Q&A: Essential 2025-2026 Updates and Pharmacist's Critical Role in Respiratory Vaccines

Georgia Travlos, PharmD, owner of The Medicine Shoppe Pharmacy, provides a roadmap for the 2025-2026 respiratory season, focusing on key updates for community pharmacy practices. She highlights 2 primary respiratory vaccines: the influenza vaccine, with a focus on recommending single-dose, thimerosal-free formulations for vulnerable populations, and the respiratory syncytial virus (RSV) vaccine, where the main update is a one-time dose recommendation for adults aged 75 years and older and those aged 50 to 74 years at increased risk.

Beyond these, community pharmacies are advised to routinely stock and screen patients for pneumococcal and shingles vaccines. The most critical role for the community pharmacist is their accessibility and expertise in administering vaccines and counseling patients, including using effective communication techniques to address skepticism by providing clear, noncoercive information on vaccine efficacy and the risks of contracting the viruses unvaccinated.

Furthermore, Travlos addresses practical aspects of vaccine administration, confirming that coadministration of the 2025-2026 respiratory vaccines is acceptable, with a suggestion of limiting it to 2 injections per visit and administering them in different arms. Outside of administering vaccines, pharmacists can leverage their clinical expertise by focusing on patient education and medication management, especially for high-risk individuals with conditions like COPD. This includes reviewing medication profiles to prevent interference with treatment, refilling necessary prescriptions for exacerbations, and recommending appropriate over-the-counter immune support items.

Drug Topics®: What are the primary respiratory viruses for which you will be offering immunizations to the public during the 2025-2026 season, and what is a key update for each?

Georgia Travlos, PharmD: For the 2025-2026 season, the CDC recommends seasonal flu vaccination with single-dose formulations that are free of thimerosal as a preservative for children, pregnant women, and adults. Also, everyone 6 months and older, with rare exceptions, should get a flu vaccine every season.

The key update on [the RSV] vaccines is that adults 75 years and older and adults aged 50 to 74 [years] at increased risk of severe RSV should receive 1 dose of the vaccine. If already vaccinated, a second vaccination should not be given at this time.

Drug Topics: Beyond the primary respiratory vaccines, what other immunizations should a community pharmacy routinely stock and screen patients for?

Travlos: Community pharmacies should stock and screen patients for their pneumococcal pneumonia vaccines and shingles vaccines.

Drug Topics: In the context of the 2025-2026 respiratory season, what is the most critical role a community pharmacist plays in increasing vaccination rates?

Travlos: The most critical role a pharmacist can play is administering vaccines, being accessible to the public, and offering their expertise on the different vaccines.

Drug Topics: How do you handle a patient who expresses skepticism or hesitancy about receiving a particular vaccine, especially as recommendations for vaccination and formulas continue to change?

Travlos: We always listen and respect a patient when they are hesitant about a vaccine. We never try to coerce a patient with any vaccine, but we provide our expertise on the subject and explain the risks and complications that could occur with contracting viruses in the unvaccinated. Explaining the efficacy of the vaccine and the low risk of [adverse] effects is crucial to helping them make an informed decision about the vaccine.

Drug Topics: The pharmacist’s role often involves coadministration of vaccines. What is the current guidance for coadministering the 2025-2026 respiratory vaccines, and how do you counsel patients on this practice?

Travlos: The current guidance for the respiratory vaccines is that coadministration is acceptable. We usually don’t recommend patients get more than 2 vaccines in 1 sitting unless they cannot ambulate very well and prefer to receive the vaccines in one visit.

Getting the RSV and flu vaccines in 1 visit can eliminate the patient from making another trip to the pharmacy. If patients agree to receive both vaccines at 1 visit, we suggest receiving them in different arms. If the patient prefers 1 arm, the injections should be at least an inch apart, and the patient should be counseled on injection site reactions.

If a patient has had [adverse] effects from the flu vaccine in the past, we usually recommend that they not receive other vaccines on the same day.

Drug Topics: Outside of vaccine administration, how can a pharmacist leverage their clinical expertise to support patients during the 2025-2026 respiratory season?

Travlos: Pharmacists can leverage their clinical expertise during the 2025–2026 respiratory season by focusing on patient education and medication management. Reviewing medication profiles is essential to identify any medications that could worsen respiratory symptoms or interfere with treatment. It is especially important to review those individuals that are at highest risk, such as the elderly and those with underlying conditions, such as COPD [chronic obstructive pulmonary disease]. It is also a good time to refill those prescriptions that are needed for any exacerbations of those conditions.

Recommending the proper over-the-counter items, such as vitamin D, zinc, vitamin C, and selenium, can help support immune health over the winter season.

Drug Topics: Is there anything else you would like to add?

Travlos: The only thing I would add is that patients should consult their physician as well when making decisions since they most likely have the most complete medical history of the patient.