardi Irawan, MD, is board-certified in internal medicine and obesity medicine and leads a primary care and medical weight-management practice in Northborough, Massachusetts. This article is general health information, not medical advice for any individual.
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