Vaccination Recommendations for Flu, COVID-19, RSV, and Pneumonia
All individuals aged ≥6 months should receive annual influenza and COVID-19 vaccines, while RSV and pneumococcal vaccines are recommended for specific age groups and those with risk factors.
Influenza (Flu) Vaccine Recommendations
- All persons aged ≥6 months should receive annual influenza vaccination, ideally by the end of October 1
- Vaccination is particularly important for those at higher risk for complications:
- Children aged 6-59 months
- Adults aged ≥50 years
- Persons with chronic medical conditions (pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders)
- Immunocompromised individuals
- Pregnant women
- Residents of nursing homes and long-term care facilities
- American Indians/Alaska Natives
- Persons with extreme obesity (BMI ≥40) 2
- For adults ≥65 years, high-dose (HD-IIV4) or adjuvanted (aIIV4) influenza vaccines are preferred 1
COVID-19 Vaccine Recommendations
- All persons aged ≥6 months should receive the 2025 COVID-19 vaccine 2, 1
- For adults aged ≥12 years: 1 dose of 2025 COVID-19 vaccine (Moderna, Novavax, or Pfizer-BioNTech) 1
- For children aged 5-11 years: 1 dose of 2025 COVID-19 vaccine (Moderna or Pfizer-BioNTech) 1
- For children aged 6 months-4 years: initial multidose series when first receiving COVID-19 vaccination, including at least 1 dose of the 2025 COVID-19 vaccine 1
- Persons who are moderately or severely immunocompromised may require additional doses 1
RSV Vaccine Recommendations
- Adults aged ≥75 years should receive a single lifetime dose of RSV vaccine 2, 1
- Adults aged 60-74 years with risk factors for severe RSV disease should receive a single lifetime dose of RSV vaccine 2, 1
- Risk factors for severe RSV disease in adults aged 60-74 years include:
- Chronic cardiovascular disease
- Chronic lung or respiratory disease
- End-stage renal disease
- Complicated diabetes mellitus
- Neurologic or neuromuscular conditions affecting airway clearance
- Chronic liver disease
- Chronic hematologic conditions
- Severe obesity (BMI ≥40)
- Moderate or severe immune compromise
- Residence in a nursing home
- Other chronic medical conditions that increase risk for severe respiratory disease 2
Pneumococcal Vaccine Recommendations
- All adults aged ≥19 years with specific risk factors should receive pneumococcal vaccination 2
- All adults aged ≥65 years should receive pneumococcal vaccination 3
- Recommended pneumococcal vaccination schedule:
- One dose of PCV15 followed by PPSV23 8 weeks later, OR
- One dose of PCV20 2
- Pneumococcal vaccination is particularly important for those with:
- Chronic medical conditions
- Immunocompromising conditions
- Anatomical or functional asplenia
- Cerebrospinal fluid leaks
- Cochlear implants 2
Special Considerations
Timing and Co-administration
- Influenza and COVID-19 vaccines can be administered simultaneously at different injection sites 1
- 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
- Continue vaccinating throughout the respiratory virus season as long as viruses are circulating 1
Vaccination in Cancer Patients
- All adults with cancer should be up-to-date on vaccinations 2
- Cancer patients should receive pneumococcal vaccination (PCV15 followed by PPSV23 8 weeks later OR one dose of PCV20) 2
- Live attenuated influenza vaccine should not be administered to severely immunocompromised persons 2, 1
Vaccination Coverage Challenges
- Despite recommendations, vaccination coverage remains suboptimal:
Disease Severity Considerations
- Among hospitalized older adults, RSV was associated with more severe disease than COVID-19 or influenza 5
- Patients hospitalized with RSV were more likely to require oxygen therapy, ICU admission, and had higher rates of invasive mechanical ventilation or death compared to those with influenza 5
- This higher severity underscores the importance of RSV vaccination for eligible older adults 5
Remember that vaccination is not a substitute for other preventive measures, but remains one of the most effective strategies to reduce the burden of respiratory infections, especially in high-risk populations.