We know that the influenza virus results in a significant number of hospitalizations and deaths each year and that influenza vaccination has had some of its most important benefits, preventing severe disease (i.e., hospitalizations or emergency department visits).  In the 2025-2026 season, there have already been 43 thousand pediatric patients hospitalized with influenza, with 16% requiring intensive care unit admission.^1,2 It is therefore important to know if the influenza vaccine is able to decrease these admissions.

Impact of Influenza Vaccination on Hospitalization and Death

Earlier this month, a systematic review was published that looked at recently published studies (i.e., from August 1, 2025, through June 30, 2026) that evaluated influenza vaccine effectiveness.³  Authors reported vaccine effectiveness of 28-67% against hospitalization or emergency department visits in pediatric patients 6 months through 17 years old (the 2021-2022 year, evaluated and reported as 28% effectiveness, was not statistically significant, with a 95% CI of -11 to 54%, but all other evaluations were).  Similar overall effectiveness findings were also reported for adults: 29-61% in studies of 19-64 year olds and 19-43% vaccine effectiveness 65 years and older studies.³  Vaccination during pregnancy also demonstrated a 44% (95% CI 31-55%) reduction in laboratory confirmed influenza disease among infants in their first 6 months of life. Influenza vaccination also has been shown to have 80% (95% CI 75-84%) effectiveness at preventing influenza-associated mortality in pediatric patients 6 months through 17 years old.³

Pediatric Influenza Mortality

Luckily, influenza does not commonly cause death in children, but the number of deaths is not insignificant either. There have been 193 pediatric deaths reported to date for this season 2025-2026 and 297 during the full 2024-2025 season.² Of the 174 deaths reported earlier in the season, approximately 85% were not fully vaccinated against influenza.⁴ It is also important to note that pediatric patients are different from adults, with only about half of the pediatric patients who die each year having an underlying condition. Of those with underlying conditions, neurologic, pulmonary, cardiac, and endocrine conditions are consistently among the most commonly reported.¹

Current Influenza Activity & Recommendations

Influenza activity is currently low, with 1.8% of tests positive.²  It is expected to slowly increase over the next few weeks to months, usually peaking between mid-November and February/March. This makes between now and Halloween the perfect time for patients to complete their influenza vaccination.

Current influenza vaccination recommendations:

• For our littlest eligible patients, those 6 months through 8 years of age, if they have not received at least 2 doses of influenza vaccine in the past, they will need 2 doses separated by at least 28 days.^5,6 The first dose is a priming dose, while the second dose strengthens the response and provides most of the protection.
• For all other patients, 6 months and older, only a single dose is recommended each year. Patients have peak protection about 2 weeks after they complete their annual vaccination.
• The American Academy of Pediatrics’ recent recommendation suggests that healthcare providers consider off-label usage of 2 doses of high-dose inactivated influenza vaccine administered 28 to 42 days apart in those 3 through 17 years of age during the first influenza season after receiving a hematopoietic stem cell transplant.^5,6
• Adults 18 through 64 years who have received a solid organ transplant and are receiving immune suppressants may receive off-label usage of the high dose influenza vaccine instead of the standard dose or recombinant.⁷
• Those who are 65 years and older have a preferential recommendation to receive an enhanced influenza vaccine with either the recombinant, high dose, adjuvanted, or mRNA influenza vaccine.^7,8

This year there are fewer standard influenza vaccine brands being produced.^5,7,8  The inactivated influenza formulations available for those 6 months and older include Fluarix, FluLaval, Fluzone, and the cell culture-based vaccine Flucelvax. For those 9 years and older, there is the recombinant influenza vaccine Flublok. There are also adult approved vaccines including MFLUSIVA approved for those 50 years and older as well as Fluzone High Dose and Fluad that are approved for those 65 years and older. Lastly, the live attenuated influenza vaccine, FluMist, is available for most healthy, non-pregnant individuals 2 through 49 years of age.  It is important to screen all patients, but pharmacists  should remember this has more precautions and contraindications, due to it being a live-attenuated vaccine.

For the 2026-2027 season, FluMist is again orderable online for patients, with each order reviewed online by a pharmacist. It is available for adults in all states except Alaska and Hawaii. However, home delivery is not available for pediatric patients in several states due to universal vaccine programs and other state specific processes for providing vaccines to pediatric patients.

Pharmacist Focus

Pharmacists play a significant role in influenza vaccinations.  An estimated 62% of the 58 million adult influenza vaccines administered and 14% of the pediatric influenza vaccines were administered in pharmacies.^9,10  However, despite the millions of doses administered, only about 47% of adults, 38% of pregnant women, and 49% of children were vaccinated in the 2025-2026 season.¹⁰ This remains well below the 2030 Healthy People goal of 70% coverage all person without contraindications 6 months of age and older.¹¹  Pharmacists are already reaching millions of patients each year.  Now we need to identify and provide a clear recommendation to the patients that remain unvaccinated to protect more of our patients from influenza-related emergency department visits, hospitalizations, and deaths.

References:

1. Centers for Disease Control and Prevention. FluView Interactive. https://gis.cdc.gov/grasp/fluview/. Updated 2026. Accessed September 21, 2026
2. Centers for Disease Control and Prevention. Weekly US Influenza Surveillance Report: Key Updates for Week 36, ending September 12, 2026. https://www.cdc.gov/fluview/surveillance/2026-week-36.html. Updated 2026. Accessed September 21, 2026
3. Senerth E, Sheikholeslamian SM, Sivakumaran K, et al. Influenza Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season. JAMA : the journal of the American Medical Association. 2026. doi:10.1001/jama.2026.18126
4. Centers for Disease Control and Prevention. Weekly US Influenza Surveillance Report: Key Updates for Week 20, ending May 23, 2026. https://www.cdc.gov/fluview/surveillance/2026-week-20.html. Updated 2026. Accessed September 21, 2026
5. Recommendations for Prevention and Control of Influenza in Children, 2026–2027: Technical Report.Pediatrics. 2026. doi:10.1542/peds.2026-078779
6. Recommendations for Prevention and Control of Influenza in Children, 2026–2027: Policy Statement.Pediatrics. 2026. doi:rg/10.1542/peds.2026-078778
7. Interim Clinical Considerations for the Use of Seasonal Influenza Vaccines in the United Stateshttps://www.cdc.gov/flu/hcp/vax-summary/seasonal-influenza-vaccines.html. Updated 2026. Accessed September 21, 2026
8. American Academy of Family Physicians. 2026-2027 Influenza, RSV, and SARS-CoV-2 Immunization Recommendations for Non-pregnant immunocompetent adults and healthcare personnel. https://www.aafp.org/assets/image/upload/v1788277985/pdf_2026_through_2027_influenza_rsv_sars_covid_2_guidance.pdf. Updated 2026. Accessed September 21, 2026
9. Centers for Disease Control and Prevention. Reported Place of Flu Vaccination by Age Group, Children 6 Months Through 17 Years, United States: National Immunization Survey-Flu (NIS-Flu), 2024–25 Influenza Season. FluVaxView. https://www.cdc.gov/fluvaxview/media/excel/OnlineReport_2024_25_AdditionalTable_FluVxPlace_Children.xls. Accessed September 21, 2026
10. Centers for Disease Control and Prevention. Weekly Flu Vaccination Dashboard. https://www.cdc.gov/fluvaxview/dashboard/index.html. Updated 2026. Accessed September 21, 2026
11. Office of Disease Prevention and Health Promotion. Healthy People 2030: Increase the proportion of people who get the flu vaccine every year. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-people-who-get-flu-vaccine-every-year-iid-09/data. Accessed September 21, 2026.

 

 

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