What physicians need to know about this flu season — ‘A conversation can go a long, long way’

Influenza is putting patients in the hospital earlier than usual this fall, and a vaccine researcher said the best protection still starts with a physician urging patients to get their flu shot now.

A fellow Johns Hopkins expert called the early cases an important reminder to vaccinate before the worst of flu season. He said a mutated H1N1 strain driving early infections can partly evade existing immunity, but this season’s vaccine still appears to recognize it.

“So I think it’s really important, particularly if you’re on the older side, where you’re more at risk for more severe influenza, you should get vaccinated. And what I tell my patients, and I encourage others to tell their patients, is that a flu vaccine is the best way to protect yourself against influenza,” said Anna Durbin, M.D., professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and director of the Johns Hopkins Center for Immunization Research.

Durbin spoke during an Oct. 29 media briefing on fall respiratory virus trends hosted by the Bloomberg School. She was joined by Andrew Pekosz, Ph.D., professor and vice chair of the W. Harry Feinstone Department of Molecular Microbiology and Immunology and co-director of the Johns Hopkins Center of Excellence in Influenza Research and Response. The experts introduced the latest data and answered questions from multiple news outlets.

How early is this flu season?

The Centers for Disease Control and Prevention (CDC) reported almost 5,000 laboratory-confirmed influenza hospitalizations nationwide during the week ending Oct. 17, the highest early-season hospitalization rate for mid-October since the 2010-2011 flu season, Durbin said.

Activity is low but increasing, particularly in the western and southern United States, Pekosz said. Early cases are driven by an H1N1 variant with new mutations, a trend noticed in mid-October. Preliminary CDC data show antibodies from the current vaccine recognize it, so the immune escape is incomplete, he said.

“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,” Pekosz said.

The vaccine’s other two components look like good matches, and protection peaks about two weeks after vaccination, Pekosz said. Early efficacy data should appear in early December, likely first from Washington and California.

Who pays for the mRNA flu vaccine?

The new messenger RNA (mRNA) influenza vaccine, licensed for patients 50 and older, worked better than traditional vaccines in that age group in clinical trials, Durbin said. Whether that translates into better protection this season is unknown.

Coverage is another hurdle. 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. Insurers must cover ACIP-recommended vaccines, as Medical Economics reported in September.

“So, although the new mRNA influenza vaccine has been approved by the FDA, we do not have a recommendation from the ACIP, and that means insurance companies don’t necessarily have to cover the cost of that vaccine, and that can limit uptake of the vaccine because it is relatively expensive,” Durbin said.

The mRNA vaccine costs more than $100, while other flu vaccines are covered, she said, so interested patients should check pharmacy stock and their coverage.

What else belongs on the checklist?

Adults 65 and older have higher-dose vaccines, and because older adults are often infected by grandchildren and other children, vaccinating children helps shield them, Durbin said.

Home tests can distinguish influenza, COVID-19 and respiratory syncytial virus (RSV), and antivirals for influenza and COVID-19 must be started within a few days of symptom onset, Pekosz said.

“So be proactive, have some at-home tests handy, and if you test positive for one of those viruses, call your pharmacy to ensure you can get the right antivirals to start taking them as early as possible,” Pekosz said.

Flu and COVID-19 vaccines can be given together, and patients 75 and older should get an RSV vaccine, Durbin said. Pekosz expects a COVID-19 surge in December and January.

What’s the best message for patients?

Fewer people are getting vaccinated, which allows influenza to spread, Durbin said. A national study found emergency department patients without a primary care physician were more than twice as likely to be behind on flu shots.

“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.