Flu Vaccine Guidance for 2025-2026

In this episode, TRC Healthcare editor, Vickie Danaher, PharmD, dives into the 2025/2026 flu vaccine season with a clear overview of what’s new and what remains consistent. From updated vaccine strain compositions and preferred products for older adults to thimerosal-free recommendations and egg allergy guidance, this episode equips you with the latest evidence-based insights.

She also tackles common patient questions, discusses coadministration with COVID-19 and RSV vaccines, and shares practical strategies to boost vaccine confidence and avoid administration errors.

Whether you're prepping for flu season or answering tough questions at the pharmacy counter, this episode has you covered.

This is an excerpt from our September 2025 Pharmacy Essential Updates continuing education webinar series.

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CE Information:

TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.

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Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Answer Questions About 2025-2026 Flu Vaccines
• Chart: Flu Vaccines for 2025-26 (United States)
• FAQ: Communicating About Flu Vaccination
• Article: Stay Current on RSV Immunization Guidance
• Article: Clarify Facts About COVID-19 Vaccines for 2025-2026

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Transcript

This transcript is automatically generated. 

00:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your go-to podcast for fast, evidence-based insights. 

00:00:11 Narrator

On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher breaks down the latest flu vaccine updates for the 2025/2026 season.

00:00:20 Narrator

What’s changed, what hasn’t, and what you need to know to answer common patient questions in an excerpt from our popular Pharmacy Essential Updates webinar series.  

00:00:30 Narrator

TRC has been a trusted resource for healthcare professionals for over 40 years—and now we’re bringing that expertise straight to your ears every 2nd and 4th Tuesday, in bite-sized, actionable episodes…right here on Clinical Capsules.

00:00:45 Narrator

This podcast offers Continuing Education credit for pharmacists and pharmacy technicians.

00:00:50 Narrator

Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:00:58 Narrator

None of the speakers have anything to disclose.  Let’s take a closer look…

00:01:07 Vickie Danaher

This is always a very popular topic that raises a lot of questions every year.

00:01:13 Vickie Danaher

And this year in particular, there's been some big changes that are leading to questions from patients and other healthcare professionals alike.

00:01:21 Vickie Danaher

So our article says you'll need to be ready with guidance about flu vaccines for 2025/2026, as confusion and misinformation abound.

00:01:31 Vickie Danaher

But first, let's start off with one thing that hasn't changed this year.

00:01:34 Vickie Danaher

And that's which patients should get a flu vaccine.

00:01:38 Vickie Danaher

So explain that an annual flu vaccine is still recommended for all patients aged 6 months and older who don't have contraindications.

00:01:47 Vickie Danaher

And in terms of the flu vaccine products, all influenza vaccines in the US will be trivalent again like last season. So they'll protect against three different strains of flu viruses.

00:01:59 Vickie Danaher

All flu vaccines will still protect against two influenza A strains, which are H1N1 and H3 N 2, and then just one influenza B strain, which is B Victoria.

00:02:13 Vickie Danaher

And new for this season, the influenza AH3N2 strain is updated in all flu vaccines.

00:02:20 Vickie Danaher

To try to match what flu strains will likely be circulating this year.

00:02:24 Vickie Danaher

So a key take away point that we can share with patients is that the flu vaccine composition is different this year and this can be especially helpful for those patients who say they don't need a flu vaccine because they got one last year.

00:02:36 Vickie Danaher

And with that background, let's discuss some common big questions that come up from patients and some changes to be aware of this season.

00:02:44 Vickie Danaher

So this is one question that comes up from our patients every year… when is the right time to get a flu vaccine?

00:02:50 Vickie Danaher

So similar to last year, CDC recommends to start vaccinating most patients in September, not July or August because of the potential for waning immunity before flu season ends.

00:03:03 Vickie Danaher

So for most people who just need one dose of flu vaccine, September or October are generally the ideal times to get vaccinated. 

00:03:12 Vickie Danaher

And that's especially because it takes about two weeks after vaccination for antibodies that protect against flu to develop. 

00:03:18 Vickie Danaher

So the goal really is to have patients vaccinated and protected before flu season ramps up.

00:03:25 Vickie Danaher

You know that typical flu activity can start in October and last through May, and it often peaks in February.

00:03:32 Vickie Danaher

But even though it's ideal to get vaccinated by the end of October, we still want to continue to vaccinate as long as flu is circulating and vaccine is available, since this can still provide protection, especially when flu season is ongoing.

00:03:46 Vickie Danaher

But keep in mind that there's some exceptions to this general rule of starting to vaccinate. In September, for example, children aged 6 months through eight years who haven't had at least two doses of flu vaccine in the past need 2 doses of flu vaccine this year. Given at least four weeks apart.

00:04:05 Vickie Danaher

And because of that separation, CDC still recommends that these kids get their first dose as soon as possible after vaccine becomes available to give enough time for that second dose to be received, ideally by the end of October.

00:04:17 Vickie Danaher

Early vaccination can also be considered in the third trimester of pregnancy to help protect the infant during the first few months of life when they're too young to be vaccinated themselves.

00:04:27 Vickie Danaher

And then for all patients, we want to make sure not to give a flu booster, regardless of when they get this year's vaccine.

00:04:35 Vickie Danaher

In adults, studies haven't shown a benefit from getting more than one dose during the same influenza season. Even among elderly patients with weakened immune systems.

00:04:45 Vickie Danaher

So again, only one dose of flu vaccine is recommended each season for patients, except those children getting vaccinated for the first time.

00:04:54 Vickie Danaher

Now let's move on to another common question for patients, which is which flu vaccine is best.

00:05:00 Vickie Danaher

So what do you think about this and what do you tell your patients when this question comes up?

00:05:06 Vickie Danaher

And in general, the key is for patients to get vaccinated with any available flu vaccine that's appropriate for their age and health status, rather than trying to worry about which flu vaccine to get or risking not getting a flu vaccine trying to find a particular product.

00:05:21 Vickie Danaher

But there are some nuances this year in terms of the recommendations.

00:05:25 Vickie Danaher

As well as some differences between the flu vaccine products that may determine which vaccine should be given.

00:05:32 Vickie Danaher

For example, for the 2025/2026 flu season, the new Advisory Committee on Immunization Practices, or ACIP, recommends that only single dose flu vaccine formulations free of the preservative thimerosal be used for children, pregnant patients, and adults. 

00:05:51 Vickie Danaher

However, be aware that this decision was based on theoretical risks and concerns about cumulative exposure to thimerosal, not any new data.

00:06:00 Vickie Danaher

And several large, well-designed studies in the US and other countries show no evidence of harm caused by the low amount of thimerosal in vaccine multidose vials.

00:06:10 Vickie Danaher

For example, studies have not supported claims that thimerosal and vaccines causes serious adverse effects such as autism. And there's also no evidence that giving a pregnant patient a flu vaccine with thimerosal poses a risk to the fetus.

00:06:25 Vickie Danaher

Because of this, evidence-based recommendations from the American Academy of Pediatrics and other medical organizations continue to support getting any licensed flu vaccine appropriate for the patient, regardless of it's in a single dose prefilled syringe or a multidose vial.

00:06:43 Vickie Danaher

Additionally, most payers will still cover flu vaccine from a multidose vial.

00:06:49 Vickie Danaher

Keep in mind that single dose influenza vaccines are already the most utilized option in the US.

00:06:55 Vickie Danaher

But if a multidose vial containing thimerosal is what's in stock, follow your state law and protocol regarding use.

00:07:02 Vickie Danaher

Most vaccine experts and clinicians would suggest not delaying vaccination if a multidose vialis available, since the benefits of flu vaccinations, such as preventing serious complications from influenza, far outweigh any theoretical risk with thimerosal.

00:07:18 Vickie Danaher

On the other hand, we do want to respect the patients request to specifically receive a preservative free flu vaccine if desired.

00:07:27 Vickie Danaher

All right, so that was 1 consideration when it comes to choosing among flu vaccine products, another big consideration is the patients age. So let's talk now about which flu vaccines are preferred for patients age 65 years and up.

00:07:40 Vickie Danaher

And for these patients, we want to continue to give a higher dose or adjuvanted flu vaccine when possible.

00:07:46 Vickie Danaher

So these would be Fluzone High-Dose, Flublok, or Fluad.

00:07:52 Vickie Danaher

Evidence suggests that these flu vaccines are more effective than standard dose flu vaccines for older patients, especially to reduce flu hospitalizations.

00:08:02 Vickie Danaher

Let's do a little quick review to remind ourselves how these preferred vaccines for patients age 65 and older are a little different than the others.

00:08:09 Vickie Danaher

So first with Fluzone high dose, it's approved for adults age 65 and older and it has four times the amount of antigen as standard dose injectable flu vaccines with the goal of this trying to be to boost immunity in older patients since the immune response to flu vaccines weakens with age.

00:08:30 Vickie Danaher

Next is flu block, which is now approved for patients age 9 and older.

00:08:36 Vickie Danaher

It's a recombinant vaccine, and it has three times the amount of antigen than standard dose injectable vaccines. And that's why CDC is using the phrase higher dose for Fluzone high dose and Flublok. So, you might hear that terminology.

00:08:51 Vickie Danaher

And then Fluad is also approved for adults over age 65, like Fluzone high dose.

00:08:58 Vickie Danaher

But Fluad has an adjuvant which is an ingredient intended to help boost the immune response.

00:09:05 Vickie Danaher

So again, these three vaccines are preferentially recommended for patients aged 65 and older, but among these three vaccines, there's no preference to use one over another, so you can use any of them that you have in stock.

00:09:18 Vickie Danaher

And if a higher dose or adjuvanted flu vaccine isn't available for an older patient, we still want to go ahead and use a standard dose flu vaccine instead rather than wait and potentially miss the opportunity for the patient to get vaccinated altogether.

00:09:35 Vickie Danaher

And then like last year, adults were a solid organ transplant recipients and who are taking immunosuppressants may get a high dose flu vaccine, or adjuvanted flu vaccine, as an option.

00:09:47 Vickie Danaher

So in other words, even though if Fluzone high dose or adjuvanted fluad are only FDA approved for patients 65 and older, they can now be given to these higher risk transplant patients based on ACIP recommendations. And in this case, there's no preference for high dose or adjuvanted flu vaccines over other standard.

00:10:07 Vickie Danaher

Dose injectable vaccines, it's just another option that these patients have.

00:10:12 Vickie Danaher

OK, so much of that was similar to last year's flu season, but one key change for this season is that the recombinant egg free flu vaccine Flublok, which was previously approved for patients age 18 years and older, can now be given to patients as young as age 9. And this is based on data demonstrating that the vaccine.

00:10:32 Vickie Danaher

Induces a similar immune response in these patients compared to adults without any safety concerns identified.

00:10:40 Vickie Danaher

Also be aware that the live attenuated intranasal flu vaccine Flumist will still be available this year in pharmacies and prescriber offices, but new this year is also going to be available in some states for patients or caregivers to self-administer the vaccine at home.

00:11:00 Vickie Danaher

Regardless of where it's given, Flumist is still indicated for otherwise healthy non immunocompromised, non pregnant patients aged 2 through 49 years, and it's especially an option if the patient refuses an injection.

00:11:14 Vickie Danaher

But there are some nuances with the at home vaccine option that you want to point out if patients ask about it.

00:11:20 Vickie Danaher

For example, patients will need to order flu mist on the product website by completing A questionnaire, and that's going to be reviewed by a healthcare professional for eligibility.

00:11:31 Vickie Danaher

If the patient is eligible, they must pay shipping for the product to be delivered for their home. They also must refrigerate the product until they're ready to use it, and they also must return the sprayer for proper disposal to the manufacturer through a prepaid return envelope.

00:11:48 Vickie Danaher

Also explained that that at home, Flumist won't be an option for those without insurance or on the vaccines for children program this year.

00:11:57 Vickie Danaher

So for these patients as well as those who don't want to go through all the steps involved with storing and disposing of the product at home, you'll want to just recommend getting the nasal spray at your pharmacy. If you stock it.

00:12:10 Vickie Danaher

And if your pharmacy does stock it, continue to administer and bill your stock of Flumist as usual. Don't dispense it for at home use and don't allow patients or caregivers to self-administer it at your practice.

00:12:24 Vickie Danaher

It must still be given by a healthcare professional in these settings.

00:12:29 Vickie Danaher

Now another group of patients that there's always questions about when it comes to getting a flu vaccine are those patients with a history of egg allergy.

00:12:36 Vickie Danaher

So I briefly wanted to touch on this. So if you remember, CDC updated their guidance on this about two years ago and it's the same for this year as well.

00:12:45 Vickie Danaher

So remember that patients with a severe egg allergy can get any flu vaccine in any setting. These patients are no longer limited to a medical setting like a doctor's office or hospital.

00:12:57 Vickie Danaher

Evidence shows that patients with an egg allergy do not have a higher reaction rate compared to those without an egg allergy, and having an egg allergy alone doesn't require any additional safety measures beyond those recommended for anyone who's getting a vaccine in our pharmacy.

00:13:13 Vickie Danaher

So continue to follow your pharmacy's usual immunization protocols, such as those for screening and having anaphylaxis kits on hand, and also point out that egg free flu vaccines, like the cell cultured Flucelvax and the recombinant vaccine flu block are still available if the patient prefers.

00:13:33 Vickie Danaher

All right, so we talked about who should get a flu vaccine and which vaccines can be used. Now let's get a bit into the why and discuss benefits and risks. So when one of your patients asks you how effective are flu vaccines or our flu vaccines safe, how do you respond?

00:13:52 Vickie Danaher

So in terms of flu vaccine efficacy explain that this varies each season, and that's based on how well the vaccines match up to the flu viruses that are circulating. So unfortunately, we don't know how effective this year's vaccines will be until the season kind of pans out, plus efficacy of the vaccine for an individual patient can also depend on their age, their health status and the timing of their vaccination.

00:14:17 Vickie Danaher

But even if we find out that the flu vaccines this year aren't well matched to circulating strains, we do know that overall flu vaccination reduces the risk of getting the flu reduces its severity and reduces the risk of flu related complications, including hospitalization and death.

00:14:34 Vickie Danaher

And as it relates to safety, reassure patients that mild side effects, such as soreness at the injection site or fatigue, may occur, but serious adverse events are extremely rare.

00:14:47 Vickie Danaher

As pharmacists and techs, we can also continue to take steps to increase vaccine confidence and decrease hesitancy. Although I know this isn't always easy. So for instance, when talking with patients about flu vaccines and any vaccine we can use open-ended questions such as what concerns you about flu vaccine or tell me more about that.

00:15:07 Vickie Danaher

We can also be listening for common misconceptions, such as the belief that the flu vaccine causes the flu or that healthy people don't need a flu vaccine.

00:15:17 Vickie Danaher

And then it's always a good idea to ask to provide facts. So kind of getting consent from a patient to help avoid the backfire effect, where providing facts that already contraindicate the person's beliefs increases hesitancy instead of reducing it.

00:15:31 Vickie Danaher

So for example, you could say something like I have some information that other people have found helpful. May I share it with you?

00:15:39 Vickie Danaher

Now we don't have time in today's session to dig too much deeper into this, but I wanted to share that we have a resource on our website called vaccine adherence addressing myths and hesitancy. That could help address common concerns and provide credible resources that can be shared with patients.

00:15:55 Vickie Danaher

And then the last flu vaccine question that we'll talk about today is whether other vaccines such as COVID-19 RSV or shingles vaccine can be given at the same time as a flu vaccine.

00:16:07 Vickie Danaher

So what do you say to patients about getting more than one vaccine at the same visit?

00:16:14 Vickie Danaher

And the answer to this hasn't changed. Patients can, and ideally should, get all needed vaccines at the same visit. With rare exceptions, Co administration is generally recommended to help prevent missed opportunities for vaccination, and it hasn't been found to negatively impact efficacy or safety.

00:16:33 Vickie Danaher

Keep in mind that there's not a maximum number of vaccines that can be given at one visit, but when multiple vaccines are given, we want to make sure to administer them in different arms.

00:16:44 Vickie Danaher

Or if you need to give them in the same arm, such as in the case of a patient getting more than two vaccines, make sure to separate each injection by at least one inch.

00:16:53 Vickie Danaher

Also document where each vaccine was given, and even consider giving patients a vaccine map in the event there's a local reaction. This can make it easier to help identify which vaccine may have been the culprit.

00:17:07 Vickie Danaher

Let's wrap up here with some tips to help prevent snares with vaccines.

00:17:12 Vickie Danaher

So remember to continue to store vaccines in separate bins or separate shelves with eye-catching labels.

00:17:18 Vickie Danaher

Keep in mind to slow down and double check that you're selecting the correct vaccine from your computer and fridge, especially with flu vaccines, it can be easy to mistake all things flu, Fluarix, Fluzone, Fluzone, high dose, etc.

00:17:31 Vickie Danaher

And then when giving vaccines bring only the needed vaccines to the administration area for one patient at a time.

00:17:39 Vickie Danaher

Ask open-ended questions to confirm you have the right patient and the right vaccines. So you could say something like to confirm what vaccines are you here to get today?

00:17:48 Vickie Danaher

And then consider showing the patient the syringe before giving the injection as another check.

00:17:55 Vickie Danaher

All right. Well, that's a wrap on our annual flu vaccine update. For details on specific influenza vaccine products, be sure to check out our highly popular chart flu vaccines for 2025/2026 available on our website.

00:18:08 Vickie Danaher

It includes approved ages for use, dose, cost, added thimerosal content, and more.

00:18:14 Vickie Danaher

It's also a good idea to bookmark that page or save it as a favorite on your computer so you can have quick access during your busy workday.

00:18:23 Vickie Danaher

Also, don't forget to see our resource communicating about flu vaccination to review guidance on immunizing kids, pregnant or immunocompromised patients and people with an egg allergy.

00:18:36 Narrator

We hope you enjoyed and gained practical insights from listening to this episode! 

00:18:41 Narrator

Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit. 

00:18:46 Narrator

Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:18:53 Narrator

We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.

00:19:07 Narrator 

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00:19:16 Narrator

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00:19:25 Narrator

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00:19:36 Narrator

Thanks for listening… stay sharp, stay current—and we’ll catch you next time on Clinical Capsules!