A pair of new studies in Morbidity and Mortality Weekly Report highlight low influenza, COVID-19, and respiratory syncytial virus (RSV) vaccine coverage in US adults, including those in nursing homes, this fall.
The US Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) recommends that everyone aged 6 months and older receive an updated COVID-19 vaccine and an annual flu vaccine. It also recommends that all nursing home residents aged 60 years and older receive a single lifetime dose of RSV vaccine.
35% and 18% vaccinated against flu, COVID
For the first study, investigators from the CDC analyzed data from the National Immunization Survey-Adult COVID Module, a random phone survey that tracks flu, COVID-19, and RSV vaccination uptake in US adults as of early November. The team also interviewed unvaccinated participants about their intent to receive the vaccines.
By November 9, 34.7% of adults reported having received a flu vaccine dose, and 17.9% had received an updated COVID-19 vaccine for the 2024-25 respiratory virus season. A total of 39.7% of adults aged 75 years and older and 31.6% of those aged 60 to 74 at high risk for severe RSV had ever received an RSV vaccine.
Uptake varied by jurisdiction and demographic characteristics and was lowest among younger adults and those with no health insurance.
Health care providers and immunization programs still have time to expand outreach activities and promote vaccination to increase coverage in preparation for the height of the respiratory virus season.
Despite low vaccine coverage, 35% of adults said that they definitely or probably would receive or were unsure about receiving the flu vaccine, and 41% said the same about the COVID-19 vaccine, meaning they hadn't ruled out vaccination. Forty percent of adults aged 75 years and older reported that they definitely or probably would receive or were unsure about receiving the RSV vaccine.
The proportion of respondents who said that they probably or definitely wouldn't be vaccinated was highest for COVID-19 (41.6%) and lowest for RSV (20.3% among those aged 75 years and older and 14.8% among those aged 60 to 74).
In comparison, flu vaccine coverage for the current season was 0.9 percentage points higher than during the corresponding period in 2023-24 (34.7% vs 33.8%) and 3.7 percentage points higher (58.6% versus 54.9%) in those aged 65 and older.
Similarly, COVID-19 vaccine uptake was 4.7 percentage points higher this season (17.9%) than in the 2023-24 season (13.2%) and 13.7 percentage points higher (38.5% versus 24.8%) in those aged 65 and older.
RSV vaccine coverage rose from the end of June 2024, when ACIP first recommended that older adults receive a single-dose RSV vaccine, to November 9. Among adults aged 75 years and older, uptake climbed 9.6 percentage points (from 30.1% to 39.7%) and among those aged 60 to 74 years, increased 8.7 percentage points (from 22.9% to 31.6%).
"Health care providers and immunization programs still have time to expand outreach activities and promote vaccination to increase coverage in preparation for the height of the respiratory virus season," the study authors wrote. "Using these data can help health care providers and immunization programs identify undervaccinated populations and understand vaccination patterns to guide planning, implementation, and evaluation of vaccination activities."
Very low COVID vaccine uptake in nursing homes
For the second study, CDC researchers and their colleagues used the same survey to evaluate vaccine uptake in nursing home residents.
As of November 10, 29.7% of nursing home residents had received an updated COVID-19 vaccine dose. Of those living at nursing homes that opted to report vaccinations against flu (59.4%) and RSV (51.8%), 58.4% had received a flu vaccine dose, and 17.9% were vaccinated against RSV.
COVID-19 vaccine coverage ranged from 19.8% in Arkansas, Louisiana, New Mexico, Oklahoma, and Texas to 38.6% in Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. COVID-19 vaccine uptake was highest in the least socially vulnerable counties (33.6%) and in small facilities (34.7%) and lowest in large facilities (28.0%).
More needs to be done at every level to protect nursing home residents, who constitute one of the population groups at highest risk for severe respiratory disease.
Flu vaccine uptake ranged from 50.9% in Alaska, Idaho, Oregon, and Washington state to 64.1% in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Flu vaccine coverage was highest in the least socially vulnerable counties (60.8%) and in small facilities (62.9%) and was lowest in large facilities (56.7%).
RSV vaccine coverage ranged from 9.3% in Arkansas, Louisiana, New Mexico, Oklahoma, and Texas to 29.2% in Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. RSV vaccine uptake was highest in the least socially vulnerable counties (21.3%) and in small facilities (24.1%) and lowest in the most socially vulnerable counties (15.3%) and large facilities (15.9%).
In comparison, by November 12, 2023, 24.0% of nursing home residents had received a COVID-19 vaccine, 68.3% had been vaccinated against flu, and 6.7% had received an RSV vaccine dose.
"During both the 2023–24 respiratory virus season and the 2024–25 season to date, coverage with all three vaccines was highest in small nursing homes and in nursing homes in North Dakota and South Dakota, suggesting that staff members in small facilities might be better able to build trust with residents and families and mitigate barriers to vaccination and that efforts by states to develop strong relationships among stakeholders are effective," the researchers wrote.
"Although CDC and other federal agencies have programs in place to address both the financial and vaccine hesitancy–related barriers to vaccination in nursing homes, more needs to be done at every level to protect nursing home residents, who constitute one of the population groups at highest risk for severe respiratory disease," they concluded.
