It’s the question on everybody’s mind. As Omicron has recently pushed COVID numbers to record heights in Australia, and NSW is staring down the barrel of a “significant flu epidemic” this winter: when is it safe to get the flu shot, after contracting COVID?

“You need to make a full recovery from a COVID infection before you have the flu shot; as soon as symptoms have gone and you feel back to normal, you would present for the flu vaccination,” says Dr Daria Fielder, a general practitioner in Sydney’s Bondi Junction. For many people, this will be 10 days to two weeks after becoming infected with COVID, she says.

“We don’t want to prolong COVID, if someone is just recovering,” says Dr Daria Fielder, of the risk of someone immunising themselves against the flu while they’re still suffering from COVID.

Ongoing COVID symptoms like a lingering feeling of tiredness or a tickly cough, she adds, are no reason to delay the flu shot. Rather, it’s fever, a sore throat and a deep hacking cough that need to have gone before a person is immunised against the flu (or any other virus).

The danger of getting the flu shot while you’re still sick with COVID is that you’ll simply be “sicker for longer”, says Fielder. This is because, while the flu vaccination cannot induce influenza – as it doesn’t contain any active flu virus – it does put stress on a person’s immune system because it prepares it to produce an immune response to a virus. “We don’t want to prolong COVID, if someone is just recovering,” she says.

Professor Bruce Thompson, head of the University of Melbourne’s School of Health Science, agrees that it’s unwise to undergo an immunisation while you’re still fighting off an infection.

“It’s a bit like running a marathon after you’ve got a horrible cold; you really don’t want to do that,” says Thompson, an epidemiologist.

The guidance comes at a crucial time, given that influenza cases in NSW more than tripled between March and April, and Victoria is experiencing its first flu season in three years.

And, just last week, NSW Chief Health Officer Dr Kerry Chant urged parents of young children to book them in for a flu vaccine because influenza for children under five is more dangerous to them than COVID – “[flu is] actually a reasonably severe disease in young children” – and the flu season has hit earlier than expected. And, because international borders have kept influenza at bay over the past two years, many young children have next to no immunity against the virus.

The guidelines for young children (despite them tending to overwhelmingly experience mild cases of COVID) are nearly identical to adults.

“If you’ve only just recovered from acute [COVID] infection; it’s similar to all of our guidance, you need to recover from that illness in terms of temperature, fever over 38 degrees, and generally how the child is feeding and drinking [before giving them any immunisation],” says Dr Nigel Crawford, director of SAEFVIC, a vaccine safety and clinical immunisation group at the Murdoch Children’s Research Institute in Melbourne. “You wouldn’t want to give a [flu] vaccine when they’re acutely unwell with COVID.”

This advice differs from the current vaccine guidelines that people who’ve just contracted COVID should wait three months for their scheduled booster, says Crawford. The COVID booster delay, he says, is to “optimise that dose three months later, rather than giving it straight away [after a COVID infection] because you’re getting some immunity from the COVID infection.”

For one thing, if a child spikes a fever after a vaccine – a common side effect – it would be difficult to tell what has triggered it; the vaccine, or their current illness, says Crawford, a pediatrician.

“COVID, for most children, has been a relatively mild illness, so as long as they’re recovered, feeling like they’re back to normal and you’re ready to take them back to childcare and out and about, that’s also the time to give them the [flu vaccine],” says Crawford.

He urges people of all ages, from six months and up, not to delay their flu vaccination, in general.

“People often wonder whether to wait, kind of thinking when the season might come, ‘Do I get it now, or wait a few months or weeks?’” he says. “Given we’re very uncertain what the season will be, and we’re even seeing cases in the last couple of weeks, we’d encourage everyone to come forward and get the flu vaccine, including those who are at highest risk [of serious illness with the flu],” he says, referring to people who have underlying medical conditions like cystic fibrosis and cancer, are otherwise immuno-compromised, or are indigenous. He urges pregnant women to also get their flu vaccine, as it will give them “double protection”; both for themselves and for their unborn children, who cannot get the vaccine until they are six months old.

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