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Health Advisory: 2025–2026 respiratory illness season vaccine recommendations

Summary

Flu

  • Everyone 6 months or older should get seasonal flu vaccine.

COVID-19

  • Stop giving last year’s (2024–2025) COVID-19 vaccine formulation.
  • Everyone 6–23 months old, 2–18 years old at high risk, and 19 years or older should get 2025–2026 COVID-19 vaccine.
  • All others 2–18 years old may get 2025–2026 COVID-19 vaccine.

RSV

  • Older adults:
    • All adults 75 years or older should get RSV vaccine.
    • Adults 50–74 years old at increased risk of RSV should get RSV vaccine.
  • Infants and young children:
    • All infants younger than 8 months entering their first RSV season should be protected via:
      • Maternal RSV vaccination (Abrysvo) during 32–36 weeks gestation, beginning Sept. 1, orRSV monoclonal antibody starting Oct. 1.
    • High risk toddlers 8–19 months old entering their second RSV season should receive RSV monoclonal antibody nirsevimab starting Oct 1.

Co-administration of COVID-19, flu, and RSV vaccines is safe.

Vaccination is an effective way to prevent severe disease, hospitalization, and death.

COVID-19 vaccine recommendations

The Health Department supports evidence-based recommendations from trusted national medical specialty societies, including American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Obstetrics and Gynecology (ACOG). Washington State Department of Health (DOH) is aligned with national medical specialty guidance, and recommends COVID-19 vaccine for all children 6 months or older. 

The specialty society recommendations differ from current Centers for Disease Control and Prevention (CDC) guidance, which advises COVID-19 vaccine more selectively based on age and risk factors. We encourage providers to follow the recommendations of national medical specialty societies when it differs from CDC guidance, and to make strong vaccine recommendations based on clinical judgment and patient needs. Links to the relevant immunization schedules and guidance are below:

To support access, DOH issued a statewide standing order under the direction of the State Health Officer. This order authorizes qualified healthcare providers to vaccinate people 6 months or older, including pregnant people, who do not have contraindications to the vaccine. For some, vaccination under this standing order will be “off-label” use of currently licensed COVID-19 vaccines. Learn more about the standing order in frequently asked questions (FAQs) for healthcare providers.

Approved COVID-19 vaccine products for the 2025–2026 season include:

  • Spikevax (Moderna) approved for 6 months or older.
  • mNEXSPIKE (Moderna) approved for 65 years or older and 12–64 years old at high risk for severe COVID-19.
  • Comirnaty (Pfizer) approved for 5 years or older.
  • Nuvaxovid (Novavax) approved for 12 years or older.

For most people, the minimum interval between their last COVID-19 vaccine dose and their updated dose is 8 weeks. See DOH COVID-19 Schedule Summary for exceptions.

Flu vaccine recommendations

AAP and AAFP recommend everyone 6 months or older get updated 2025–2026 flu vaccine to reduce the risk of flu and its potentially serious complications. All flu vaccines are trivalent this year.

Some children 6 months–8 years old need 2 doses of flu vaccine, including those who:

  • Are getting flu vaccine for the first time.
  • Previously got only 1 dose of flu vaccine.
  • Have an unknown vaccination history.

People who are pregnant or might be pregnant during flu season should get flu vaccine. However, pregnant people and those with certain medical conditions or those who are immunocompromised should not get live, attenuated intranasal flu vaccine.

Adults 65 years or older are recommended to preferentially get high dose, recombinant, or adjuvanted flu vaccine when available.

It is ideal for most people to get flu vaccine in September or October. Continue to offer flu vaccine throughout the season, as long as flu viruses are circulating.

RSV recommendations for children

AAP recommends protection against RSV for all infants entering their first RSV season and for certain children 8–19 months old at increased risk for severe RSV disease.

Infants younger than 8 months entering their first RSV season can be protected via:

  • Maternal vaccination: Pregnant individuals should receive the Abrysvo RSV vaccine during 32–36 weeks gestation, or
  • Infant monoclonal antibody immunization: Infants should receive RSV immunization after birth.[1]

For children 8–19 months old at increased risk for severe RSV disease entering their second RSV season, the RSV monoclonal antibody nirsevimab is specifically recommended for this group.

Abrysvo maternal vaccination details:

  • Administer Sept. 1–Jan. 31.
  • 1 dose during 32–36 weeks gestation.
  • Subsequent pregnancies: additional doses not recommended.
  • Abrysvo is the only FDA-approved RSV vaccine for pregnant people.

RSV monoclonal antibody details:

  • Administer Oct. 1–March 30.
    • For infants born during this time, monoclonal antibody should be administered within 1 week of birth, ideally at the hospital.
  • AAP recommends RSV monoclonal antibody for infants if:
    • The mother did not get RSV vaccine during pregnancy.
    • You don’t know the mother’s RSV vaccination status.
    • The infant was born within 14 days of maternal RSV vaccination.
  • AAP recommends nirsevimab for children up to 19 months old entering their second RSV season if they:
    • Are American Indian or Alaska Native.
    • Have chronic lung disease of prematurity and require medical support during the 6 months before the start of their second RSV season.
    • Are severely immunocompromised.
    • Have severe cystic fibrosis.
  • Two products are available this season:
    • Clesrovimab (Enflonsia): 1 dose for infants younger than 8 months regardless of weight entering their first RSV season. Not recommended for infants 8 months or older.
    • Nirsevimab (Beyfortus):
      • A single dose for infants younger than 8 months (50 mg for infants <5 kg and 100 mg for infants ≥5 kg) entering their first RSV season.
      • A single 200 mg dose administered as 2 IM injections (2 x 100 mg) for children up to 24 months old, regardless of body weight, in the risk groups listed above.
  • Except in rare circumstances, infants younger than 8 months who are born 14 or more days after their mother got RSV vaccine don’t need RSV monoclonal antibody. Learn more about special situations and populations.

RSV recommendations for adults

3 RSV vaccines are licensed for use in adults 50 years or older:

  • Arexvy (GlaxoSmithKline).
  • mRESVIA (Moderna).
  • Abrysvo (Pfizer).

AAFP recommends a single dose of RSV vaccine for all adults 75 years or older, as well as adults 50–74 years old who are at increased risk of severe RSV disease based on comorbid medical conditions such as:

  • Cardiovascular disease.
  • Lung disease.
  • End-stage renal disease or dependence on hemodialysis or other renal replacement therapy.
  • Diabetes mellitus with end-organ damage.
  • Severe obesity.
  • Liver disorders.
  • Neurologic or neuromuscular conditions.
  • Hematologic disorders.
  • Moderate or severe immune compromise.
  • Living in nursing homes or other long-term care facilities that assist with activities of daily living.
  • Other chronic medical conditions or risk factors that a healthcare provider determines might increase the risk of severe disease due to respiratory infection.

More resources

[1] Most infants will require protection via maternal vaccination or monoclonal antibody but not both. In rare situations a clinician might choose to recommend monoclonal antibody for an infant who is already protected via maternal vaccination as described in the next section.

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