What ACIP Recommended for Flu Vaccination in the 2025–26 Season

Each year the Advisory Committee on Immunization Practices (ACIP) issues recommendations for using flu vaccines in the United States. For the 2025–26 season, as before, it recommended routine annual flu vaccination for everyone 6 months and older who has no contraindication. This summarizes what changed and what stayed the same that season; ACIP issues new recommendations every year, so later seasons’ guidance supersedes it.

Four updates for 2025–26

1. New vaccine composition. In March 2025 the Food and Drug Administration (FDA) set the strains for 2025–26. All U.S. flu vaccines that season were trivalent, covering an influenza A(H1N1) virus, an influenza A(H3N2) virus and an influenza B (Victoria lineage) virus. The H3N2 component was updated from the previous season.
2. FluMist at home. In September 2024 the FDA approved the nasal spray FluMist (a live attenuated vaccine) for self-administration by people aged 18–49, or administration by a caregiver 18 or older to children and teens aged 2–17. It was expected to become available during 2025–26 through a program in which eligible people order it and have it shipped, temperature-controlled, to their door. The same recommendations and cautions apply as when a provider gives it.
3. Flublok from age 9. In March 2025 the FDA extended the recombinant vaccine Flublok, previously approved from age 18, to children and teens aged 9 through 17, based on a study showing comparable immune responses to adults aged 18–49. The most common side effects in 9- to 17-year-olds were pain at the injection site (34.4%), muscle aches (19.3%), headache (18.5%) and malaise (16.1%). Flublok is not approved for children under 9.
4. No thimerosal. On June 26, 2025, ACIP recommended that children 18 and younger, pregnant women and all adults receive flu vaccines only in single-dose formulations free of thimerosal as a preservative. This recommendation was not reviewed by ACIP’s influenza work group or developed with its usual evidence frameworks.

When to get vaccinated

For most people who need one dose, the best time is September or October, but vaccination should continue as long as flu is circulating and vaccine is available. July and August are generally too early — protection can wane during the season, especially in older adults — unless later vaccination may not be possible. Exceptions:

• Children needing two doses (ages 6 months–8 years who had not received at least two doses before July 1, 2025, or whose history is unknown) should get the first dose as early as possible, even in July or August, so the second, at least 4 weeks later, can come by the end of October.
• Children needing one dose may be vaccinated in July or August — for example at a back-to-school checkup.
• Pregnant women in the third trimester in July or August may be vaccinated then, because vaccination in pregnancy protects infants in their first months, before they can be vaccinated. Those in the first or second trimester should preferably wait for September or October.

Choosing a vaccine

• Everyone should get a vaccine approved for their age — except that solid organ transplant recipients aged 18–64 on immunosuppressive drugs may receive the high-dose or adjuvanted vaccine as acceptable options.
• For adults 65 and older, ACIP preferentially recommends a high-dose inactivated, recombinant or adjuvanted inactivated vaccine; if none is available, any age-appropriate vaccine should be used. For everyone else, it prefers no particular vaccine.
• The nasal spray (LAIV3) is not for people under 2 or over 49, during pregnancy, for immunocompromised people, for people with certain medical conditions, or around the time of taking flu antiviral drugs.
• Everyone 9 and older needs just one dose. Children aged 8 who need two doses should get both even if they turn 9 in between. Injected vaccines go into the muscle, usually at 0.5 mL; with multidose (thimerosal-containing) vials no longer recommended, there was no ACIP-recommended Afluria formulation for children 6–35 months, while Fluzone 0.5-mL syringes can be used from 6 months.

Allergies and cautions

• Anyone who has had a severe allergic reaction to a vaccine component, or to a particular flu vaccine, should not receive that vaccine; an allergist may help identify the cause.
• Egg allergy is not a reason to skip flu vaccination. ACIP recommends that everyone 6 months and older with egg allergy be vaccinated with any vaccine otherwise appropriate — egg-based or not — with no extra precautions beyond those for any vaccine. A review of 20 studies found no cases of anaphylaxis in egg-allergic people.
• Moderate or severe acute illness is a general reason to wait, and a history of Guillain-Barré syndrome within 6 weeks of a previous flu vaccine is a precaution for all flu vaccines.

Sources

Based on Grohskopf LA, Blanton LH, Ferdinands JM, Reed C, Dugan VG, Daskalakis DC, "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2025–26 Influenza Season," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.