As we enter immunization season, pharmacists need to be prepared for 2025 updates:

  • Pneumococcal vaccination age now starts at 50 years old
  • RSV vaccines expand into younger high-risk adults
  • COVID-19 formulations are reformulated to cover current variants
  • Influenza vaccines have updated strain composition with the option of self-administration for certain patients.

This article reviews the most up-to-date Centers for Disease Controls and Prevention (CDC) recommendations as of September 12, and provides pearls on pharmacy workflow, counseling and revenue opportunities.

Pneumococcal Vaccines: Updated CDC Recommendations (2024–2025)

  • Routine age: adults ≥50 years (and 19–49 with qualifying chronic conditions).
  • Preferred: PCV20 or PCV21 (single dose; series complete).
  • Alternative: PCV15 → PPSV23 ≥1 year later (≥8 weeks if immunocompromised, CSF leak, cochlear implant).2
At-a-Glance Chart
Population/AgeVaccine OptionNotes

Adults ≥50

PCV20 or PCV21 (1 dose)

No PPSV23 needed.2

Adults 19–49 w/ risk factors

PCV20 or PCV21 (1 dose)Includes chronic heart/lung disease, diabetes, smokers, immunocompromised.2

If PCV15 used

PCV15 → PPSV23 (≥1 year; ≥8 weeks if high risk)Alternative path.2

Prior PPSV23 only

Give PCV15/20/21 ≥1 year laterNo further PPSV23 needed.2

Prior PCV13 only

Give PCV20/21 ≥1 year laterCompletes series.2

Counseling Pearl: “Most adults now complete pneumococcal protection with one conjugate dose (PCV20 or PCV21).”

RSV Vaccines: Indications, Seasonality, and Protection

Seasonality (U.S.): typically October–March peak.2   Although RSV vaccination may happen any time of year, the maximum benefit is in late summer/early fall.

Indication:

  • Adults ≥75 years
  • Adults 50-74 years at increased risk, such as:
    • Chronic lung disease (COPD, severe asthma)
    • Chronic heart disease
    • Moderate-to-severe immune suppression (e.g., HIV with low CD4 count, transplant recipients, chemotherapy, biologic immunosuppressants)
    • Chronic kidney or liver disease
    • BMI ≥ 40kg/m2
    • Nursing home resident
    • Diabetes (complicated or requiring insulin/SGLT2 inhibitor)
  • Vaccinating high-risk adults starting at age 50 was updated in summer 2025.2
Products available:
  • Arexvy® (Item #296996)
  • Abrysvo® (Item #296574, 296566, 609719, 389411)
  • mResvia® (Item #398826, 759266, 759274)

Pearl: The greatest impact is on patients at risk for hospitalization (older adults with cardiopulmonary disease or immunocompromised states). 

Counseling Tip—How to protect during RSV season: frequent handwashing, avoid close contact when symptomatic, consider masking in crowded indoor settings, avoid smoke exposure, and stay current on flu/COVID-19/pneumococcal vaccinations to reduce co-infection risk.

COVID-19 (2025–2026): Strain, Products, and Practical Choices

Strain coverage (2025–2026)
FDA advised a monovalent JN.1-lineage with LP.8.1 preferred for this season’s vaccines. See manufacturers’ 2025–26 formulas that target LP.8.1.7

Product comparison
 

Spikevax® (Moderna)6

mNEXSPIKE® (Moderna, next-gen)10, 11

Comirnaty® (Pfizer-BioNTech)9

Nuvaxovid® (Novavax)14

M&D Item #

#702456 for 12 years+

#702498 for 6 mo-11years

#630038

#630053 for 12 years+

#630061 for 5-11 years

#630079 for 6 mo-5 years

 

Antigen design

Full prefusion spike (LP.8.1)

Targeted domains (NTD + RBD) of spike; next-gen design (JN.1-lineage/LP.8.1 targeting)

Full prefusion spike (LP.8.1)

Protein based, Full prefusion spike (LP.8.1)

Typical adult dose

50 µg (0.5 mL)

Lower dose (~10 µg class; labeling varies by age/indication)

30 µg (prefilled, label by age/risk)

50 µg (0.5 mL)

Who’s it for (U.S. 2025–26)

≥65 years or 6 mo–64 years at high risk

Previously vaccinated ≥65 years and 12–64years at high risk

≥65 years, and 5–64years at high risk

≥65 years or 12–64 years at high risk

Storage Notes

Fridge stability up to 60 days (within shelf-life)

Fridge stability up to 90 days (within shelf-life)

Fridge stability for up to 10 weeks. SDV may be stored in ultra-low freezer at -90° to-60°C

Fridge stability within shelf life

Pharmacist recommendation:

  • Healthy, 12–64 years: use what’s on hand promptly (Spikevax or Comirnaty).
  • ≥65 years or high-risk: any LP.8.1-updated mRNA is appropriate; mNEXSPIKE may be preferred where available (targeted design, longer fridge stability), but do not delay vaccination waiting for a specific brand.2

Influenza 2025–2026: Strain Composition + Brand Examples

Trivalent strain composition5

  • Egg-based (Fluarix, FluLaval, Fluzone, Fluad (aIIV3, ≥65), Fluzone High-Dose (HD-IIV3, ≥65):
    • A/Victoria/4897/2022 (H1N1)pdm09-like
    • A/Croatia/10136RV/2023 (H3N2)-like
    • B/Austria/1359417/2021 (B/Victoria lineage)-like.
  • Cell-/recombinant-based (Flucelvax, Flublok):
    • A/Wisconsin/67/2022 (H1N1) pdm09-like
    • A/District of Columbia/27/2023 (H3N2)-like
    • B/Austria/1359417/2021 (B/Victoria lineage)-like.

Administration:

If Not Given the Same Day

  • Non-live vaccines (flu shots, mRNA COVID-19, RSV, pneumococcal): no minimum interval is required—they can be given together or at any interval before/after one another.4
  • Only for live vaccines (e.g., FluMist LAIV): if not co-administered the same day as another live vaccine, separate by ≥4 weeks.4
New updates for the 2025/2026 season:
  • FluMist®, a live attenuated intranasal vaccine was approved for at home use in patients ages 2-49 years. Patients can order product to be shipped to their home for self-administration in 36 states.13
  • Flublok® received an expanded indication for ages ≥9 years, previously approved for ≥18 years.1
  • The CDC recommends seasonal flu vaccination with single-dose formulations free of thimerosal as a preservative.1
  • The H3N2 strain was updated this season for both egg-based and non-egg-based vaccines.1

Counseling Pearl: When patients prefer to stagger, prioritize flu in Sept–Oct, RSV in Oct–Nov (for eligible adults), and COVIDas soon as available.

OTC & Supportive-Care Recommendations (patient handout friendly)

  • For common post-vaccine effects (soreness, low-grade fever, myalgias): acetaminophen (Tylenol®) as labeled; optional ibuprofen if appropriate; cold/heat packs; hydration.
  • Upper-respiratory symptom relief (if patients get seasonal viruses): cough drops, cough syrups as indicated, tissues, humidifier, rest, fluids.
  • Immune-support supplements (discuss with PCP/pharmacist; avoid if contraindicated): vitamin C, zinc, elderberry (Sambucus) may modestly reduce duration/severity for some patients; evidence varies—avoid in pregnancy, autoimmune flares, and significant drug-herb interactions.
  • Red flags for referral/ER: high persistent fever, shortness of breath, chest pain, confusion, signs of allergic reaction, or symptoms lasting >72 hours/worsening.

Pharmacist Workflow & Revenue Tie-Ins

  • Screen at POS/dispensing for eligibility; bundle (flu + COVID-19 + pneumococcal ± RSV).
  • Appointment-based model via your pharmacy system; send SMS campaigns for due vaccines.
  • Medicare billing: covered for pneumococcal, influenza, COVID-19, RSV; align inventory (HD-IIV3, aIIV3, RIV3) to your ≥65 years population.2
References

References (APA)

    1. Centers for Disease Control and Prevention. (2025, Aug 6). 2025–2026 flu season.
    2. Centers for Disease Control and Prevention. (2025, Jul 2). Adult immunization schedule notes.
    3. Centers for Disease Control and Prevention. (2024, Jul 24). Timing & spacing of immunobiologics. 
    4. Centers for Disease Control and Prevention. (2025). Flu vaccine coadministration. 
    5. U.S. FDA. (2025, Mar 13). Influenza vaccine composition 2025–2026. 
    6. Moderna. (2025). Spikevax (2025–2026 formula) Prescribing Information. 
    7. U.S. FDA. (2025, May 22). COVID-19 vaccines (2025–2026 formula)—JN.1 lineage, LP.8.1 preferred. 
    8. Pfizer. (2025, Aug 27). Comirnaty approval (2025–2026 formula; LP.8.1). https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontechs-comirnaty-receives-us-fda-approval
    9. U.S. FDA. (2025). Comirnaty 2025–2026 Package Insert. 
    10. U.S. FDA. (2025). MNEXSPIKE (overview & indications). 
    11. FDA filing summary for mRNA-1283 (mNEXSPIKE) (stability & antigen domains). 
    12. CDC. (2025, Aug 28). ACIP influenza recommendations (≥65 preferential products).
    13. AstraZeneca (2025, Aug 15). FLUMIST Now available for home delivery.
    14. U.S. FDA. (2025). Nuvaxovid 2025-2026 Package Insert.