Your fall 2025 vaccine guide

Each year about this time, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) meets to make recommendations on who should receive protective vaccines against such seasonal respiratory illnesses as flu, COVID-19, and respiratory syncytial virus (RSV). The recommendations guide doctors' advice to patients and even determine whether the shots are covered by insurance.

This year, after U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. fired every member of the long-standing scientific committee, academic physicians and their patients have been left with conflicting information from the CDC, professional medical societies, and multistate coalitions that have popped up to issue vaccine recommendations.

AAMCNews recently spoke with academic vaccine experts, infectious disease physicians, representatives of professional medical societies, and others to answer your most pressing questions about seasonal vaccines this fall.

What's out there now, and are there any indications of what kind of season it will be for respiratory illnesses?

After there was a surge in COVID infections this past summer, CDC data show that the illness is declining across most states, though wastewater treatment data indicate the prevalence of illness is still high.

"The summer surge was noteworthy but not huge," says William Schaffner, MD, professor of infectious diseases and preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee. "The omicron variants out there produce a great deal of milder illness, but don't appear to be quite as severe [as earlier variants], though they are still putting people into the hospital." Based on previous COVID seasons, the winter surge is expected to be more severe.

Although the season's flu illness certainly will result in hospitalizations and deaths, the outlook is relatively optimistic. "We had such a fierce influenza season last year," Schaffner says. "It would be unusual to have two really bad seasons back-to-back."

Right now, infectious disease physicians aren't seeing much in the way of flu or RSV. But that's not surprising, since those respiratory illnesses tend to make their appearance a bit later in the season. Flu typically starts in late September and October, while RSV begins in October.

What is the dominant COVID variant and what are the primary symptoms of the illness this time around?

The most common variant right now is the stratus variant, which is also known as XFG. It is a new omicron variant and is now surpassing the nimbus variant.

The symptoms of stratus are similar to what many have come to expect from omicron variants of COVID, says James Bigham, MD, clinical professor of family medicine and community health at the University of Wisconsin School of Medicine and Public Health and a former vaccine science fellow at the American Academy of Family Physicians (AAFP). These symptoms include cough, congestion, fevers, fatigue, muscle aches, headache, and GI symptoms.

"Severe sore throat is one of the hallmarks of recent COVID infections," Bigham says. "Some have referred to the symptom as razor blade sore throat."

Is there a new booster for COVID, and should I get it?

In August, the U.S. Food and Drug Administration (FDA) approved new COVID boosters from Moderna, Pfizer, and Novavax that target the descendants of the omicron variant. COVID vaccines currently provide the best protection against the disease. Pharmacies should be offering only updated boosters at this time, Schaffner says.

Previously, the FDA recommended that anyone age 6 months and older receive the shot. But last month the CDC revoked emergency-use authorizations for COVID vaccines. Now the vaccines are approved only for people over 65 and those at high risk for complications. Access and requirements also vary by state (more on that below).

In recent weeks several medical organizations have issued their own recommendations based on existing evidence on the risks and benefits of the shots. Here's how they differ from the CDC's guidelines.

For children: While the CDC currently advises parents of children ages 6 months to 17 years to consult with a doctor about vaccinating them, the American Academy of Pediatrics (AAP) and the AAFP both explicitly recommend COVID vaccinations for babies ages 6 through 23 months and for older high-risk children.

"We know that the youngest children, those 6 to 23 months, are at risk for more severe infection," says Kristina Bryant, MD, professor of pediatrics in the Division of Pediatric Infectious Diseases at the University of Louisville School of Medicine and a member of the AAP's Committee on Infectious Diseases.

"Six months to 2 years of age is a dangerous time for kids," concurs Margot L. Savoy, MD, MPH, chief medical officer of the AAFP. "Even now, the unvaccinated kids in that age group are getting hospitalized and dying more often of COVID-19. They are second only to people 65 and older."

Among children hospitalized for COVID between October 2022 and April 2024, nearly 45% were ages 6 to 23 months, CDC data show.

The AAP recommends a risk-based strategy for kids ages 2 to 18. It prioritizes vaccines based on a child's individual risk for more severe disease, such as that linked to conditions such as asthma or diabetes. "However, the AAP is also advising that even children in this age group who are completely healthy but the parents just want to protect them from COVID-19, they should be able to get the vaccine," Bryant says.

For adults: Although the CDC recommends a COVID vaccination only for adults 65 and older or those with high-risk conditions, the AAFP continues to recommend that all individuals 18 and older receive an updated COVID shot each year.

Adults 65 and older are the most likely to be hospitalized and die from COVID, and while the rates of both have declined since the pandemic's peak, COVID still caused some 48,000 deaths in 2024, data show.

Now is a good time to receive the COVID vaccine for several reasons, Bigham says. For one thing, it takes up to four weeks for a vaccine to become fully effective. "We want to make sure we have adequate lead time before the winter surge of infections happens," he says.

Although it's hard to predict when the uptick in infections might occur, based on past years, late October or November are good guesses. (It could start earlier, though, if the current variant is more readily transmissible than previous ones, Bigham says.)

For pregnant women: The CDC no longer advises pregnant women to get the COVID vaccine, a stance that the American College of Obstetricians and Gynecologists (ACOG) opposes.

"ACOG still strongly recommends that all pregnant and lactating people get the vaccine," says Mark Turrentine, MD, a professor of obstetrics and gynecology at Baylor College of Medicine in Houston and a member of ACOG's Committee for Immunization, Infectious Disease, and Public Health Preparedness. "Even by CDC guidance, pregnancy is considered a high-risk condition."

Savoy adds, "Getting COVID during pregnancy is very dangerous for people who are pregnant, which means it also threatens the pregnancy. If you're not getting enough oxygen, neither is your baby. It's also extremely dangerous for that first six months, when your baby's at high risk."

Research shows that women infected with COVID before conception or during the first trimester of pregnancy have more than twice the risk of miscarriage as uninfected women. COVID infection is also linked to higher rates of preterm birth, preeclampsia, and other adverse pregnancy outcomes, data suggest.

Who should get the RSV vaccine?

Women who are pregnant are also susceptible to RSV, a serious respiratory illness that is particularly dangerous during pregnancy and increases the risk of pregnancy-related problems, such as preeclampsia and premature birth. In fact, the CDC recommends that women who are pregnant get the RSV vaccine between 32 and 36 weeks of pregnancy. The vaccination is available from September to January.

"It's given during that gestational age range because there are some concerns that the vaccine may have an association with preterm labor and delivery," Turrentine says. "You also want to have immunization in the mom at least two weeks prior to delivery."

The CDC recommends that Infants younger than 8 months of age 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. It's recommended that they receive the vaccine between October and March, optimally during October or November, or within the baby's first week of life.

The type of monoclonal antibody a child gets is age specific. "Either nirsevimab or clesrovimab can be used for infants less than 8 months of age who are entering their first RSV season only," says Bryant. "Only nirsevimab is approved for use in kids 8 to 19 months of age who are entering their second RSV season."

The CDC also recommends a onetime dose of the RSV vaccine for people 75 and older and people 50 to 74 at increased risk of severe RSV. The best time for vaccination is late summer to early fall.

Should I get a flu vaccine?

The answer: "a resounding yes," says Schaffner. "Vaccines, year in and year out, have been shown to have a substantial impact in keeping people out of the hospital, even when the vaccinations aren't a good match [with circulating strains]."

Each year the vaccine is formulated based on how influenza from one year is predicted to mutate in the subsequent year. This year's influenza vaccine protects against two strains of influenza A (H1N1 and H3N2), one of which is new, and one strain of influenza B (Victoria), says Bigham.

There's a high-dose vaccine for people 65 and older. According to the CDC, it contains four times the amount of antigen used to trigger an immune response as a regular flu shot, to provide optimal protection to those in this age group.

Despite the recommendations, fewer than half of Americans, adults or children, get the vaccine, research shows. This despite the heavy toll that flu takes each year. In the 2024-25 respiratory season, flu claimed the lives of 27,000 Americans, including 266 children.

"We need to do a better job of communicating to parents that influenza is not just another cold," says Bryant. "It can be a serious, life-threatening viral illness, but we have a safe and effective vaccine that can protect children from the most severe consequences of flu."

Bryant is hopeful that a nasal spray formulation now available for use at home will increase the number of families who opt for vaccination. It's approved for people ages 2 to 49, but not for those who are pregnant.

"The way it works is, a person goes online, requests the vaccine from a centralized pharmacy, and fills out a series of questions about eligibility," says Bryant. "And if they or their child is eligible, they could request that the vaccine be sent directly to their home. It comes with detailed instructions."

Should I ask for a flu shot that doesn't contain thimerosal?

In June the CDC's new ACIP panel recommended getting a flu shot that doesn't contain thimerosal. Yet vaccine experts overwhelmingly agree that thimerosal, which is used as a preservative in some multidose vials, is harmless. The FDA website states that thimerosal is safe.

Thimerosal has been used in vaccines dating back to the 1930s, but it came under suspicion in the late 1990s as a culprit behind autism. Thimerosal was removed from childhood vaccines in 1999 out of an abundance of caution.

However, "no one has ever been able to prove a link between the two," says Savoy. "If I had to choose between no vaccine at all and one with thimerosal, I would choose the one with thimerosal, because I know that influenza kills people and there is no evidence of harm from thimerosal."

Today, less than 10% of flu vaccine contains thimerosal. "These are usually used in places where they're giving out lots and lots of vaccines," Savoy says. If a patient is concerned, though, they can ask the practitioner providing the shot if it contains thimerosal.

Should I get my vaccines all at once or space them out?

There are arguments for and against getting more than one jab at a time, but either way, vaccines are safe and effective, experts say.

"You can get all of them at the same visit," says Schaffner. "You may get a sore arm, but you can get that with just one of them. There's not a cumulative effect."

Don't worry that you'll get less than the vaccines' full effects if you're receiving them at the same time. Savoy says the body can mount an effective immune response to two infections simultaneously, so is capable of responding to more than one vaccine.

From a public health standpoint, physicians may wish to get multiple shots into the arms of eligible patients when they have them in the room. "A vaccine deferred is frequently a vaccine never received," says Schaffner.

But choosing to get one vaccine one day and return for another a few weeks later can also be a sound strategy-say, if you want the updated COVID booster now but prefer to wait until mid- to late-October for your flu shot.

"To some degree, we begin to get some waning of protection over time, and we want the flu vaccine to extend protection through February and into March," says Schaffner. "So you don't want to get it too early. My recommendation is any time in October."

If you miss that deadline, it's not too late to roll up your sleeve in November or even later, he adds.

If I get sick, does it make sense to take an antiviral (Tamiflu for the flu and Paxlovid for COVID)?

If you come down with the flu, taking the medication Tamiflu may be a smart move. "It has been shown to likely shorten the duration of influenza by one to two days and is most effective in healthy individuals," says Bigham. Some studies have shown as much as a 50% reduction in hospitalization for those treated with Tamiflu. However, the conclusions of a more recent meta-analysis involving higher-risk people who were hospitalized with flu and receiving antiviral medication were less certain, Bigham cautions.

"That said, if someone has comorbidities that increase their risk for severe infection or hospitalization from influenza, it is reasonable for them to receive Tamiflu in an effort to mitigate severe symptoms, as this may prevent hospitalization," Bigham says. Just be sure to start the drug within 48 hours of the start of symptoms. "Timing is critical," he says.

Likewise, there are some significant advantages to taking Paxlovid for COVID. The medication is approved for all adults (and authorized for children 12 or older who weigh at least 88 pounds). Although Paxlovid may cause diarrhea and muscle aches, or leave a bad taste in the mouth, the benefits of the drug outweigh the risks. Research found that among people with COVID who took Paxlovid within five days of experiencing symptoms, the drug reduced the proportion who were hospitalized or died by about 88%, compared with those who took a placebo.

"Paxlovid works," says Schaffner. "It assists in reducing the chance of your illness evolving into something serious enough to require hospitalization."

Paxlovid users also had a shorter duration of symptoms and were less likely to use health care resources than did people who didn't take the drug.

The medication is recommended for people who are 50 and older and those with certain underlying medical conditions, including diabetes, obesity, asthma, and chronic lung diseases. However, there can be interactions with some medications.

"Your provider should review your medical history and the medications you're taking, and see whether you have liver or kidney disease, because that might modify the dose or make it more or less likely that you'll get the drug," says Schaffner.

Will I be able to get my vaccines this fall?

With all the conflicting information, you might wonder if you'll be able to get the vaccines recommended by your doctor. Indeed, some pharmacies such as CVS and Walgreens have limited access to COVID vaccines in some states, requiring a doctor's prescription from patients in 16 states to comply with laws there.

Patients in Massachusetts, Nevada, and New Mexico face further restrictions: CVS says it cannot administer the vaccine at all, even with a prescription, in these states, due to local regulations, CBS News has reported.

However, during a widely anticipated ACIP meeting on Sept. 18 and 19, the committee rejected a proposal to require a prescription for the vaccine, which may cause confusion for patients, providers, and pharmacies. (Meanwhile, AHIP, a trade association for health insurance plans in the United States, announced that insurers would continue to cover all ACIP-recommended immunizations that were recommended as of Sept. 1, 2025, including updated COVID vaccines, with no cost sharing for patients through the end of 2026.)

Still, "given the recent ACIP vote that requires individuals to see a health care provider to discuss COVID vaccination, it may not be as simple as past years, when patients could simply go to their local pharmacy," Bigham says. "If a visit to a clinic is necessary to receive a COVID vaccine, I would recommend individuals look into scheduling that visit in the near term, if possible."

To increase the uptake of vaccines, new multistate coalitions have formed, aimed at helping health care providers in those states to supply the vaccines to patients. The West Coast Alliance comprises California, Hawaii, Oregon, and Washington, while the Northeast Public Health Collaborative includes Connecticut, Delaware, Maine, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

Their efforts to offer vaccines for everyone who can benefit from them highlights what's at stake with the conflicting guidelines.

"During the respiratory illness season, we see millions of influenza, RSV, and COVID infections, which lead to millions of health care visits, hundreds of thousands of hospitalizations, and tens of thousands of preventable deaths every year," says Bigham. "Vaccines are a key tool we have to reduce the rate and severity of these infections."