What are the recommended flu and Covid-19 (Coronavirus disease 2019) vaccine protocols for the fall of 2025?

Flu and COVID-19 Vaccine Recommendations for Fall 2025

For fall 2025, all individuals aged ≥6 months should receive the 2025-2026 seasonal influenza vaccine and the 2025 COVID-19 vaccine, with vaccination ideally completed by the end of October 2025. 1

Influenza Vaccine Recommendations

General Population

• All persons aged ≥6 months should receive the 2025-2026 seasonal influenza vaccine, preferably by the end of October 2025 1
• Continue vaccinating throughout the influenza season as long as influenza viruses are circulating and unexpired vaccines are available 1
• Early vaccination (July/August) is discouraged for most adults due to potential waning immunity by the end of the season 1

Children

• Children aged 6 months through 8 years who need 2 doses should receive their first dose as soon as vaccine becomes available to ensure completion of both doses before the end of October 1
• Children require 2 doses if they have not received ≥2 doses of influenza vaccine before July 1,2025
• Dose volumes for children 6-35 months vary by product:
  • Afluria Quadrivalent: 0.25 mL
  • Fluarix Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent: 0.5 mL
  • Fluzone Quadrivalent: 0.25 mL or 0.5 mL 1

Adults ≥65 Years

• High-dose (HD-IIV4) or adjuvanted (aIIV4) influenza vaccines are preferred for adults ≥65 years 1
• Solid organ transplant recipients receiving immunosuppressive medications may receive HD-IIV4 or aIIV4 without preference over other age-appropriate vaccines 1

Special Populations

• Live attenuated influenza vaccine (LAIV) should not be administered to:
  • Severely immunocompromised persons
  • Caregivers of severely immunocompromised persons requiring a protected environment (should avoid contact for 7 days after vaccination) 1
• LAIV may be administered to persons with mild to moderate asthma or recurrent wheeze 1

COVID-19 Vaccine Recommendations

General Population

• All persons aged ≥6 months should receive at least one dose of the 2025 COVID-19 vaccine formulation 1
• The 2025 COVID-19 vaccine will target currently circulating SARS-CoV-2 strains to provide protection against severe COVID-19-associated illness and death 1

Special Populations

• Persons who are moderately or severely immunocompromised may require additional doses; follow the most current CDC guidance 1
• The number of doses needed and intervals between doses may vary based on previous vaccination history and immunocompromise status 1

Co-administration of Vaccines

• Influenza and COVID-19 vaccines can be administered simultaneously at different injection sites 1
• Recent evidence suggests concurrent administration may enhance spike-specific antibody responses to SARS-CoV-2 without interfering with influenza vaccine responses 2
• If administering COVID-19 vaccines with influenza vaccines that might cause more injection site reactions (e.g., HD-IIV4 or aIIV4), consider using different limbs 1

Vaccine Effectiveness

• Preliminary data from the 2024-2025 season showed influenza vaccine effectiveness of:
  • 32-60% against outpatient influenza illness in children and adolescents
  • 63-78% against influenza hospitalization in children and adolescents
  • 36-54% against outpatient influenza illness in adults
  • 41-55% against influenza hospitalization in adults 3

Future Developments

• Combined influenza and COVID-19 vaccines are in development and may be available in the future 4, 5
• A phase 3 trial of mRNA-1083 (combined influenza and COVID-19 vaccine) showed promising results in adults ≥50 years, with noninferior and often superior immunogenicity compared to separate vaccines 4

Important Considerations

• For persons with acute COVID-19:
  • Those with moderate or severe COVID-19 should defer vaccination until recovery
  • Those with mild or asymptomatic COVID-19 might consider brief deferral to avoid confusing COVID-19 symptoms with post-vaccination reactions 1
• Vaccination should continue throughout the respiratory virus season as long as viruses are circulating 1, 3
• Travelers to the Southern Hemisphere or tropics should consider vaccination 2 weeks before departure if they haven't received the current seasonal vaccines 1

Common Pitfalls to Avoid

1. Delaying vaccination until influenza activity is detected locally, which may result in missed opportunities for protection
2. Administering LAIV to severely immunocompromised individuals or their close contacts requiring a protected environment
3. Failing to identify children who need two doses of influenza vaccine
4. Not considering the potential benefits of concurrent administration of influenza and COVID-19 vaccines
5. Neglecting to vaccinate throughout the entire respiratory virus season