Before patients ask: what practices should know about flu season

The window of time is closing for medical practices to finish flu vaccinations before the worst of flu season hits in late fall and winter, two Johns Hopkins experts said.

Meanwhile, they also flagged a new question for front-desk staff and billing teams. A newly licensed influenza vaccine for adults 50 and older lacks a federal advisory committee recommendation, which means insurers are not necessarily required to cover it.

While most of the country has yet to see significant influenza activity, early cases have sent patients to the hospital.

“Right now, there is no cause for concern, but this should be viewed as a good last call to get your influenza vaccination for this year because the vaccines work best if they’re taken before the influenza season starts,” said Andrew Pekosz, Ph.D., professor and vice chair of the W. Harry Feinstone Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health.

Pekosz, co-director of the Johns Hopkins Center of Excellence in Influenza Research and Response, spoke during an Oct. 29 media briefing hosted by the Bloomberg School with Anna Durbin, M.D., professor in its Department of International Health and director of the Johns Hopkins Center for Immunization Research. The experts answered questions from multiple news outlets.

Why is now the window?

Protection from the flu vaccine takes about two weeks to reach its maximum, then lasts several weeks to several months, Pekosz said. Activity is low but increasing, particularly in the West and South, and states that are quiet now will not stay that way.

“There’s never a state in the United States that misses influenza during an influenza season,” Pekosz said.

Hospitalizations are already climbing, with almost 5,000 laboratory-confirmed cases in the week ending Oct. 17, the highest mid-October rate since the 2010-2011 season, Durbin said, citing the Centers for Disease Control and Prevention.

Should your practice stock the mRNA vaccine?

The new messenger RNA (mRNA) influenza vaccine is licensed for people 50 and older and performed better than traditional vaccines in clinical trials in that age group, Durbin said.

Durbin said the administration fired the previous members of the Advisory Committee on Immunization Practices (ACIP). ACIP has added new members but has not met in 2026 due to legal challenges of the member appointments and recommendations. Without an ACIP recommendation, insurers are not obligated to pay for the mRNA vaccine, which costs more than $100, while other influenza vaccines are covered, she said.

That matters for practices that buy inventory up front. American Academy of Family Physicians President Sarah Nosal, M.D., told Physicians Practice that vaccine stocking costs and unpaid counseling time already strain practices, and insurance coverage still hinges on ACIP.

“If you are interested, please check with your pharmacy to see if they have it, and importantly, to see if your insurance will cover it,” Durbin said.

Staff should be ready to counsel on side effects. The mRNA vaccine can cause body aches and a low-grade fever and probably has more side effects than traditional flu vaccines, Durbin said.

Can one visit cover several vaccines?

Flu and COVID-19 vaccines can be given at the same time, and adults 65 and older have higher-dose flu vaccines, Durbin said. Patients 75 and older should get a respiratory syncytial virus (RSV) vaccine, as should immunocompromised patients and those 50 and older with underlying lung disease, she said.

Pekosz urged patients coming in for a flu shot to ask about pneumococcal, COVID-19 and RSV vaccines as well.

“This is the time of year where all of those vaccines against respiratory infections should be looked at, and you should think about getting updated for them if you’re eligible,” Pekosz said.

He expects RSV within weeks and a COVID-19 surge in December and January.

What happens when patients get sick?

Home tests can distinguish influenza, COVID-19 and RSV, Pekosz said. Antivirals for influenza and COVID-19 shorten symptoms and reduce the risk of severe illness, but only if started within a few days of symptom onset. He advised patients to confirm now that their pharmacy stocks antivirals and to ask how to get a prescription.

For practices, that means calls from patients with a positive home test may need a fast response.

Who’s watching for side effects?

Every vaccine, including the mRNA vaccine, is monitored through passive reporting to the Vaccine Adverse Event Reporting System and active surveillance in health care systems, Durbin said. In October, the U.S. Department of Health and Human Services announced a proposal to pay physicians for time spent filing those reports.

For unsure patients, Durbin pointed back to the practice.

“What I encourage people to do is talk to your physician. If you have a good relationship with your physician, if you have questions about whether or not you should be vaccinated against influenza, or have questions about the vaccines themselves, talk to your physician. A conversation can go a long, long way,” Durbin said.