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Who should get the 2025–2026 flu vaccine and what are the recommended timing and dosing for different age groups?
Executive summary
For the 2025–2026 season U.S. guidance recommends influenza vaccination for everyone aged ≥6 months, with single‑dose, thimerosal‑free formulations advised for children, pregnant women and adults, and enhanced (high‑dose or adjuvanted) options recommended for adults ≥65 years (CDC/ACIP) [1] [2]. Timing: vaccination is ideally given in early fall (September–October) for most people, but timing can be adjusted for infants, pregnant people and older adults because of waning immunity and special circumstances [3] [4].
1. Who should get the 2025–26 flu vaccine: the universal base line
U.S. federal recommendations again state that routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications; public health authorities and clinical organizations reiterate that this remains the primary prevention strategy [5] [1]. Multiple state and provider notices echo that everyone ≥6 months should receive an updated 2025–26 vaccine to reduce risk of illness and severe outcomes [3] [6].
2. Special groups with explicit product or formulation guidance
ACIP and CDC added a new, operational recommendation for 2025–26: children ≤18 years, pregnant women, and all adults should receive only single‑dose formulations that are free of thimerosal as a preservative [2] [1]. For adults aged ≥65 years, CDC and public reporting note a preference for “enhanced” vaccines (high‑dose or adjuvanted) to improve immune response and reduce severe outcomes in that age group [7] [8].
3. Children — doses, intervals and age‑specific preparations
Children aged 6 months through 8 years who have not previously completed an influenza vaccine series may need two doses of 2025–26 vaccine given at least 4 weeks apart; ACIP guidance specifies that children who require two doses should receive both even if they age past the cutpoint between doses (for example turn 9) between dose 1 and dose 2 [9]. Vaccine product labeling and CDC tables specify volume differences for very young children (Afluria and Fluzone dose volumes noted for 6–35 months vs older ages), and clinicians must check product inserts because some presentations (e.g., 0.25‑mL prefilled syringes) changed availability for 2025–26 [1] [10].
4. Pregnant people and infants — timing and benefits
Pregnant people are specifically included in the thimerosal‑free single‑dose recommendation [2]. CDC and UK guidance both note that vaccination during pregnancy protects the person and transfers antibodies that help protect newborns during early months of life; the vaccine can be given at any stage of pregnancy but earlier fall vaccination is encouraged to ensure protection during peak season [11] [12].
5. Timing: when to get the shot and who should delay or aim later
Public health communications emphasize September–October as ideal timing for most to achieve protection before influenza activity climbs, with vaccination offered through the season [7] [3]. Scientific commentary and public health analysts point out waning immunity—especially in adults ≥65—so early summer vaccination is discouraged for older adults unless there’s concern they won’t be reachable later [4]. Jurisdictions advise planning for fall clinics; vaccine supply is expected to be adequate and distributed beginning summer into early fall [13] [14].
6. Product landscape and availability: trivalent vaccines and new authorizations
All U.S. flu vaccines for 2025–26 are trivalent (A(H1N1), A(H3N2), and a B/Victoria lineage) per FDA and CDC summaries; manufacturers and public health agencies report shipments of multiple product types (egg‑based, cell culture–based, adjuvanted, high‑dose, recombinant, and live attenuated nasal spray) with some expanded age indications (e.g., Flublok approved down to age 9) and FluMist authorized for self‑ or caregiver administration mechanisms [11] [2] [14] [15].
7. Trade‑offs, evidence and uncertainties to weigh
Evidence shows vaccine performance varies by age and by product type — for example, studies highlight stronger immune responses to high‑dose or adjuvanted products in older adults and variable cellular responses across products — which underlies recommendations for enhanced vaccines in people ≥65 [16] [17]. At the same time, ACIP’s thimerosal‑free single‑dose recommendation was an operational safety/administration decision; GRADE and EtR frameworks were not applied to that specific recommendation, and ACIP materials acknowledge this nuance in how the recommendation was developed [2].
8. Practical takeaways and where to check next
If you are ≥6 months old, plan to get the 2025–26 flu vaccine this fall; pregnant people and those planning a pregnancy should be prioritized, and adults ≥65 should seek enhanced formulations when available [1] [7] [2]. For exact dosing by age and product, timing nuances (e.g., two‑dose rules for young children) and local availability, consult the CDC’s MMWR summary and product‑specific tables and your health care provider or local public health department [1] [10]. Available sources do not mention personalized clinical exceptions beyond the contraindications and precautions summarized in CDC product tables; discuss individual medical questions with your clinician [1].