With two relatively non-existent flu seasons — not to mention a weariness over repeated COVID boosters — Michigan residents might be reluctant to roll up their sleeves this fall for an annual flu shot.

Not good, experts say.

“Flu is going to circulate — absolutely,” said Joe Fava, assistant professor of pharmacy practice at Wayne State University.

Despite worries of a “twindemic” (of flu and COVID), influenza practically disappeared from Michigan and the United States through much of the pandemic millions of people isolated at home and took safety precautions.

“People were masking up, hand-sanitizing,” said Farah Jalloul, state emergency preparedness coordinator for the Michigan Pharmacists Association. “If anyone sneezed, everyone walked away from them.”

But fewer people are toting masks around these days, and daily safety protocols have loosened, if not disappeared altogether, from schools.

So expect a more typical flu season this year along with staying on top of the newly redesigned COVID vaccine.

What’s new with flu

In Michigan, the season typically begins in October, peaking in December, January or February — though the season peaked late last winter.

Without the large volumes of flu sufferers the past two years, immunity against it has dropped, said Josh Petrie, a researcher specializing in influenza at the Wisconsin-based Marshfield Clinic Research Institute. Petrie worked at the University of Michigan flu lab until earlier this year and continues to collaborate with the Michigan researchers as part of the CDC’s national flu surveillance network.

Looking forward, he said Friday, “I’d guess we’ll have a flu season more typically like those before the pandemic.”

That’s not the only reason to be concerned about influenza this year.

While flu activity remains low around Michigan, according to the latest state health department surveillance report, some worry that a particularly rough flu season in Australia that peaked in June — Australia’s wintertime flu season — could be bound for the United States.

Too early?

The Biden administration has encouraged people to get the updated COVID booster as soon as they are eligible. The new vaccine, which is now available in Michigan, has been tailored to target the current omicron subvariants.

But administration officials have faced some pushback by suggesting people get both shots — for COVID and flu — at the same time. Some health experts worry that getting a flu shot in early September may be too early, given the late peak of the flu season this past year.

The flu shot’s effectiveness wanes after several months, in part, because flu strains shift and the body’s immune response against the virus fades in the months following the shot. (In comparison, some vaccines, like those against measles, rubella, and diphtheria, protect for a lifetime.)

But Fava, Jalloul and Petrie told Bridge that healthy people should worry more about making sure they get a flu shot than trying to time it to when the virus will peak this year.

The calculation: If getting both shots at the same time makes it more likely you won’t forget one of them, just get them and don’t worry about whether they are perfectly timed.

The flu season is too unpredictable to precisely time a vaccine, anyway, Petrie said.

“It would be nice to time your flu vaccine to as close to the beginning of the season as possible, but it’s just not predictable,” he said.

The alternative is to wait, but the worry is that flu season will be well underway before individuals are once again reminded about the flu.

“It might be a little bit early, but the trade off is getting people vaccinated in the first place,” he said.

For her part, Jalloul said she usually gets the flu shot as soon as, or soon after, supplies arrive in the summer — August or September, she said. Fava usually gets his in mid-September, he said.

Petrie, the flu researcher, said Friday he was going to get his flu shot this week, but misplaced his wallet.

The new COVID booster

For some Michiganders, including those over 50, the newly designed COVID booster is a fifth jab to fight the coronavirus.

Despite that, interest in the latest shot has been steady this week, said Jalloul of the pharmacists’ association.

Of course, she said, those asking for the COVID and flu shots now are the most motivated — often older Michiganders who are most at risk for severe disease if they’re infected.

Following federal guidance, Jalloul also recommends a “two-fer” visit to pharmacy customers — a COVID booster and the seasonal flu shot at the same time.

The U.S. Centers for Disease Control and Prevention recommends that influenza shots be offered during September or October, and they should remain available as long as influenza viruses are circulating.

Recommendations are different for young children. Children ages 6 months through 8 years require two doses. They should receive the first dose when the vaccine becomes available in the summer.

People moderately or severely infected with COVID-19 are advised to hold off getting a flu shot until they’ve recovered.

The Michigan Department of Health and Human Services has set a goal this year of 4 million Michiganders vaccinated against the flu last year. It fell short last year, with 3.3 million being vaccinated, according to the state’s flu dashboard. More than 3.1 million of them were given by Jan. 1.