A guide to fall vaccines

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With the shift in seasons, doctors and health systems are bracing for the return of respiratory viruses and the resulting wave of illness. Vaccination is a key part of the defense strategy to keep people healthy and out of the hospital.

Unlike in past years, the Centers for Disease Control and Prevention (CDC) has not issued updated vaccine recommendations for the 2026-27 respiratory-virus season. That's in part because the CDC's Advisory Committee on Immunization Practices (ACIP) has been sidelined by ongoing litigation over its membership and childhood vaccine policy changes.

"With ACIP in legal limbo, professional societies have stepped into that gap and are providing solid, evidence-based information," says William Schaffner, MD, a professor of preventive medicine in the Department of Health Policy and a professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, in Nashville, Tennessee.

Here's what you need to know about the upcoming respiratory-virus season ­- and what you can do now to prepare.

What vaccines are recommended for Americans this fall?

The nation's leading medical societies - including the American Association of Family Physicians, the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, and the Infectious Diseases Society of America - have jointly issued the following recommendations:

Influenza

Individuals 6 months and older, including those who are pregnant, should get an annual vaccine. People over age 65 should ask for a high-dose or mRNA vaccine.

COVID-19

All children ages 6 months to 23 months and those ages 2 to 18 at high risk or who desire the shot should receive an annual vaccine. Adults 19 and older, including those who are pregnant, should be vaccinated annually. People over age 65 should receive a shot every six months.

RSV (respiratory syncytial virus)

Women who are in their first eligible pregnancy and 32 weeks to 36 weeks pregnant between September 1 and March 1 should get the one-time vaccine. Infants whose mothers did not receive the vaccine, and children ages 8 months to 19 months in certain risk groups, should receive monoclonal antibodies. Adults 75 and older and those ages 50 to 74 with increased risk for severe RSV should receive a one-time vaccine. Although people can get the shot at any time of the year, the CDC says that the best time is late summer or early fall, ahead of the seasonal uptick in viral activity.

When should people be getting fall vaccines?

Experts say October is prime time for rolling up your sleeve(s).

With flu season already underway in parts of the country, "the earlier the better," says James D. Campbell, MD, MS, interim division head of Pediatric Infectious Disease and Tropical Pediatrics at the University of Maryland School of Medicine and chair of the AAP's Committee on Infectious Diseases. "A good rule of thumb is for everyone to get vaccinated before Halloween, which is prior to the really heavy season." (Keep in mind that it takes a couple of weeks for the body to mount the maximum immune response after vaccination.)

If you miss that window, however, a vaccine is still worthwhile since it provides protection into March or even April.

Are insurers expected to cover the cost of vaccines?

Even with the lack of new federal recommendations regarding vaccination, most insurers have said they will continue to cover flu, COVID, and RSV vaccines, according to AHIP, which represents the health insurance industry. Medicare is required to provide coverage.

Can I get more than one vaccine at a time?

It's perfectly okay to get two shots - say, a flu shot and a COVID shot - during the same appointment.

"I personally get them at the same time," says Ryan Maves, MD, an infectious disease and critical care physician at Atrium Health Wake Forest Baptist and a professor of infectious disease and internal medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina. "I don't like going to the pharmacy twice."

If you decide to double up, Schaffner suggests getting a vaccine in each arm to account for possible reactions.

Last year's flu season was a doozy. Are there any indications for how severe the flu season might be this year?

Scientists can glean some clues about the upcoming season by observing influenza season in other regions of the world that see flu first, but it's still only guesswork, Schaffner says.

"The last two years we've had serious flu seasons," he says. "Last year I did not predict that. The flu faked us out."

This year the flu has surprised scientists by appearing about a month earlier than usual. West Coast states are already seeing a meaningful rise in cases.

Schaffner believes vaccination should be a habit, regardless of flu patterns or predictions. "It should just be a routine activity every fall, because there will always be flu," he says.

"Even an average season leads to tens of thousands of deaths," adds Maves. "One hundred of those deaths will be in children. And we can be sure that vaccination will reduce this risk."

According to preliminary data from the CDC, influenza caused at least 32 million illnesses, 390,000 hospitalizations, and 24,000 deaths, including the deaths of 195 children, in the United States during the 2025-26 flu season.

How good a match is this year's flu shot to the virus that's circulating?

"Every year there's surveillance done around the globe for the different types of circulating influenza viruses," says Campbell. "In late winter, the decision on which viruses are most likely to be circulating the following flu season is made, and those are provided to vaccine manufacturers to start producing them."

The 2026-27 flu vaccine was updated to more closely match the H3N2 variant that dominated last season, including the subclade K virus. However, during the last week of September, the H1N1 strain accounted for 96% of positive flu cases in the U.S., data show.

Still, it's premature to say whether this year's vaccine will be less effective as a result, Maves says.

"It's been suggested that the new strain being seen on the West Coast may evade preexisting immunity to some degree, but these cases are also being seen before most people have received their seasonal vaccines," he notes. "It is certainly worthy of concern, but for now I think our collective advice is the same: Get the influenza vaccine - maybe a little earlier than usual."

What are the options for flu vaccination?

In addition to standard shots, a nasal spray (FluMist) is available for people ages 2 to 49 and can be administered at home, Campbell says. The nasal spray is about as effective as the shots and is a good choice for people who want to avoid needles. As with the other vaccines, coverage is provided by most insurers.

Individuals 65 or older are eligible to receive vaccines specially formulated to produce a stronger immune response, as their bodies don't usually mount as robust a reaction as those of younger people. According to the CDC, this high-dose vaccine (called Fluzone) contains four times the amount of antigen - the part of the virus that the immune system recognizes as foreign and responds to by producing antibodies - as the regular shot. Another vaccine for older adults (Fluad) contains an adjuvant, an ingredient that boosts the immune system's response to the vaccine's antigen. Although many pharmacies automatically offer these vaccines to older adults, it's wise to ask for one if you are in the target group.

This year there's a significant new entry (mFlusiva) - a vaccine based on mRNA technology, the same science behind most COVID-19 shots. It's approved for people 50 and older.

"Although the data are not yet complete, they indicate that the vaccine produces higher levels of antibodies than does the standard vaccine," says Schaffner. That could make it more effective.

However, says Maves, the new mRNA vaccines were compared with standard-dose vaccines in the initial clinical trials. Although it is reasonable to expect increased protection, "we really don't know how it compares in protection to higher-dose vaccines. And it may cause more of a reaction than standard shots - not unlike what a subset of people experience after COVID vaccination."

One of the potential advantages of an mRNA vaccine is the ability of the industry to produce the vaccines more quickly, compared with the conventional shots, Schaffner says.

"In the future it might be possible for the company that makes [the mRNA flu shot, Moderna,] to wait a little longer before it starts manufacturing the vaccine," he says. "That means, because the flu changes all the time, there might be a better match between what's in that vaccine and the virus that's circulating."

What are the benefits of flu shots beyond preventing or lessening the severity of influenza?

Beyond lowering the risk of illness and hospitalization, the flu shot seems to arm the immune system to fend off other problems.

"Influenza is an intrinsically pro-inflammatory process, and the inflammation that increases when people have influenza can provoke heart attacks, strokes, and secondary bacterial infections, such as pneumonia, which can in turn provoke those same problems," says Maves. "Vaccines clearly reduce the risk of those complications, especially in people at high risk for heart attack and stroke."

By the same token, data from the University of Texas Health Science Center at Houston found that people 65 and older who receive the flu vaccine have a significantly lower risk of developing Alzheimer's disease than those who don't. Recent research has shown that the high-dose flu vaccine recommended for those 65 and older is even more protective against Alzheimer's, particularly among women.

Is there an updated COVID-19 vaccine? If so, what strains does it cover?

The U.S. Food and Drug Administration has approved updated versions of the COVID vaccines - the Moderna and Pfizer vaccines using mRNA technology, and the Novavax protein-based shot. Available at pharmacies, hospitals, and clinics, they're aimed squarely at the currently circulating mutation of the virus.

"The variants we're seeing now are all descendants of the Omicron lineage that hit during the big wave of the acute pandemic" in 2021, says Maves.

The new formulations target the widely circulating JN.1-lineage XFG variant, and data suggest they should be very effective, particularly for children and older adults, who are most vulnerable to COVID infection. Last year's shots cut the risk of severe adverse outcomes by 50% or more.

If you got COVID during the recent summer surge, do you still need a vaccine?

Yes, but you don't need to get it right away. To prevent illness, the body produces antibodies against the virus that should provide temporary protection against reinfection.

Doctors advise waiting a few months before getting the updated COVID shot.

"You can get it earlier if you'd like, but you're probably fine for three months," says Maves.

RSV vaccines are relatively new, used just in the past two or three seasons. How are they performing so far?

Two new vaccines against RSV hit the market in 2023, and data show that they are meeting or exceeding expectations. A study involving 14.8 million older adults found that in the 2023-24 season, the vaccines reduced the chances of hospitalization or death from the illness by 80%.

Vaccination during pregnancy has also proved beneficial in fighting RSV in infants, Schaffner says. Recent data show that maternal vaccination was 77% effective against hospitalization for infants up to 6 months of age.

These vaccinations and the use of monoclonal antibodies in newborns has been "spectacularly successful in reducing illness and hospitalizations of infants and babies," Schaffner says. "It's changed pediatric practice. You ask any pediatrician and they'll say, 'My winter has changed.'"

Should I get an RSV booster?

If you have received an RSV shot, you don't need another one - at least for the time being.

"The RSV vaccine continues to be a one-shot deal" for adults, says Schaffner. Still, because the shot is relatively new, researchers will monitor the data to see how well its protection holds up. Revaccination may be warranted in the future.

"This hasn't been determined yet, and there is a degree of uncertainty because we don't have the ACIP to advise us," says Schaffner. "We're going to be dependent on professional societies to make new recommendations. So far, they've just reinforced the previous recommendations."

How have RSV recommendations changed this year?

Last year it was recommended that infants younger than 8 months who were born during or who are entering their first RSV season receive an RSV monoclonal antibody shot if their mothers were not immunized during pregnancy.

This year the AAP expanded its immunization recommendations to some children entering their second RSV season, as accumulating research shows that certain groups remain at a higher-than-average risk of serious complications from the disease after the first season. Children eligible for a second-season dose include those ages 8 months to 19 months with certain high-risk conditions: congenital heart disease, some lung and neuromuscular conditions, and Down syndrome or other chromosomal conditions, as well as those born before 32 weeks of gestation.

The expansion to a second dose also applies to children with some forms of cystic fibrosis, chronic lung diseases that require medical support, and all Native American and Alaska Native children.

In addition, ACOG has extended the recommended window for the RSV vaccine for pregnant women. Previously from September 1 through January 31, the window now extends from September 1 to March 1.