Flu Surge 2026: Record Hospitalizations — What Nurses Need to Know

Updated: 1/5/26

Nurses are heading into a challenging 2025 to 2026 flu season, as influenza A(H3N2) drives a fast rise in cases and hospitalizations across the United States. CDC and other experts warn that this early surge is already straining emergency departments and inpatient units, especially in communities with low vaccination coverage.

For bedside nurses, this means more patients with respiratory symptoms, greater demand for isolation and PPE, and an urgent need to reinforce flu vaccination and basic infection prevention at every encounter.

Current 2025 to 2026 Flu Surge

CDC reports that in late December, about one quarter of respiratory specimens tested in clinical laboratories were positive for influenza, and more than 90 percent of those were influenza A viruses, mostly A(H3N2).​

Flu related hospitalizations are rising in all age groups, with a cumulative rate of 18.2 per 100,000 people by Week 51 of the season, the third highest at this point since 2010 to 2011.​

In one recent week alone, CDC recorded more than 19,000 flu hospitalizations, compared with roughly 9,000 the week before, and estimates more than 3,100 flu deaths so far this season.

 

2025-2026 Available Flu Vaccines

There are numerous flu vaccines available to the general public, all of which are covered by private and public insurance. Those without insurance can often get a low-cost or even no-cost flu vaccine at major pharmacies. The availability of specific types will vary based on location and population needs. The CDC recommends that all individuals over 6 months of age receive their annual flu vaccine by the end of October. 

The four most common flu shots this year are:

• Standard dose flu shots. An inactivated influenza vaccine is given via intramuscular injection.
• High-dose shots for people 65 years and older.
• Shots that are made with the flu virus grown in cell culture. No eggs are involved in the production of this vaccine.
• Live attenuated influenza vaccine. A vaccine made with an attenuated live virus that is given by a nasal spray vaccine.

The CDC has a complete breakdown of all the flu vaccinations available in the United States for the 2025-2026 flu season.

According to the Food and Drug Administration (FDA), the trivalent formula for the egg-based influenza vaccine contains the following:

• an A/Victoria/4897/2022 (H1N1)pdm09-like virus
• an A/Croatia/10136RV/2023 (H3N2)-like virus
• a B/Austria/1359417/2021 (B/Victoria lineage)-like virus

According to the FDA, the trivalent formula for the cell or recombinant-based influenza vaccine contains the following:  

• an A/Wisconsin/67/2022 (H1N1)pdm09-like virus
• an A/District of Columbia/27/2023 (H3N2)-like virus
• a B/Austria/1359417/2021 (B/Victoria lineage)-like virus

Trivalent flu vaccines are formulated to protect against three main types of seasonal flu, including, 

• A(H1N1) virus
• A(H3N2) virus
• B/Victoria lineage virus

There are very few contraindications for the standard dose flu vaccine, but it is important to speak to your doctor if you have any questions.

The live attenuated nasal spray vaccine is contraindicated in the following populations according to the CDC:

• Adults age 50 or older
• Children 2 years through 17 years of age who are receiving aspirin- or salicylate-containing medications.
• Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months.
• Children younger than 2
• People who are immunocompromised (ex. Cancer patients or individuals living with HIV/AIDS)
• People who care for severely immunocompromised persons who require a protected environment
• People who have taken influenza antiviral drugs within the previous 48 hours, such as Tamiflu.
• Pregnant women

The high-dose flu vaccine is specifically designed for people 65 years and older, as it is intended to give older individuals a better immune response, which will give better protection against the flu. The vaccine contains four times the antigen of a standard-dose flu vaccine.

Vaccine Effectiveness Amid This Season's Surge

Experts interviewed by NPR note that this year’s predominant flu strain has undergone genetic changes, so there is concern about a mismatch between the circulating virus and the vaccine. However, early data from the United Kingdom suggest that this season’s vaccine is still providing roughly 30 to 40 percent protection against hospitalization in adults, which is consistent with typical flu vaccine effectiveness in preventing severe outcomes.

CDC and infectious disease specialists continue to describe vaccination as the most important step to reduce the risk of serious flu complications, especially for older adults, young children, pregnant people, and those with chronic conditions.

Current challenges:

• NPR reports that adult flu vaccination coverage is “just over 40 percent” this season, and experts worry that lower uptake is contributing to the high number of hospitalizations.
• CDC has reported multiple influenza associated pediatric deaths this season, all linked to influenza A, which further underscores the importance of vaccination and prompt treatment in children.

 

Switch from Quadrivalent to Trivalent

A major difference that some might notice is the move from the quadrivalent vaccine to the trivalent. This change occurred during the 2024-2025 flu season and was in part due to historical research of flu infections, but also projected data for the upcoming season. To provide context, the U.S. transitioned to the quadrivalent flu vaccine during the 2013-2014 flu season to incorporate a second Flu B virus because, at the time, both Flu B viruses were seen, and the research showed that there was little cross-protection between the two lineages. 

The two B virus lineages found in the quadrivalent were, 

• B/Yamagata lineage
• B/Victoria lineage

The World Health Organization (WHO) and the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) found that influenza B/Yamagata lineage had not been seen in patients after March 2020, and the recommendation was made to remove this lineage from all future flu vaccines. 

FluMist Self Administration

Another exciting change for the 2025-2026 flu season is at-home administration of FluMist nasal spray. The FluMist Home Program allows for eligible individuals to self-administer or administer to another individual (with training) the vaccine. The plan was proposed last flu season, but didn't take effect until this year. 

While relatively new, the program is available in 34 states, with plans to add more in the coming years. Adults must order the vaccine via the FluMist website after answering a medical screening questionnaire and paying for shipping. The order is reviewed by a pharmacist, and if approved, the vaccine is delivered to your door. 

FluMist is still available at doctors' offices or retail pharmacies for those who do not qualify for the program or do not want to self-administer.

Actionable Tips for Nurses This Flu Season

• Monitor local FluView and state health department updates so you know when community activity is high in your region.
• Reinforce vaccination with patients and staff, especially those at higher risk of complications, noting that vaccines still reduce the risk of hospitalization and severe illness even when strain match is imperfect.
• Encourage masking for patients with respiratory symptoms in waiting rooms and crowded clinical areas, consistent with expert recommendations that highlight masks and distancing as additional tools to curb transmission.

Nurses have a crucial role in promoting vaccination, addressing vaccine hesitancy, and providing accurate, timely education. According to the American Nurses Association, keeping immunizations up-to-date protects both healthcare workers and the individuals they serve.

 

🤔Nurses, share your thoughts in the discussion forum below!