Respiratory Virus Season 2025-26: What’s Changed for RSV, Flu, and COVID Vaccines?
The 2025-26 respiratory virus season opened with reformulated flu, COVID, and RSV products and a restructured ACIP that has shifted COVID guidance to shared clinical decision-making. Primary care faces a more fragmented landscape — and more questions from patients.
Why Respiratory Virus Season 2025-26 Is in the News Right Now
The 2025-26 respiratory virus season is unfolding under unusual conditions for primary care. In July 2025, HHS Secretary Robert F. Kennedy Jr. dismissed all 17 sitting members of the Advisory Committee on Immunization Practices (ACIP) and reconstituted the panel.
The new committee, chaired by Martin Kulldorff, MD, PhD, voted in September 2025 to shift COVID-19 vaccination from a universal recommendation to shared clinical decision-making for everyone aged six months and older.
The American Academy of Family Physicians (AAFP), the American Medical Association, the Infectious Diseases Society of America (IDSA), and the American College of Physicians have publicly diverged from the new ACIP guidance, leaving family physicians to reconcile competing recommendations against patient questions.
The Background
Each respiratory virus season recap circles the same three pathogens — influenza, RSV, and SARS-CoV-2 — but the products and recommendations shift each year. Vaccine effectiveness (VE) refers to real-world performance; immunization schedules drive insurance coverage under the Affordable Care Act.
When ACIP downgrades a recommendation to shared clinical decision-making (SCDM), vaccines remain covered without cost sharing if the schedule lists them — but the patient-facing message changes from “should” to “may, after a conversation with your clinician.”
Respiratory Virus Season 2025-26 Evidence at a Glance
The peer-reviewed evidence base for current immunizations remains robust. A December 2025 NEJM systematic review of 511 studies summarized real-world effectiveness across the three vaccines:
- Influenza (2025-26 trivalent — H1N1, H3N2, IBV): pooled VE against hospitalization of 48% (95% CI, 39–55) in adults 18–64 and 67% (95% CI, 58–75) in children. Early UK estimates this season suggest 70–75% in children and 30–40% in adults.
- COVID-19 (XBB.1.5 mRNA): hospitalization VE of 46–50% in adults overall and 37% in immunocompromised adults. CDC analyses of the 2024-25 vaccine reported 76% effectiveness against hospitalization.
- RSV in adults ≥60 years: single-dose VE ≥68% against hospitalization. Coverage among adults 75 and older rose from 28.8% to 47.5% across the 2024-25 season.
- RSV in infants: nirsevimab VE 79–83% against hospitalization in pooled analyses; maternal RSVpreF (Abrysvo) 68% against infant hospitalization. Clesrovimab, a longer-acting monoclonal antibody, was added in June 2025 for infants under eight months entering their first season.
FluMist live attenuated intranasal influenza vaccine was approved for self-administration in people 2 through 49 years old in 2024-25, and the FDA discontinued the COVID-19 Emergency Use Authorization in August 2025, replacing it with full label restrictions on age and risk groups.
Where Experts Disagree
The COVID vaccine recommendation has become the focal point of disagreement this respiratory virus season. ACIP voted unanimously to recommend SCDM for everyone six months and older, with explicit language that benefit is greatest for those at increased risk.
The AAFP took a separate position, recommending COVID-19 vaccination for all adults — including pregnant and lactating people — and for all children 6–23 months, plus any child 2–18 years at increased risk. The IDSA and AMA issued statements describing the new ACIP guidance as a clear departure from prior practice.
For RSV, ACIP added clesrovimab for infants in a 5–2 vote. Retsef Levi, PhD, dissented, saying he wanted more caution before broad rollout in healthy infants:
“I don’t feel this is ready to be administered to all healthy babies.” — Retsef Levi, PhD, ACIP member, June 2025 meeting
A separate motion to require a prescription for COVID-19 vaccines failed by a 6–6 tie, broken by chair Kulldorff’s vote against.
The Practical Question for Clinicians
For family physicians, the practical question is how to counsel efficiently when ACIP and AAFP differ. Recent CDC modeling estimates that 48% of infant RSV hospitalizations could be averted at last year’s combined uptake of nirsevimab plus maternal Abrysvo, and most infants need only one of those two products.
Adults 75 and older — and adults 50–74 with high-risk conditions — should receive a single lifetime RSV dose, ideally before community circulation rises in the fall. The 2025-26 trivalent flu vaccine is recommended for everyone aged six months and older, with thimerosal-free single-dose formulations preferred for children 18 and under.
For COVID, document a brief shared decision-making conversation that names the patient’s specific risk factors, then update the immunization record so insurance coverage rules apply. Coadministration of all three vaccines in a single visit produced noninferior immunogenicity in randomized trials and remains a reasonable workflow.
What to Watch For
- Late-season respiratory virus season activity from H3N2 clade K, which carries mutations that may partially evade vaccine-induced immunity but remains a partial match.
- Real-world effectiveness data for the 2025-26 COVID-19 formulation, expected from CDC vaccine effectiveness networks.
- Upcoming ACIP meetings, where pediatric MMRV recommendations and additional COVID guidance are likely to be revisited.
- Insurance coverage decisions that follow each ACIP vote — particularly for COVID-19 vaccines now sitting in shared clinical decision-making territory.
Sources
- CDC Center for Forecasting and Outbreak Analytics. 2025-2026 Respiratory Disease Season Outlook — December Update. Centers for Disease Control and Prevention, December 19, 2025. CDC December 2025-26 Season Outlook
- Osterholm M, Brueck H, Lipsitch M, et al. Updated Evidence for Covid-19, RSV, and Influenza Vaccines for 2025–2026. NEJM, December 4, 2025. NEJM systematic review of 2025-26 vaccines
- HHS. ACIP Recommends COVID-19 Immunization Based on Individual Decision-making. HHS Press Release, September 19, 2025. HHS press release on ACIP September 2025 vote
- AAFP. Influenza, RSV and COVID-19 Vaccines in Primary Care Offices: 2025 Update. Family Practice Management, September 2025. AAFP 2025 fall vaccine guidance
- The Medical Letter. COVID-19 Update: 2025-2026 Vaccine Formulations and Recommendations. The Medical Letter, 2025. Medical Letter on 2025-26 COVID vaccine
- Medical Economics. ACIP Votes on Flu, RSV Vaccines for Upcoming 2025-2026 Respiratory Illness Season. Medical Economics, 2025. Medical Economics coverage of ACIP June 2025 votes
- Johns Hopkins Bloomberg School of Public Health. Media Briefing: Vaccine and Virus Trends Ahead of Winter. December 17, 2025. Johns Hopkins December 2025 media briefing