This season’s flu vaccines look different: all three strains have been updated, and the first mRNA-based flu vaccine has joined the lineup.
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Vickie Danaher, PharmD, discusses the 2026-2027 flu vaccine update. She breaks down which patients should be vaccinated, which vaccines are preferred for older adults, and what to watch for with the new mRNA-based vaccine.
You’ll hear practical insights on the best timing for flu vaccination, higher-dose and adjuvanted vaccines for adults 65 and older, egg allergy guidance, the at-home nasal spray option, co-administration with COVID-19, RSV, and shingles vaccines, and ways to prevent vaccine errors. Plus, Vickie shares how to answer common patient questions and build vaccine confidence, helping healthcare teams stay ahead as the 2026-2027 flu season ramps up.
This is an excerpt from our September 2026 Pharmacy Essential Updates continuing education webinar series.
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CE Information:
TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Flu Vaccines for 2026-2027
- Chart: Flu Vaccines for 2026-27 (United States)
- FAQ: Communicating About Flu Vaccination
- Algorithm: Vaccine Adherence: Addressing Myths and Hesitancy
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Transcript:
This transcript is automatically generated.
00:00:00 Narrator
Which new flu vaccine could easily be mistaken for an RSV or COVID-19 vaccine?
00:00:06 Narrator
Should older adults wait for an enhanced flu vaccine if none is available?
00:00:15 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:21 Narrator
On this episode, Associate Editor and Clinical Pharmacist, Vickie Danaher, breaks down the 2026-2027 flu vaccines, including the first mRNA-based flu vaccine.
00:00:32 Narrator
She shares which vaccines are preferred for which patients, how to answer common patient questions, and other key things healthcare professionals need to know before flu season ramps up in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:47 Narrator
This podcast offers continuing education credit for pharmacists and pharmacy technicians.
00:00:51 Narrator
Please log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:59 Narrator
None of the speakers have anything to disclose.
00:01:02 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday, bringing concise, actionable insights from TRC experts straight to your ears.
00:01:10 Narrator
Let’s dive in.
00:01:17 Vickie Danaher
All right, let’s go ahead and jump right into our topic about flu vaccines for this season.
00:01:21 Vickie Danaher
And this is always a very popular topic that raises a lot of questions every year.
00:01:28 Vickie Danaher
And this year in particular, there’s been a few changes with flu vaccines, including the approval of the first mRNA-based flu vaccine added into the mix.
00:01:38 Vickie Danaher
But before we go into what’s new, let’s start off with one thing that hasn’t changed this year, and that’s which patients should get a flu vaccine.
00:01:47 Vickie Danaher
So explain that an annual flu vaccine is still recommended for all patients six months and older who don’t have contraindications.
00:01:58 Vickie Danaher
And in terms of the flu vaccine products, all seasonal influenza vaccines in the US will be trivalent again like last season.
00:02:07 Vickie Danaher
So they’ll protect against three different strains of flu viruses.
00:02:12 Vickie Danaher
They’ll contain two influenza A strains, which are H1N1 and H3N2, and then just one influenza B strain, which is B/Victoria.
00:02:26 Vickie Danaher
And for 2026-2027, all three of these components will be updated compared to the strains used in the flu vaccine last season.
00:02:35 Vickie Danaher
This includes a change to protect against the flu A(H3N2) subclade K virus that spread widely and caused a sharp rise in severe flu cases last year.
00:02:47 Vickie Danaher
So a key point that we can share with patients is that the flu vaccine composition is different this year to try to better match what flu viruses are anticipated to be circulating.
00:02:58 Vickie Danaher
And this can be especially helpful for those patients who say they don’t need a flu vaccine this year because they got one last year.
00:03:06 Vickie Danaher
Now with that background, let’s discuss some common questions that come up from patients and some changes to be aware of this season.
00:03:14 Vickie Danaher
And one big question that comes up every year is when is the right time to get a flu vaccine?
00:03:21 Vickie Danaher
So how do you usually reply to this question?
00:03:24 Vickie Danaher
And when do you suggest getting immunized against influenza?
00:03:30 Vickie Danaher
So like previous years, it’s recommended to start vaccinating most patients in September, not July or August, because of the potential for waning immunity before flu season ends.
00:03:42 Vickie Danaher
So for most people who just need one dose of flu vaccine, September or October are generally the ideal times to get vaccinated, especially because it takes about two weeks after vaccination for antibodies that protect against flu to develop.
00:03:58 Vickie Danaher
So the goal is to have patients vaccinated and protected before flu season ramps up.
00:04:05 Vickie Danaher
Typical flu activity can start in October and last through May, often peaking in February.
00:04:12 Vickie Danaher
But even though it’s ideal to get vaccinated by the end of October, continue to vaccinate as long as flu is circulating and vaccine is available.
00:04:22 Vickie Danaher
This can still provide protection even when flu season is ongoing.
00:04:27 Vickie Danaher
But keep in mind that there are some exceptions to this general rule of starting to vaccinate in September.
00:04:33 Vickie Danaher
For example, children aged six months through eight years who haven’t had at least two doses of flu vaccine in the past need two doses of flu vaccine this year, given at least four weeks apart.
00:04:48 Vickie Danaher
And because of that separation, it’s recommended that these kids get their first dose as soon as possible after vaccine becomes available to kind of give enough time for that second dose to be received, ideally by the end of October.
00:05:01 Vickie Danaher
Early vaccination in July or August can also be considered for pregnant patients in the third trimester of pregnancy to help protect the infant during the first few months of life when they’re too young to be vaccinated themselves.
00:05:15 Vickie Danaher
In general, I’ll explain that protection from flu vaccine usually lasts for at least five to six months.
00:05:21 Vickie Danaher
And don’t give a flu booster for any patient regardless of when they get this year’s vaccine.
00:05:27 Vickie Danaher
In adults, studies haven’t shown a benefit from getting more than one dose during the same influenza season, even among older adults with weakened immune systems.
00:05:37 Vickie Danaher
So again, only one dose of flu vaccine is recommended each season for patients, except those children who are getting vaccinated for the first time.
00:05:46 Vickie Danaher
Now let’s move on to another common question from patients, which is, which flu vaccine is best or which flu vaccine should I get?
00:05:53 Vickie Danaher
So what do you think about this and what do you tell your patients when this question comes up?
00:05:59 Vickie Danaher
And overall, the key is for patients to get vaccinated with any available flu vaccine that’s appropriate for their age and health status, rather than worrying about which flu vaccine to get or risking not getting a flu vaccine at all trying to find a particular product.
00:06:15 Vickie Danaher
There are some nuances with this, as well as some differences between the flu vaccine products that may determine which vaccine should ideally be given.
00:06:24 Vickie Danaher
And one key consideration with this is for our older patients, age 65 years and up.
00:06:31 Vickie Danaher
We know that these patients are especially vulnerable to severe complications from influenza and aging decreases the body’s ability to develop a good immune response after the flu vaccine, which places older people at a greater risk of illness.
00:06:47 Vickie Danaher
So for patients aged 65 years and up, we want to continue to preferentially give an enhanced flu vaccine such as the higher dose or adjuvanted flu vaccine when possible.
00:07:00 Vickie Danaher
Evidence suggests that these flu vaccines are more effective than standard flu vaccines for older patients, especially to reduce flu hospitalizations.
00:07:10 Vickie Danaher
Let’s dig into the enhanced flu vaccines for patients 65 years and up and see how they’re a little different than the others.
00:07:18 Vickie Danaher
So first with Fluzone High Dose, it’s approved for adults 65 and older, and it has four times the amount of antigen as standard dose injectable flu vaccines, with the goal of trying to boost immunity in older patients, again, since the immune response to flu vaccines weakens with age.
00:07:39 Vickie Danaher
Next is Flublok, which is approved for ages 9 and older.
00:07:44 Vickie Danaher
It’s a recombinant vaccine, and it has three times the amount of antigen than standard dose injectable vaccines.
00:07:53 Vickie Danaher
That’s why you often hear the phrase higher dose for both Fluzone high dose and for Flublok.
00:08:02 Vickie Danaher
And then Fluad is also approved for adults over 65, like Fluzone High Dose, but it has an adjuvant, which is an ingredient intended to help boost the immune response.
00:08:15 Vickie Danaher
Last is the new vaccine mFlusiva, which is the first mRNA-based flu vaccine.
00:08:22 Vickie Danaher
It’s approved for patients 50 and older, and it’s also considered a preferred option for patients 65 years and up based on recommendations from the American Academy of Family Physicians or AAFP.
00:08:37 Vickie Danaher
It uses the same mRNA technology that many patients became familiar with COVID-19 vaccines, and in the future, this could allow manufacturers to respond more rapidly to changing influenza strains.
00:08:53 Vickie Danaher
In clinical studies, it was found that mFlusiva prevents about one additional case of influenza illness for every 125 patients vaccinated relative to or compared with a standard flu shot.
00:09:06 Vickie Danaher
But it’s important to note that the clinical efficacy or clinical benefit of mFlusiva hasn’t been directly studied versus higher dose or adjuvanted flu vaccines, and the indication for ages 65 and older was given accelerated approval due to immune data only, meaning that it was approved based on the vaccine’s ability to generate an immune response in these patients rather than direct evidence showing fewer cases of influenza illness.
00:09:40 Vickie Danaher
Trials for effectiveness are ongoing and continued approval for this age group may be contingent upon the results of these studies.
00:09:48 Vickie Danaher
Also keep in mind that mFlusiva causes more injection site pain and flu-like symptoms such as fatigue than standard flu vaccines.
00:09:58 Vickie Danaher
And Medicare Part B will cover it, but other care coverage may vary.
00:10:06 Vickie Danaher
If you stock mFlusiva, dispense a 0.3 mL IM dose to patients 50 years and older.
00:10:14 Vickie Danaher
Make sure to store it in the refrigerator, not in the freezer, like some other mRNA vaccines.
00:10:22 Vickie Danaher
And also watch for look-alike errors or confusion with other vaccines.
00:10:27 Vickie Danaher
mFlusiva could easily be mistaken for mRESVIA, an RSV vaccine, or for the COVID-19 vaccine, mNEXSPIKE.
00:10:39 Vickie Danaher
So again, an enhanced flu vaccine such as the higher dose or adjuvanted flu vaccine is preferentially recommended for patients aged 65 and older.
00:10:50 Vickie Danaher
And among these vaccines, you can use any of them that you have in stock.
00:10:55 Vickie Danaher
But if an enhanced flu vaccine isn’t available for an older patient, we still want to go ahead and use any age-appropriate flu vaccine instead, rather than wait and potentially miss the opportunity for the patient to get vaccinated altogether.
00:11:11 Vickie Danaher
Now let’s talk about how to approach vaccination in younger patients or other special populations.
00:11:19 Vickie Danaher
And the bottom line here is to still dispense any flu vaccine appropriate for the patient’s age and health status, whether that be an injectable flu vaccine or an intranasal flu vaccine.
00:11:33 Vickie Danaher
Now of the injectable options, take note that the standard dose inactivated flu vaccine, Afluria, will no longer be available.
00:11:44 Vickie Danaher
But this shouldn’t impact the overall vaccine supply.
00:11:47 Vickie Danaher
And then one quick reminder on formulations.
00:11:53 Vickie Danaher
If you remember last year, ACIP members voted to recommend single dose flu vaccines that don’t contain the preservative thimerosal.
00:12:03 Vickie Danaher
But evidence continues to support the safety of multi-dose vials, and Fluzone will be the only multi-dose vial flu vaccine this season.
00:12:13 Vickie Danaher
Professional medical associations and other experts say that vaccination generally shouldn’t be delayed if that’s the available option, but continue to follow your state laws and protocol.
00:12:26 Vickie Danaher
In terms of special populations, like last year, adults who are solid organ transplant recipients and who are taking immunosuppressants may also get a high-dose flu vaccine or adjuvanted flu vaccine as an option.
00:12:42 Vickie Danaher
So in other words, even though Fluzone high dose or the adjuvanted Fluad vaccine are only FDA approved for patients 65 and older, they can be given to these higher risk transplant patients based on ACIP recommendations.
00:13:00 Vickie Danaher
And in this case as well, there’s no preference for high dose or adjuvanted flu vaccine over other standard dose injectable vaccines.
00:13:12 Vickie Danaher
Another group of patients that there’s always questions about when it comes to getting a flu vaccine are those patients with a history of egg allergy.
00:13:20 Vickie Danaher
So remember that patients with severe egg allergy can get any flu vaccine in any setting.
00:13:28 Vickie Danaher
These patients are no longer limited to a medical setting such as a physician’s office or hospital.
00:13:35 Vickie Danaher
Evidence shows that patients with an egg allergy do not have a higher reaction rate compared to those without an egg allergy.
00:13:43 Vickie Danaher
And egg allergy alone doesn’t require any additional safety measures for flu vaccination beyond those recommended for any recipient of any vaccine.
00:13:54 Vickie Danaher
So continue to follow your pharmacy’s usual immunization protocols such as for screening and having anaphylaxis kits available.
00:14:03 Vickie Danaher
And point out that the egg-free flu vaccines, which are the cell-cultured Flucelvax and the recombinant flu vaccine, Flublok, are still available if the patient prefers.
00:14:16 Vickie Danaher
And the mRNA flu vaccine, mFlusiva, also does not contain egg protein.
00:14:24 Vickie Danaher
Now let’s shift gears and briefly talk about the live attenuated intranasal flu vaccine, or FluMist, which some of us may dispense in our pharmacies.
00:14:33 Vickie Danaher
Like last year, it will also be available direct to consumer in some states for patients or caregivers to self-administer the vaccine at home.
00:14:45 Vickie Danaher
Now, regardless of where it’s given, FluMist is still indicated for otherwise healthy, non-immunocompromised, non-pregnant patients age 2 through 49 years of age, especially if the patient refuses an injection.
00:15:05 Vickie Danaher
But there’s some nuances with the at-home vaccine option that you’ll want to point out if patients ask about it.
00:15:11 Vickie Danaher
For example, patients will need to order FluMist on the product website by completing a questionnaire, which will be reviewed by a healthcare professional for eligibility.
00:15:21 Vickie Danaher
If the patient is eligible, they must pay shipping for the product to be delivered to their home, refrigerate the product until they’re ready to use it, and then also return the sprayer for proper disposal to the manufacturer through a prepaid return envelope.
00:15:38 Vickie Danaher
Also explain that at-home FluMist isn’t currently an option for those without insurance or on the Vaccines for Children program.
00:15:47 Vickie Danaher
So for these patients, as well as those who don’t want to go through all the steps involved with storing and disposing the product at home, you want to just recommend getting the nasal spray at your pharmacy if you stock it.
00:16:00 Vickie Danaher
And if you do stock the intranasal flu vaccine, continue to administer and bill your stock as usual.
00:16:07 Vickie Danaher
Don’t dispense it for at-home use or allow patients or caregivers to self-administer it at your practice.
00:16:15 Vickie Danaher
If you dispense it, you still have to administer it.
00:16:19 Vickie Danaher
Okay, so we talked about who should get the flu vaccine and which vaccines can be used.
00:16:25 Vickie Danaher
Now let’s get a bit into the why and discuss benefits and risks.
00:16:30 Vickie Danaher
So when one of your patients asks you how effective are flu vaccines or are flu vaccines safe, how do you respond?
00:16:41 Vickie Danaher
In terms of flu vaccine efficacy, explain that this varies each season based on how well the vaccines match the flu viruses that are circulating.
00:16:50 Vickie Danaher
So we won’t know how effective this year’s vaccines will be until the season pans out.
00:16:57 Vickie Danaher
Plus, efficacy of the vaccine for an individual patient can also depend on their age, health status, and timing of vaccination.
00:17:06 Vickie Danaher
But even if we find out that the flu vaccines this year aren’t well matched to circulating strains, we do know that overall flu vaccination reduces flu severity and flu-related complications, including hospitalization and death.
00:17:21 Vickie Danaher
For example, last season, there was a mismatch between the vaccine and circulating viruses, but vaccinations still reduced the risk of flu-related emergency department or urgent care visits by about 35% and hospitalizations by 27%.
00:17:39 Vickie Danaher
And specifically in children, a recent study in Pediatrics by CDC experts found that vaccines reduce the risk of children and teens dying from flu by about 80%.
00:17:53 Vickie Danaher
As it relates to safety, reassure patients that mild side effects such as soreness at the injection site or fatigue may occur, but serious adverse reactions are extremely rare.
00:18:06 Vickie Danaher
You may also hear that updated labeling for flu vaccines used in children now includes information about a very small increased risk of febrile seizures in kids younger than five years old based on two observational post-marketing studies.
00:18:23 Vickie Danaher
Help put this in perspective by clarifying that this amounts to about one additional febrile seizure for every 20,000 to 40,000 doses administered.
00:18:34 Vickie Danaher
These seizures are rare and brief, occur within 24 hours following vaccination, and are generally harmless with no long-term effects.
00:18:44 Vickie Danaher
Importantly, influenza illness itself can also trigger febrile seizures, and this information does not change the overall favorable risk-benefit profile of influenza vaccination.
00:18:57 Vickie Danaher
As pharmacists and techs, we should also be aware of strategies to help foster trust and increase vaccine confidence.
00:19:05 Vickie Danaher
For instance, when talking with patients about flu vaccines and actually any vaccine, we can use open-ended questions such as what concerns you about flu vaccination or tell me more about that.
00:19:19 Vickie Danaher
Listen for common misconceptions such as the belief that the flu vaccine causes the flu or that healthy people don’t need a flu vaccine and ask to provide facts.
00:19:30 Vickie Danaher
Getting that consent is important to help avoid the backfire effect, where providing facts that contradict a person’s belief increases hesitancy instead of reducing it.
00:19:41 Vickie Danaher
So for example, you could say something like, I have some information that other people have found helpful.
00:19:46 Vickie Danaher
May I share it with you?
00:19:50 Vickie Danaher
Now we don’t have time in today’s discussion to dig deeper into this, but I wanted to share that we have a resource on our website called Vaccine Adherence, Addressing Myths and Hesitancy that can help address common concerns and provide credible resources that can be shared with patients.
00:20:07 Vickie Danaher
And then the last flu vaccine question that we’ll talk about today is whether other recommended vaccines such as COVID-19, RSV, or shingles vaccine can be given at the same time as a flu vaccine.
00:20:20 Vickie Danaher
So what do you say to patients about getting more than one vaccine at the same visit?
00:20:25 Vickie Danaher
And the answer to this hasn’t changed.
00:20:28 Vickie Danaher
Patients can and ideally should get all needed vaccines at the same visit with rare exceptions.
00:20:35 Vickie Danaher
Co-administration is generally recommended to help prevent missed opportunities for vaccination and hasn’t been found to negatively impact efficacy or safety, although some patients may have more side effects, such as injection site pain or fatigue.
00:20:52 Vickie Danaher
Keep in mind that there’s not a maximum number of vaccines that can be given at one visit, but when giving multiple vaccines, remember to administer them in different arms.
00:21:03 Vickie Danaher
Or if you need to give them in the same arm, such as in the case of a patient getting more than two vaccines, separate each injection by at least one inch.
00:21:14 Vickie Danaher
Document where each vaccine was given and even consider giving patients a vaccine map.
00:21:19 Vickie Danaher
In the event that there’s a local reaction, this can make it easier to help identify which vaccine may have been the culprit.
00:21:27 Vickie Danaher
Let’s wrap things up here with some tips to help prevent errors with any vaccine.
00:21:32 Vickie Danaher
Continue to store vaccines in separate bins, on separate shelves, or with eye-catching labels.
00:21:40 Vickie Danaher
Keep in mind to slow down and double check that you’re selecting the correct vaccine from your computer and fridge.
00:21:46 Vickie Danaher
It can be easy to mistake all things flu.
00:21:48 Vickie Danaher
So Fluarix, Flucelvax, Fluzone, Fluzone High Dose, and so forth.
00:21:53 Vickie Danaher
Bring only the needed vaccines to the administration area for one patient at a time.
00:21:59 Vickie Danaher
Ask open-ended questions to confirm you have the right patient and the right vaccines.
00:22:04 Vickie Danaher
For example, you could say something to the patient like, to confirm, what vaccine are you here to get today?
00:22:11 Vickie Danaher
Consider showing the patient the syringe before giving the injection as another double check.
00:22:18 Vickie Danaher
All right, well, that’s a wrap on our annual flu vaccine update.
00:22:22 Vickie Danaher
For details on specific influenza vaccine products, check out our highly popular chart, flu vaccines for 2026-2027, available on our website.
00:22:32 Vickie Danaher
It includes approved ages for use, dose, costs, and more.
00:22:37 Vickie Danaher
Feel free to bookmark that page or save it as a favorite on your computer so you can have quick access during your busy day.
00:22:45 Vickie Danaher
Also, don’t forget to see our resource communicating about flu vaccination to review guidance on immunizing kids, pregnant or immunocompromised patients, and people with an egg allergy.
00:22:58 Narrator
Thanks for listening.
00:22:59 Narrator
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00:23:03 Narrator
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00:23:15 Narrator
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00:23:20 Narrator
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