CDC COCA call outlines 2025–26 influenza recommendations: vaccination now, molecular testing, and prompt antivirals

On a CDC Clinician Outreach and Communication Activity (COCA) webinar, presenters from the agency’s Influenza Division outlined 2025–26 Advisory Committee on Immunization Practices (ACIP) recommendations, urged clinicians to vaccinate patients who remain unvaccinated, and reviewed testing and antiviral guidance.

The presentation, led by Dr. Tim Yuecki, chief medical officer in the Influenza Division at CDC’s National Center for Immunization and Respiratory Diseases, and Dr. Lisa Grohskopf, a medical officer in the same division, highlighted that influenza activity is increasing and that “the time to get vaccinated for this season is right now” for people aged 6 months and older who have not yet received a vaccine.

Why it matters: Last season was a high-severity influenza season in the United States with substantial pediatric severe outcomes, including 109 reported cases of influenza-associated encephalopathy (37 with acute necrotizing encephalopathy) and low prior vaccination coverage among those cases. CDC presenters said vaccination, accurate testing, and timely antiviral treatment remain key clinical tools to reduce severe outcomes.

Vaccine recommendations and composition Dr. Grohskopf summarized the 2025–26 updates published in MMWR. ACIP recommends routine annual influenza vaccination for all persons aged 6 months and older without contraindication. Notable updates for the season include an updated vaccine composition for H3N2, availability of the live attenuated intranasal vaccine (FluMist) for self- or caregiver administration within approved age bands, an expanded approved age indication for the recombinant vaccine Flublok (RIV3) down to age 9 years, and a recommendation to use seasonal influenza formulations that do not contain thimerosal as a preservative when available.

Vaccine effectiveness Presenters reviewed preliminary 2024–25 vaccine effectiveness (VE) estimates from four CDC networks. For children (6 months–17 years), VE estimates ranged roughly 32–60% for outpatient illness and 63–78% for inpatient illness; adult VE estimates were roughly 36–54% for outpatient and 41–55% for inpatient care. Dr. Grohskopf noted VE tends to be lower against H3N2 viruses in some networks and that real-world VE for 2025–26 will be tracked as the season progresses.

Testing guidance Dr. Yuecki emphasized that molecular influenza assays (including rapid molecular tests) are preferred for clinical management because of higher sensitivity. He recommended rapid molecular testing for outpatients and molecular testing (RT‑PCR or other molecular assays) for hospitalized patients; multiplex assays are advised for immunocompromised patients to identify other respiratory pathogens when clinically indicated. Specimen type matters: nasopharyngeal and mid‑turbinate nasal swabs provide higher yield than throat swabs.

Antiviral treatment guidance CDC presenters reviewed four FDA‑approved antivirals recommended for treatment: neuraminidase inhibitors including oseltamivir (oral) and zanamivir, the intravenous peramivir option, and the cap‑dependent endonuclease inhibitor baloxavir (single oral dose). They reiterated that antiviral treatment offers the greatest clinical benefit when started as soon as possible, ideally within 48 hours of illness onset, and that oseltamivir is recommended for hospitalized patients and for those with progressive or severe illness regardless of time since onset. “For hospitalized patients, oseltamivir treatment is recommended as soon as possible,” Dr. Yuecki said.

Baloxavir: advantages and cautions Presenters noted baloxavir’s single‑dose regimen, faster reduction in upper respiratory viral RNA within 24 hours, and evidence of greater efficacy against influenza B in clinical trials. However, Dr. Yuecki cautioned about emergence of baloxavir‑associated resistance observed in some trials—reported in up to about 10% of cases in adolescents and adults and at higher frequency in younger children—which has been associated with longer symptom duration; documented person‑to‑person transmission of resistant viruses has been rare. Baloxavir is recommended for persons aged 5 years and older; oseltamivir remains the recommended option for all ages and is preferred for pregnant women, hospitalized patients, those with progressive illness, and immunocompromised patients.

Pediatric severe outcomes and vaccination gaps Dr. Yuecki drew attention to pediatric neurologic complications last season: among the 109 reported influenza‑associated encephalopathy cases, the median age was 5 years, 74% required pediatric intensive care, 54% needed invasive mechanical ventilation, and only 16% of vaccine‑eligible children had received influenza vaccine before illness. He used these data to underscore the potential for severe pediatric outcomes and to urge vaccination uptake.

Q&A and next steps In the webinar’s brief Q&A, presenters reiterated age indications—baloxavir for ≥5 years, oseltamivir for all ages—and summarized situations favoring one antiviral over another. The webinar concluded with instructions for continuing education credit via CDC TRAIN and a note that a captioned on‑demand video and transcript will be posted at www.cdc.gov/coca.

The COCA webinar provides clinicians with the CDC’s current operational guidance for vaccination, testing, and antiviral use for the 2025–26 influenza season; presenters emphasized ongoing surveillance to monitor vaccine match and real‑world VE as the season unfolds.