As we prepare for the 2025-2026 flu season, staying up to date on the latest vaccination guidelines and public health recommendations is essential. The 2024-2025 flu season saw moderate-to-severe activity in various regions, emphasizing the importance of widespread immunization efforts to prevent hospitalizations and complications. The CDC has issued updated guidance to ensure communities remain protected.
Policy & regulatory updates for 2025-2026
Continued use of trivalent flu vaccines
For the second consecutive year, the FDA has approved trivalent influenza vaccines, following the removal of the B/Yamagata lineage from vaccine formulations. The trivalent vaccine contains:
- Two influenza A strains
- One influenza B strain (B/Victoria lineage)
The FDA’s 2025-2026 recommended strains are:
- A/Victoria/4897/2022 (H1N1)pdm09-like virus
- A/Croatia/10136RV/2023 (H3N2)-like virus
- B/Austria/1359417/2021 (B/Victoria lineage)-like virus
According to the FDA, a sufficient and varied supply of FDA-approved trivalent seasonal influenza vaccines is expected to be available for the 2025-2026 flu season in the U.S. This means that multiple manufacturers are projected to produce enough vaccine doses to meet national demand, helping ensure broad access for individuals across all recommended age and risk groups.
Shift in strain-selection advisory process
Unlike prior seasons, the 2025 strain-selection panel did not involve external advisory bodies like VRBPAC or ACIP. Instead, internal reviewers from the FDA, CDC, and DOD made the final strain recommendations.
Expanded eligibility for Flublok and FluMist
According to the CDC, two influenza vaccines – Flublok and FluMist – have recently received expanded indications, allowing them to be administered to a broader range of patients than before.
- Flublok (recombinant trivalent vaccine) is now approved for individuals aged 9 years and older (previously 18+).
- FluMist (Live Attenuated Influenza Vaccine – LAIV3) can now be self- or caregiver-administered for individuals aged 9 years and older. These updates increase administration flexibility in pharmacy and community settings, especially for pediatric and adolescent patients.
Thimerosal-free recommendations
In a notable policy shift, the ACIP now recommends preferential use of thimerosal-free, single-dose flu vaccines; this does not strictly ban thimerosal-containing formulations though. It means that, when available, providers are encouraged to use thimerosal-free options.
Importantly, thimerosal-containing multi-dose vials still exist, though they are becoming increasingly rare (used in only about 4–5% of U.S. flu shots)
Clinical guidance on flu vaccinations
COVID-19 and flu: a dual vaccination approach
The dual threat of influenza and COVID-19 remains a significant public health consideration. For the 2025-2026 season, the CDC continues to recommend co-administration of influenza and COVID-19 vaccines for individuals aged 6 months and older. Updated COVID-19 boosters tailored to the latest variants will be available alongside flu vaccines this fall.
Why is co-administration recommended?
- Convenience for patients and providers, encouraging better vaccine uptake.
- No known safety concerns; studies show that while mild side effects—like fatigue or soreness—may occur, they are generally short-lived and manageable
- No schedule conflict—vaccines can be administered at different injection sites during a single visit (e.g., arms) with no minimum interval required.
When to get vaccinated
Flu vaccines are expected to be available in early August, with September and October remaining the ideal vaccination window for the general population.
However, when flu vaccine supply is constrained, the CDC recommends focusing on individuals at higher risk for complications, including:
- Children aged 6 months through 4 years
- People aged 50 years and older
- Those with chronic conditions, such as pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic, hematologic, metabolic disorders (e.g., diabetes)
- Immunocompromised individuals, including organ transplant recipients
- Pregnant people, including up to 2 weeks postpartum
- Children 6 months–18 years on salicylate medications who are at risk for Reye syndrome
- Residents of long-term care facilities
- American Indian or Alaska Native populations
- Individuals with extreme obesity (BMI ≥ 40)
- Healthcare personnel
- Household contacts or caregivers of children under 5 or adults aged 50+, or those with high-risk medical conditions
Also, if there is uncertainty about a patient returning during the recommended window, it’s better to vaccinate them early to ensure continuous protection.
Patient counseling: nasal spray, bird flu, and new strain concerns
For patients opting for the nasal spray flu vaccine, it’s important to educate them that the vaccine contains a weakened live virus, which cannot cause influenza illness. Common side effects like nasal congestion or mild irritation are not indicators of infection but rather a typical immune response.
Regarding avian influenza (H5N1 bird flu), while sporadic cases in poultry and livestock have raised concerns, the risk to the general public remains extremely low. The flu vaccine does not offer protection against bird flu; however, the U.S. government maintains a preparedness plan to develop targeted vaccines should an outbreak occur.
Emerging research: broader health benefits
Recent studies continue to explore the potential broader health benefits of annual influenza vaccination, including possible reductions in cardiovascular events, stroke risk, diabetes onset, and certain cancer mortalities. Additionally, universal flu vaccine candidates targeting conserved viral proteins remain in development and could redefine influenza prevention strategies in the coming years.
Key takeaways for pharmacists for the coming flu season
As trusted healthcare providers, pharmacists are pivotal in promoting vaccination awareness, addressing patient concerns, and ensuring communities are protected against the flu as well as other respiratory illnesses. By staying informed and proactive, pharmacists can help reduce the seasonal impact of influenza and support public health efforts.
Stay ahead this flu season — protect yourself, your patients, and your community.
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