Every autumn, somewhere between the first cold snap and the first sniffle, I get the same question from patients: Which shots do I actually need this year? It’s a fair question, because the answer has gotten more complicated — three different respiratory viruses, several vaccines each, and recommendations that have shifted more than usual lately. So let me walk through it the way I’d explain it across the desk.
Three viruses, not one. Flu, COVID-19, and RSV are different infections, and we now have vaccines aimed at each. They tend to circulate together in the colder months, which is why “respiratory virus season” has become the more honest phrase than “flu season.”
Influenza. The flu shot remains a yearly event for almost everyone — the recommendation continues to cover essentially all adults and children six months and older. People sometimes dismiss flu as a bad cold, but the scale matters: the CDC estimated that flu vaccination prevented roughly 240,000 hospitalizations in the 2024–2025 season, mostly in adults 65 and older. That’s the population I worry about most, and it’s where the vaccine earns its keep.
COVID-19. The vaccines are now updated seasonally, much like the flu shot, with the formulation re-matched to circulating variants. The strongest case for an updated dose is in adults 65 and older, who continue to carry the highest risk of hospitalization and death. A 2025 systematic review in the New England Journal of Medicine found that recent mRNA boosters reduced hospitalization in adults by roughly 46–50% against the variants studied. That protection is real but imperfect, and it fades over months — which is exactly why timing the dose for the season makes sense rather than chasing it year-round.
RSV. This is the newer piece, and the one patients know least about. RSV can be genuinely dangerous in older adults. The current guidance recommends a single dose for all adults 75 and older, and for adults 50–74 who have conditions that raise their risk of severe disease. Three vaccines are licensed for this group. Importantly, RSV vaccine is — for now — a one-time dose for most people, not an annual one.
A word of honesty about the guidance itself. The advisory process behind these recommendations has been unusually turbulent over the past year, with several changes and legal challenges. I mention that not to alarm you but to explain why your pharmacist, your news feed, and your neighbor may all say slightly different things. My advice: confirm the current recommendation with your own physician, who knows your risk factors, rather than relying on a headline.
How I think about it. Vaccines are a tool for reducing the severity of illness more than eliminating the chance of it. If you’re older, immunocompromised, or living with heart or lung disease, the math tilts strongly toward vaccination. If you’re young and healthy, the decision is more individual — and worth an actual conversation rather than a reflex in either direction.
References
- CDC. 2025–2026 Respiratory Disease Season Outlook. https://www.cdc.gov/cfa-qualitative-assessments/php/data-research/season-outlook25-26.html
- New England Journal of Medicine. Updated Evidence for Covid-19, RSV, and Influenza Vaccines for 2025–2026. https://www.nejm.org/doi/full/10.1056/NEJMsa2514268
- CDC. RSV Vaccine Guidance for Adults. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html
