Until recently, respiratory syncytial virus (RSV) was widely regarded as a childhood infection. That changed as surveillance revealed its substantial toll on older adults, especially those with heart or lung disease. Each year, RSV is responsible for an estimated 60,000–160,000 hospitalizations and 6,000–10,000 deaths among U.S. adults aged 65 and older. These figures are comparable to seasonal influenza, yet public awareness and vaccination rates remain low.
For the 2025–2026 respiratory season, the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) have updated guidance to include a broader adult population. Two key shifts define this season: vaccination is now recommended for all adults aged 75 and older, and it is advised for adults 50–74 years old who are at increased risk of severe RSV disease. Pharmacies will once again serve as the main access point for RSV vaccination, often alongside flu and COVID-19 shots. With three approved vaccines available, namely, Arexvy (GSK), Abrysvo (Pfizer), and mRESVIA (Moderna), clinicians and pharmacists must understand eligibility, timing, and co-administration best practices. This guide summarizes who should get vaccinated, when, and how to safely combine RSV immunization with other seasonal vaccines during the 2025–2026 season.
Eligibility & Recommendations — Who Should Get RSV Vaccine in 2025–2026
The 2025–2026 season marks a turning point in RSV vaccination policy for adults. After reviewing emerging data from two full seasons of real-world use, the CDC and ACIP formally expanded recommendations to include a wider at-risk population. Under current guidance, all adults aged 75 and older are recommended to receive a single dose of an approved RSV vaccine. This expansion reflects the consistently high hospitalization and mortality rates seen in this group, along with evidence that immune response remains robust and protective for at least two RSV seasons following vaccination.
For adults aged 50–74, vaccination is recommended for those with chronic conditions including heart failure, chronic obstructive pulmonary disease (COPD), diabetes, or weakened immunity. The three vaccines currently approved for adults, i.e., GSK’s Arexvy, Pfizer’s Abrysvo, and Moderna’s mRESVIA, are considered interchangeable in terms of efficacy and safety, though their formulations differ. Clinical trials in older adults demonstrated vaccine efficacy ranging from 80% to 90% against severe RSV disease in the first season and durable protection for at least two years, meaning most adults vaccinated in 2023 or 2024 do not yet require another dose.
For now, the CDC advises that RSV vaccination is not annual. Data from post-licensure studies indicate durable protection for at least two years, meaning most adults vaccinated in 2023 or 2024 do not yet require another dose. However, the CDC continues to evaluate whether booster schedules will eventually be recommended for older adults with waning immunity or evolving viral subtypes.
Timing & Seasonality — When to Administer at the Pharmacy
Unlike influenza, which follows a well-defined annual pattern, RSV activity can vary by region and year. In most parts of the United States, cases begin to rise in late fall, peak during winter, and taper off by early spring. For the 2025–2026 season, the CDC recommends vaccinating eligible adults before the onset of widespread RSV transmission, ideally between August and October 2025. This schedule allows time for an optimal immune response before community circulation intensifies. Timing matters because RSV vaccine protection is strongest within the first two seasons after vaccination.
Pharmacies should plan for a staggered rollout to avoid overwhelming staff. The fall vaccination surge should be coordinated with flu and COVID-19 campaigns to maximize efficiency. Pharmacists can use their dispensing records to identify eligible patients and send targeted reminders. Since RSV activity can vary by region, pharmacists should monitor local case reports and adjust timing accordingly. The goal is to complete vaccination before community transmission begins to ensure peak protection during the highest-risk period.
Co-administration and Safety — Can RSV Be Given with Flu / COVID?
The CDC now states clearly that RSV, flu, and COVID vaccines may be administered together, preferably in different arms. This recommendation is based on extensive immunogenicity and safety data collected across several clinical trials and real-world surveillance studies. One of the most frequent questions older adults ask when considering RSV vaccination is whether it can be given at the same time as their annual influenza or COVID-19 shot. Since the introduction of adult RSV vaccines in 2023, researchers and public health agencies have been closely studying co-administration (the practice of giving multiple vaccines during the same visit) to determine its safety, immune response, and practicality.
For example, a 2024 New England Journal of Medicine study examined older adults who received Arexvy (GSK) concurrently with a high-dose influenza vaccine. Immune responses to both were non-inferior to separate administration, while side effects were limited to mild fatigue, muscle soreness, or short-term arm pain. Similar findings were observed in Pfizer’s Abrysvo co-administration studies, which paired the RSV vaccine with mRNA-based COVID boosters in adults aged 60 and older. Across these studies, no significant increase in serious adverse events was detected.
That said, reactogenicity, i.e., the short-term physical response to vaccination, can be slightly more noticeable when multiple vaccines are administered in a single session. Patients may experience fatigue, low-grade fever, or tenderness at both injection sites for one or two days. Pharmacists should normalize these effects during counseling, explaining that they reflect an active immune response, not illness or complication. Hydration, rest, and over-the-counter pain relievers can help manage discomfort.
Certain individuals may still benefit from staggered scheduling, particularly those with complex health profiles, frailty, or previous strong reactions to vaccines. For such patients, spacing RSV and influenza vaccines by one or two weeks can make side effects easier to tolerate. Pharmacists should approach this through shared decision-making, balancing convenience with comfort and clinical factors.
Pharmacy Practice & Patient Counseling
The first task is identifying eligible patients. Pharmacists can use existing medication records and clinical notes to flag individuals over 75 or those between 50 and 74 with chronic conditions like heart failure, COPD, diabetes, or weakened immunity. Integrating RSV prompts into pharmacy management software can help streamline these efforts during the fall vaccination surge. Pharmacists should clearly explain that RSV is not just a “cold.” For older adults, it can lead to pneumonia, hospitalization, or worsening of underlying disease. Patients often underestimate the virus because it’s less publicized than flu or COVID-19. Explaining that RSV vaccination has similar importance and that a single dose provides at least two years of protection helps build confidence and compliance.
Marketing also plays a key role. Pharmacies can frame RSV immunization as part of a “respiratory protection package,” a single seasonal visit that covers flu, COVID-19, and RSV. Digital reminders, window posters, and localized SEO (e.g., “RSV vaccine near me for seniors”) can draw in eligible patients. For patients, RSV vaccination fits into a broader shift toward routine, seasonal respiratory protection. It is a mindset that integrates flu, COVID, and RSV shots as complementary defenses. The pharmacy setting provides the trust, convenience, and immediacy that make this possible.
Pharmacists should also be prepared to address common concerns. Many patients ask about side effects, which are generally mild: soreness at the injection site, fatigue, or headache. Others worry about the newness of the vaccine; pharmacists can reassure them that these vaccines went through rigorous clinical trials involving thousands of older adults. Clear, empathetic communication helps patients make informed decisions about their health.
Conclusion
For pharmacists, this season’s campaign is about more than logistics, it’s about helping patients understand their personal risk and make informed, confident choices. Each conversation at the counter is an opportunity to dispel myths, explain the longevity of protection, and encourage co-administration of vaccines that can prevent hospitalizations and save lives.
RSV vaccination represents both a public health milestone and a pharmacy opportunity. By combining education, accessibility, and efficiency, pharmacists can help transform RSV prevention into a new standard of care for America’s aging population. Looking forward, the next step is cultural: making RSV immunization as expected and accepted as the annual flu shot. If achieved, the 2025–2026 season could mark not only a new phase in adult vaccination, but a lasting model for preventive public health in aging America.
References
- Centers for Disease Control and Prevention. (2025). RSV vaccine guidance for adults. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html
- Centers for Disease Control and Prevention. (2025, August 18). Clinical overview of respiratory illnesses: Coadministration of flu, COVID-19, and RSV vaccines. https://www.cdc.gov/respiratory-viruses/hcp/clinical-overview/index.html