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Ask the Experts: Influenza: Vaccine Recommendations

Results (26)

CDC’s influenza vaccination recommendations from the July 2025 CDC immunization schedules remain in effect for 2026–27, under the terms of the federal court orders halting implementation of votes made by ACIP after its membership was changed in June 2025. CDC continues to recommend annual influenza vaccination for all people without a contraindication, beginning at age 6 months.  

This season, separate seasonal vaccination recommendations for use of influenza, COVID-19, and RSV vaccines were published by the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), and the Infectious Diseases Society of America (IDSA). All of the medical societies emphasize the benefits of routine annual influenza vaccination.  

Important 2026–27 updates are summarized below: 

  • All three vaccine virus components changed for 2026–27. All U.S. influenza vaccines remain trivalent, containing two influenza type A strains and one influenza type B strain. 
  • In August 2026, FDA approved mFlusiva (Moderna), the first mRNA influenza vaccine, for people age 50 years and older. 
  • Carrying over last season’s recommendations, CDC recommends high-dose inactivated influenza vaccine (HD-IIV, Fluzone High-Dose by Sanofi), adjuvanted inactivated influenza vaccine (aIIV, Fluad by Seqirus), or recombinant influenza vaccine (RIV, Flublok by Sanofi) preferentially for adults age 65 years and older.  
  • AAFP recommends HD-IIV, aIIV, RIV, or the new mRNA influenza vaccine preferentially for people age 65 and older.  
  • AAP recommends any age-appropriate product for children without preference.  
  • ACOG recommends an age-appropriate IIV or RIV during pregnancy. The live-attenuated influenza vaccine (LAIV, FluMist by AstraZeneca) is not recommended during pregnancy, and the mRNA vaccine is not approved for use during pregnancy because of a lack of data on its use during pregnancy.  
  • IDSA recommends an age-appropriate 2026–27 influenza vaccine for immunocompromised people. AAP and IDSA provide additional details in their guidance documents on the optimal timing of vaccine administration and, in certain circumstances, product choice, for children and adults with significant immunocompromise due to disease or treatment.  
Last reviewed: September 23, 2026

ACIP recommends annual vaccination for all people ages 6 months and older who do not have a contraindication to influenza vaccination.

Last reviewed: September 3, 2025

CDC’s current 2026–27 interim clinical considerations are available at www.cdc.gov/flu/hcp/vax-summary/seasonal-influenza-vaccines.html. The version published on September 1, 2026, does not contain information about the mRNA influenza vaccine (mFlusiva by Moderna) which was licensed by FDA on August 5, 2026.  

In the absence of a functional ACIP at CDC during 2026, separate seasonal respiratory virus vaccination recommendations were published by the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), and the Infectious Diseases Society of America (IDSA). Their recommendations were informed by the Vaccine Integrity Project (VIP) of the University of Minnesota and the American Medical Association (AMA), which conducted a systematic review of relevant scientific literature published since the previous season’s vaccination recommendations were made. Published studies of the new mFlusiva mRNA influenza vaccine were included in the VIP review. AAP, AAFP, ACOG, and IDSA recommendation documents, plus the published evidence reviews, are all available from the AMA website at www.ama-assn.org/amaone/vaccine-recommendations. 

Last reviewed: September 23, 2026

Moderna’s mFlusiva is the first FDA-approved mRNA influenza vaccine. FDA approved it on August 5, 2026, for people age 50 years and older. It is not approved for use during pregnancy due to a lack of data on its use during pregnancy. It is supplied as a preservative-free, single-dose prefilled syringe and is administered as a 0.38 mL intramuscular dose. It is contraindicated for people who have had a severe allergic reaction (e.g., anaphylaxis) to a prior dose of mFlusiva or to a component of the vaccine. It contains no egg protein, preservatives, or antibiotics; it does contain polyethylene glycol (PEG). It is stored at standard temperatures for refrigerated vaccines: 2° to 8°C (36° to 46°F); it should never be frozen. It may be kept at room temperature, at 8° to 25°C (46° to 77°F), for up to 12 hours, but it should not be returned to the refrigerator after room-temperature storage begins. FDA information, including the package insert, is available at www.fda.gov/vaccines-blood-biologics/vaccines/mflusiva.

A large-scale, randomized clinical trial comparing its effectiveness to a standard, egg-based inactivated influenza vaccine (IIV) found it to be moderately superior to standard egg-based IIV, preventing 26.6% more cases of influenza infection in the study population age 50 years and older. This result is similar to the 24.4% relative reduction in influenza infections measured in a randomized clinical trial comparing high-dose influenza vaccine (HD-IIV) to standard, egg-based IIV among adults age 65 years and older that was published in 2014. Side effects, including injection site pain, fatigue, headache, and other systemic symptoms were significantly more common in mFlusiva recipients, but were generally mild and lasted a median of two days. 

A separate study in people age 65 years and older measured a somewhat stronger antibody response to mFlusiva compared to HD-IIV; however, this serologic study did not compare the products’ relative effectiveness at preventing clinical infections.  Further studies of mFlusiva’s clinical effectiveness in people age 65 years and older are planned. 

The September 1, 2026, CDC interim clinical considerations for the use of 2026–27 influenza vaccines are silent on mFlusiva. The American Academy of Family Physicians (AAFP) recommends mFlusiva as one of four preferred options for adults age 65 years and older, based upon the clinical trial evidence of its superior effectiveness against influenza infection compared to standard IIV. View the AAFP 2026–27 season recommendations for COVID-19, influenza, and RSV vaccination of immunocompetent adults and healthcare personnel at www.aafp.org/assets/image/upload/v1788277985/pdf_2026_through_2027_influenza_rsv_sars_covid_2_guidance.pdf.  

Last reviewed: September 23, 2026

Multiple manufacturers are producing inactivated, recombinant, and live attenuated influenza vaccines for the U.S. market for the 2025–26 season. All vaccines are trivalent (containing two influenza A and one influenza B virus vaccine antigen).

Immunize.org offers a 1-page printable document that summarizes each of the products available for the current influenza vaccination season: www.immunize.org/catg.d/p4072.pdf. Availability of the licensed influenza vaccines packaged in multidose vials (MDVs) containing thimerosal as a preservative vary by manufacturer.

Last reviewed: September 3, 2025

The 2025–26 vaccines are all trivalent (containing two influenza A and one influenza B strains). The B/Yamagata virus vaccine antigens are no longer included in influenza vaccines because B/Yamagata viruses have not been detected globally since March 2020.

The 2025–26 vaccines include a new influenza A(H3N2) component.

Egg-based influenza vaccines include:

  • an A/Victoria/4897/2022 (H1N1)pdm09-like virus;
  • an A/Croatia/10136RV/2023 (H3N2)-like virus; and,
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.

Cell culture-based or recombinant vaccines include:

  • an A/Wisconsin/67/2022 (H1N1)pdm09-like virus;
  • an A/District of Columbia/27/2023 (H3N2)-like virus; and,
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
Last reviewed: September 3, 2025

All nine 2025–26 influenza vaccines approved for adults are trivalent, containing two influenza A strains and one influenza B strain.

There are six injectable inactivated influenza vaccine (IIV) options for all adults age 18 years or older. Four egg-based standard dose IIV vaccines (SD-IIVs), one recombinant influenza vaccine (RIV), and one cell culture-based one (ccIIV) are available, all given as an intramuscular (IM) injection:

  • Afluria (CSL Seqirus): 0.5 mL/dose
  • Fluarix (GSK): 0.5 mL/dose
  • Flublok (RIV, Sanofi): 0.5 mL/dose
  • FluLaval (GSK): 0.5 mL/dose
  • Fluzone (Sanofi): 0.5 mL/dose
  • Flucelvax (ccIIV, CSL Seqirus): 0.5 mL/dose

One egg-based live attenuated nasal spray vaccine, FluMist (LAIV, AstraZeneca), is an option for healthy, non-pregnant adults through age 49 years: 0.2 mL (given intranasally, 0.1 mL in each nostril).

Three injectable vaccines, all given IM, are ACIP-preferred options for adults age 65 years or older:

  • Flublok (RIV, Sanofi): 0.5 mL/dose, licensed for use in people age 9 years or older
  • Fluzone High-Dose (egg-based HD-IIV, Sanofi): 0.5 mL/dose, licensed for adults age 65 years and older
  • Fluad (egg-based aIIV with MF59 adjuvant, CSL Seqirus): 0.5 mL/dose, licensed for adults age 65 years and older

Although licensed by FDA only for use in adults age 65 years or older, ACIP also recommends off-label use of Fluzone HD or Fluad as acceptable options for influenza vaccination of solid organ transplant recipients age 18 through 64 years who are on immunosuppressive medication regimens, without a preference over other age-appropriate IIVs or RIV.

Last reviewed: September 3, 2025

For people age 6 months through 64 years, CDC recommends any available age-appropriate influenza vaccine product.

For adults age 65 years and older, three influenza vaccines are preferentially recommended: Fluzone High-Dose (HD-IIV, Sanofi), Flublok recombinant (RIV, Sanofi), and Fluad adjuvanted (aIIV, CSL Seqirus). In June 2022, ACIP concluded that these three vaccines are potentially more effective than standard dose, unadjuvanted flu vaccines. However, if none of the three products are available, people age 65 years and older should get any other age-appropriate influenza vaccine.

Review the full explanation for the ACIP decision to prefer these products in this age group in the 2022 ACIP recommendations for influenza vaccination: www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7101a1-H.pdf.

ACIP recommends that solid organ transplant recipients (SOTRs) age 18 years through 64 years have the option of receiving HD-IIV or aIIV, both of which are licensed for people age 65 years or older. However, HD-IIV and aIIV are not preferentially recommended over age-appropriate influenza vaccine products for SOTRs.

Last reviewed: September 3, 2025


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Last reviewed: September 3, 2025

For most people who need only 1 dose of influenza vaccine, vaccination should ideally be offered in September and October. For people not vaccinated by the end of October, vaccination efforts should continue as long as influenza viruses are circulating and unexpired vaccine is available.

Vaccination in July and August should be avoided for most groups unless there is concern that vaccination later in the season might not be possible. Early vaccination has been associated with waning of vaccine-induced immunity and decreased vaccine effectiveness before the end of the influenza season, particularly among older adults.

Vaccination in July and August may be considered for people in their third trimester of pregnancy, to allow time for protective maternal antibodies to transfer to the fetus, providing protection during early infancy. Children younger than age 9 years who need two doses of vaccine this season should receive their first dose as soon as possible so that they can get their second dose before the end of October. Children who need only one dose can be considered for vaccination in July or August.

Last reviewed: September 3, 2025


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Last reviewed: September 3, 2025

CDC and ACIP make no recommendation for revaccination later in the season of people who have been fully vaccinated for the season, regardless of when the current season vaccine was received.

Last reviewed: September 3, 2025

Peak influenza activity generally occurs in the Northern Hemisphere during December through March, most frequently in January or February. Providers should continue vaccinating patients through spring, as long as there is continued circulation of influenza viruses and they have unexpired vaccine in stock and unvaccinated patients in their office.

Because influenza occurs in many areas of the world during April through September, vaccine should be given to travelers who missed vaccination in the preceding fall and winter. Another late season use of vaccine is for children younger than age 9 years who needed 2 doses of vaccine but failed to get their second dose. For each of these situations, vaccine can be given through the month of June since most injectable influenza vaccine has a June 30 expiration date.

Last reviewed: September 3, 2025


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Last reviewed: September 3, 2025

Yes, influenza vaccines may be coadministered with other recommended vaccines.

The live attenuated nasal spray influenza vaccine (FluMist, LAIV) may be given on the same day as any other live or inactivated vaccines. However, if two live vaccines are not given on the same day, they should be separated by at least 4 weeks.

There are now several vaccines containing nonaluminum adjuvants recommended for adults (including Nuvaxovid [COVID-19], Shingrix [zoster], Heplisav-B [HepB], Arexvy [RSV] and Fluad [aIIV, influenza]). Because of the limited data on the safety or reactogenicity of simultaneous administration of two or more vaccines containing nonaluminum adjuvants and the availability of nonadjuvanted influenza vaccine options, ACIP advises considering a nonadjuvanted influenza vaccine in situations in which influenza vaccine and another vaccine containing a nonaluminum adjuvant are due at the same visit. However, influenza vaccination should not be delayed if a specific brand of vaccine is not available.

Last reviewed: November 16, 2025


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Last reviewed: November 16, 2025

Yes, coadministration of influenza and RSV vaccines at the same visit is acceptable. CDC has provided the details of available information in its guidance on RSV vaccination of older adults: www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html#administration-other-vaxs.

CDC advises that when deciding whether or not to coadminister other vaccines with an RSV vaccine, consider whether the patient is up to date with currently recommended vaccines, the feasibility of the patient returning for additional vaccine doses, their risk for acquiring vaccine-preventable disease, vaccine reactogenicity profiles, and patient preferences.

Last reviewed: September 3, 2025

Healthcare providers should vaccinate any person who failed to get vaccinated in the previous vaccination season and who wants to reduce their risk of getting influenza during their upcoming travel, particularly if they are at high risk for influenza-related complications. This includes people who are traveling to the tropics, traveling with organized tourist groups at any time of year, or traveling to the Southern Hemisphere during April–September.

Last reviewed: September 3, 2025

There should be a minimum of 4 weeks between the doses in such situations.

Last reviewed: September 3, 2025

Because more than one type or subtype of influenza virus can circulate in any given influenza season, providers should offer influenza vaccination to unvaccinated people throughout the influenza season, including people who may have had an influenza illness already in the season.

Last reviewed: September 3, 2025


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Last reviewed: January 9, 2026

Protection from influenza vaccine wanes after vaccination (the amount of protection and the speed of waning varies by strain and by recipient age) but generally persists for at least 5–6 months.

Last reviewed: September 3, 2025

First, injectable influenza vaccines cannot cause influenza because they contain only parts of the virus. The live attenuated nasal spray vaccine is modified so that it cannot cause influenza because it cannot replicate at human body temperature. Fewer than 1% of vaccinated people might develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These vaccine side effects are not the same as having influenza, but people may confuse the side effects with illness.

Other reasons a person might have had influenza illness or an illness that they thought might be “the flu” after vaccination include:

  • Protective immunity doesn’t develop until 1–2 weeks after vaccination. Some people who get vaccinated after influenza viruses are already circulating may be infected with influenza before the vaccination can stimulate protective immunity.
  • For many people, “the flu” is any illness with fever, cold symptoms or gastrointestinal symptoms. If they get any viral illness, they may blame it on influenza vaccine or think they got “the flu” despite being vaccinated. Influenza vaccine only protects against specific influenza viruses, not all viruses.
  • Vaccinated people can get influenza illness despite vaccination. Influenza vaccination is our best available protection against influenza disease; however, vaccination reduces the risk of infection, it does not prevent all infections.

Vaccine effectiveness (VE) varies by age and by season, depending upon the circulating viruses. In most recent seasons, influenza vaccination has reduced the risk of illness by between roughly 40% and 60% in the vaccinated population (including all ages) during seasons when most circulating influenza viruses are well-matched to the vaccine. VE is generally lower for adults age 65 years and older. Influenza vaccination has also been shown to reduce influenza disease severity even if someone does get sick after vaccination, and vaccination reduces the risk of influenza hospitalization and deaths in children and adults. Influenza vaccination also reduces the risk of stroke and acute cardiac events, like heart attack and heart failure, among people with heart disease.

For more information on this topic, go to: www.cdc.gov/flu-vaccines-work/index.html.

Last reviewed: September 3, 2025

Giving patients an influenza VIS is mandatory under the National Childhood Vaccine Injury Act of 1986. The VIS must be given to all adults as well as to parents or guardians of children prior to vaccination. Two VISs are available, one for live attenuated influenza vaccine (LAIV) and one for inactivated influenza vaccine (IIV) and recombinant vaccine (RIV). The IIV and RIV VIS and all of its translations are available here: www.immunize.org/vaccines/vis/influenza-inactivated/. The LAIV VIS and all of its translations are available here: www.immunize.org/vaccines/vis/influenza-live/. Current influenza vaccine VISs are dated January 31, 2025. No specific VIS is available for mRNA influenza vaccine (mFlusiva) at this time.  
 
Immunize.org also offers a printable PDF document with QR codes for easy access to all of the IIV and RIV influenza vaccine VIS translations: www.immunize.org/wp-content/uploads/catg.d/p2092.pdf. Healthcare providers or recipients can scan the codes to access a digital copy of the translation on their mobile device. 

Last reviewed: September 23, 2026

The most important factor in preventing outbreaks is annual vaccination of all residents and staff who work at facilities such as nursing homes, assisted living facilities, and other group living situations. Groups that should be targeted include physicians, nurses, and other personnel working or volunteering in hospitals and outpatient settings who have contact with high-risk patients in all age groups, and providers of home care to high-risk people (for example, visiting nurses, therapists, and volunteers).

Last reviewed: September 3, 2025

If a patient or family member cannot remember if the patient received influenza vaccine this season and no record is available, proceed with administering influenza vaccine, even if it might mean an extra dose is given. When a patient reports that they HAVE received influenza vaccine but does not have written documentation, ACIP states that in the specific case of influenza (and pneumococcal polysaccharide) vaccination, patient self-report of being vaccinated can be accepted as evidence of vaccination.

Last reviewed: September 3, 2025

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