Issue 1799: February 12, 2025

Confident healthcare provider recommendations for influenza vaccine are powerfully persuasive. This influenza season has been a tough one, and it is far from over. To help you maximize patient protection, Immunize.org, in collaboration with CSL Seqirus, updated the 65+ Flu Defense website.



This helpful site includes information, tools, and tips for communicating with adults age 65 and older about the scope and severity of influenza. Resources include:

• Influenza in Adults 65+: The Facts
• Influenza Vaccination: Questions Patients Aged 65 and Older Frequently Ask Their HCP
• The Importance of Preventing Influenza and COVID-19

Older adults are at increased risk of severe influenza, COVID-19, and RSV illness, including hospitalization and death, especially if they are not up to date on these vaccinations. A clinician recommendation is the most important reason why a patient will get vaccinated.

Check out the updated 65+ Flu Defense website to assist your ongoing efforts in protecting this vulnerable population.

For week 5, ending February 1, CDC’s Weekly U.S. Influenza Surveillance Report, FluView, showed influenza-like illness activity at high to very high levels in 45 of 47 reporting jurisdictions. At that time, 7.8% of outpatient visits were for influenza-like illness, well above the epidemic threshold of 3.0% for the tenth consecutive week. Ten pediatric deaths associated with seasonal influenza virus infection were reported during week 5, bringing the 2024–25 season total to 57 pediatric deaths.



RESP-NET
Visit the CDC Respiratory Virus Hospitalization Surveillance Network (RESP-NET) for weekly reports of hospitalizations due to three vaccine-preventable seasonal respiratory viruses: COVID-19, influenza, and RSV.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that, as of January 25, 44.5% of children age 6 months through 17 years received influenza vaccination, similar to the same time in 2024 (44.9%), but much lower than the same time in 2020 (58.3%).



CDC recommends everyone age 6 months and older get annual influenza vaccination. Given the high levels of circulating influenza across the country, vaccination remains important for all eligible, unvaccinated people.

Identify pharmacies in your area that may offer influenza and COVID-19 vaccines by entering a zip code in the VaccineFinder on Vaccines.gov or Vacunas.gov.

Related Links

• CDC: Weekly National Flu Vaccination Dashboard main page
• CDC: FluView main page
• CDC: RESP-NET main page
• Immunize.org: free clinical resources and patient handouts related to influenza
• Immunize.org: Vaccines A–Z: Influenza main page

Immunize.org recently added mpox images to its Image Library, a resource for images of infectious diseases to educate yourself and others.



Located within the Clinical Resources menu, the Image Library section contains an overview page and a list of specific disease-related categories. Most clinical images included are in the public domain and can be reproduced without permission. If an image is copyrighted, information is provided so you can obtain permission from the copyright holder.

The Image Library Overview page also links to other vaccine-related image libraries from CDC and the History of Medicine websites.

In most of the contiguous United States, recommendations call for discontinuing RSV vaccination (Abrysvo, Pfizer) during pregnancy each year on January 31, in line with the typical seasonality of RSV. In these areas, maternal vaccination from 32 through 36 weeks and 6 days gestation should generally resume on September 1.

RSV continues to circulate widely. CDC recommends administration of nirsevimab (Beyfortus, Sanofi) through March 31 to all susceptible infants younger than 8 months of age in most of the contiguous United States. As with RSV vaccination during pregnancy, specific recommendations concerning timing of RSV immunization in tropical areas or in Alaska may vary due to differences in RSV seasonal patterns. RSV preventive antibodies provide immediate protection to the young child. Nirsevimab is important for all infants not otherwise protected against RSV if they are younger than 8 months. Those who are at high risk for severe RSV disease age 8 months through 19 months should also get nirsevimab during their second RSV season.

Refer to the 2025 CDC Recommended Immunization Schedule for Children and Adolescents or to Immunize.org’s nirsevimab standing orders template for details. There are no issues with nirsevimab supply.

RSV-NET is part of the Respiratory Virus Hospitalization Surveillance Network (RESP-NET), which monitors laboratory-confirmed hospitalizations associated with RSV, influenza (FluSurv-NET), and COVID-19 (COVID-NET). As of January 18, 2025, 5 of every 1,000 U.S. infants younger than age 1 year were hospitalized for RSV this season. Many of these hospitalizations are preventable through maternal RSV vaccination or nirsevimab administration.

Related Links

• CDC: Healthcare Providers: RSV Vaccination for Pregnant Women web page
• CDC: RSV Immunization Guidance for Infants and Young Children web page
• Immunize.org: Standing Orders for Administering Nirsevimab RSV Preventive Antibody (Beyfortus, by Sanofi) to Infants

This week, our featured episode from the Ask the Experts Video Series is After the Preteen Dose of Tdap, When Is the Next Tdap Dose Due? Dr. Moore explains that someone who received a dose of Tdap at age 11 or 12 years should receive a booster dose of Td or Tdap vaccine 10 years later, unless tetanus prophylaxis is required sooner due to an injury or if Tdap vaccination is needed during pregnancy.

The 1-minute video is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions.

Like, follow, and share Immunize.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise.

• Facebook at ImmunizeOrg
• Instagram at ImmunizeOrg
• LinkedIn at ImmunizeOrg
• YouTube at ImmunizeOrg

Journalists seek out Immunize.org experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a recent citation.

• Washington Post: In Idaho, a Preview of RFK Jr.’s Vaccine-Skeptical America (2/8/25)

Immunize.org reviewed and updated its Ask the Experts: Vaccine Recommendations web page with the latest CDC web links. With the addition of nirsevimab (Beyfortus, Sanofi) to the infant schedule, with a 1-mL injection volume to deliver a 100-mg dose, we have received several questions concerning maximum injection volumes in a single limb. Infants who need nirsevimab may also need routine vaccinations at the same visit.

A new question was added regarding acceptable injection volumes:

Q: Is there a strict limit to the volume of vaccine and/or monoclonal antibody that can be administered in a single limb (deltoid or thigh) at one immunization visit? Someone told me recently not to administer more than 1 mL of volume into an infant’s thigh.

A: This question has arisen more frequently since the introduction of the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi), which has an injection volume of 1 mL for infants younger than 8 months who weigh 5 kg or more at the time of immunization. High risk children entering their second RSV season require a Beyfortus dose volume of 2 mL. Beyfortus is often administered at a routine visit when other infant immunizations are due.

There is no specific guidance to not exceed 1 mL in one muscle. In fact, there is no clear standard of practice and reference texts vary in guidance. Facilities or health systems may have medication policies/procedures that outline guidance for their staff. Professional judgement is needed when administering intramuscular medications or immunizations to people, including children, because muscle size varies from person to person.

CDC experts suggest a range of volume, depending upon the muscle injected. For the deltoid, the typical volume injected is 0.5 mL (maximum: 2 mL). For the vastus lateralis (the thigh), the typical volume that may be injected is 1–4 mL (maximum: 5 mL). Infants and toddlers fall at the lower end of these ranges, whereas adolescents and adults generally fall on the higher end of the range.

If more than 1 mL of volume needs to be injected into the thigh, that can be done while staying well within the acceptable range. Use of combination vaccines, when indicated and available, can decrease injection volume.

Laminated booklets of the 2025 U.S. child and adolescent immunization schedule and the 2025 U.S. adult immunization schedule are available now in the Immunize.org shop. The laminated booklets are shipping now.

The schedules are available online as PDFs from CDC at no cost. Immunize.org’s laminated booklets are ideal for use in any busy healthcare setting where vaccines are given. Features include:

• Durability: Their tough coating can be wiped down, and they can stand up to a year's worth of use.
• Format: Each schedule is produced in an 8.5” X 11” booklet format; with color coding for easy reading, our laminated schedules replicate the original CDC formatting, including all tables and notes. The adult schedule is 16 pages and the child and adolescent schedule is 20 pages.
• Easy access to CDC updates: The CDC online schedule includes an addendum page that will display ACIP’s new recommendations as CDC adopts them during 2025. Each Immunize.org laminated schedule addendum page includes QR codes you can scan to view or print the online addendum page as it is revised.
• Bonus content: Both schedules include a bonus page with Immunize.org’s popular 1-page handout summarizing the dose, route, and needle size recommendations for all vaccines and recipients.

• Immunize.org: Laminated Child and Adolescent Immunization Schedules (0–18 years) web page
• Immunize.org: Laminated Adult Immunization Schedules (19 and older) web page
• Immunize.org: Shop Immunize.org main page

Infectious IDeas, a podcast series from NFID, brings leading experts together for thought-provoking conversations. The latest entry in the series, A Lifelong Champion of Vaccine Safety, features Kathryn Edwards, MD, a member of the Board of Directors of Immunize.org. A description from the web page appears below.

Join Marla Dalton, PE, CAE, and William Schaffner, MD, for an inspiring conversation with Kathryn M. Edwards, MD, a renowned expert in childhood respiratory diseases and vaccine safety. Edwards shares her journey from a budding chemist to a trailblazer in the prevention of pediatric infectious diseases and an advocate for ensuring vaccine safety and efficacy in the US.

In Clinical Resources: Improving the Vaccination Experience, Immunize.org provides print and video tools to create a positive vaccination experience and ease injection anxiety in children and adults. Links to additional resources from trusted partner organizations are also provided.

The web page links to eight printable resources on addressing vaccination anxiety (four for providers, four for recipients), two in-depth webinars, and six brief videos (listed below). As with all Immunize.org resources, these are free to download, link, copy, and share.



The video topics include:

• How to Administer Multiple Intramuscular Vaccines to Adults During One Visit
• Using Enhanced Screening Checklists for Contraindications to Vaccination
• Addressing Vaccination Anxiety for Infants: Strategies for Vaccine Recipients and Caregivers
• Addressing Vaccination Anxiety: Strategies for Healthcare Professionals
• Fainting Related to Vaccination: What You Need to Know
• Addressing Vaccination Anxiety for Children: Strategies for Vaccine Recipients and Caregivers

Related Link

• Immunize.org: Clinical Resources: Improving the Vaccination Experience web page

On February 6, JAMA published Reflections on the Successes of Pediatric Vaccines, a Viewpoint piece from Kathryn Edwards, MD. A portion of the last paragraph appears below.

Vaccines have been so effective that many of the common diseases that used to plague children have disappeared. We do not see a neighbor with polio or a child who is deaf from Hib meningitis, nor must we mourn an infant who died from pneumococcal pneumonia or infant pertussis. In light of the COVID-19 pandemic and increasing vaccine hesitancy, a level of mutual trust must be reestablished among parents, clinicians, vaccine scientists, and public health authorities and a dialogue supported in which each side listens to the concerns of the other. We all share a common goal to provide a healthy environment for our children. They represent our future. It is our responsibility to use our knowledge and resources to keep them healthy. We have come a long way in preventing disease through vaccination and we must not lose our progress.

• Wednesday, February 12 at 4:00 p.m. (ET)
• Thursday, February 13 at 12:00 p.m. (ET)

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