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A summary of presentations from the weekly Summit partner webinars

November 13, 2025 – The latest Summit Summary

Surveillance of Respiratory Vaccine Preventable Viruses Council of State and Territorial Epidemiologists (CSTE) – Lisa McHugh, PhD, MPH, Director, Bureau of Epidemiology, State Epidemiologist, Department of Health, Bureau of Epidemiology and Karen Martin, MPH, Epidemiologist Supervisor, HIV/STI, Emerging, and Respiratory Disease Section, Infectious Disease Epidemiology, Prevention, and Control Division

Lisa McHugh, PhD, MPH, and Karen Martin, MPH, gave an update about surveillance of respiratory vaccine preventable viruses.

Viral Respiratory Disease Surveillance – Lisa McHugh, PhD, MPH and Karen Martin, MPH
Although most data about viral respiratory diseases are collected and analyzed at the state and local level, the data feeds that are collated and processed at the federal level are not currently operational, due to the federal shutdown. So, updates to various reporting functions (e.g., FluView, hospital and forecasting data) have not been happening on the CDC website. Lab testing support has continued but may be limited.

Despite the federal shutdown, some key CDC staff in respiratory surveillance are continuing to work and respond to issues. States are utilizing CSTE and regional connections to maintain surveillance.

Virologic (Laboratory) Surveillance
State influenza surveillance coordinators work within a variety of systems to maintain awareness of trends:

  • State public health labs — These labs receive specimens from hospitals, providers, urgent care, etc.
  • Electronic lab reports — Respiratory viruses are reportable in some states.
  • National Respiratory and Enteric Virus Surveillance System (NREVSS) — Federal reporting from this system is available to states.
  • CDC — Additional testing for sequencing and strain typing is available here.

Viral Respiratory Disease Surveillance
States have the ability to monitor trends through a variety of surveillance data sources, including:

  • Syndromic: Influenza-like Illness (ILI)/Acute Respiratory Illness (ARI) — Data are primarily from emergency departments; states may have their own syndromic system or tap into national programs (e.g., National Syndromic Surveillance Program [NSSP]). CSTE looks at chief complaint data, which can be parsed for ILI/ARI data to establish trends.
  • Outpatient Influenza-like Illness Surveillance Network (ILINet) — Managed by the federal government but run through state programs, this is an outpatient provider-based system where the number of patients with influenza-like illness and total patient populations are reported, and specimens are sent. This is supplemented by syndromic surveillance.
  • Other Community Surveillance — Community surveillance varies state to state and may include school absenteeism, community surveys, and wastewater surveillance.

Outbreaks/Clusters
In almost all states, outbreaks and clusters of respiratory illnesses are reportable. Definitions and reporting processes, which can be setting-specific (e.g., long-term care, schools, childcare centers), vary from state to state.

Disease-Specific Surveillance
The focus for disease-specific surveillance is on severe cases and deaths. There are CSTE case definitions for pediatric influenza and COVID-19 mortality, and RSV mortality for all ages.

  • Currently, pediatric influenza is nationally notifiable (i.e., reported to the CDC for national burden surveillance), and pediatric COVID-19 mortality will be nationally notifiable in January 2026.
  • This past season recorded the highest pediatric mortality since pediatric mortality became reportable.
  • CSTE is updating the pediatric flu and RSV mortality position statements this season, to improve alignment between the three illnesses.

Respiratory Virus Hospitalization Surveillance Network (RESP-NET)
RESP-NET is made up of three networks that monitor laboratory-confirmed hospitalizations and the outcomes associated with those diseases. The following platforms cover more than 30M people, or about 10% of the population of the United States.

  • FluSurv-NET — currently includes 14 states
  • RSV-NET — currently includes 13 states
  • COVID-NET — currently includes 13 states
  • For H5N1 — surveillance is ongoing for affected farms and individuals who have been exposed to the virus, and regular surveillance systems are bolstering surveillance for influenza A H5 and other novel influenza types and testing specimens, accordingly.
    • Three human cases have been found through routine surveillance since the start of the outbreak in the United States in 2022.

Public Reporting
Most respiratory disease data is generally publicly available.

  • Most states produce a publicly available weekly viral respiratory report during the respiratory season, or year-round; some states have dashboards.
  • States have embraced a pan-respiratory approach over the past few years, at least for flu, COVID-19, and RSV. It’s important to be able both to separate the data by disease but also put data in the context of overall burden of respiratory diseases for health messaging and prevention measures, including, for example, masking policies in health systems.
  • State-level data and activity levels are fed into the national system.

Current Activity Status
Coming off a particularly severe influenza season, we are in the waiting phase for respiratory illness in the current season.

  • Activity is low for COVID-19, flu, and RSV, despite a late wave of COVID-19 in late summer/early fall.
  • Some flu and RSV are circulating, but it is too early to determine a strain or vaccine match for flu.
  • Enterovirus and rhinovirus, which are common for this time of year, appear to be declining after a recent increase.

The CDC FluView website — where you can access state-specific information by hovering over the states on the ILINet map — was reviewed, along with examples of current state respiratory data dashboards.

QUESTIONS & ANSWERS

Q: How much surveillance of vaccine uptake is being done during the shutdown and now that the shutdown is over?
Karen Martin (CSTE): I can speak to what’s happening in Minnesota; I would imagine it’s probably similar in other states. We utilize the data from our immunization information system, and as the season progresses — and I believe we have the data live already — we do have some coverage rates that we post on our website.
Lisa McHugh (CSTE): What folks need to remember is a lot of those data that are being fed federally are coming from the states. Most of those data are coming from statewide immunization registries, where providers are reporting into those registries the number of vaccines that are being administered, and so, just like CDC’s looking at those data, we look closely at them on the state side to see how much vaccine’s being taken. I know here in Pennsylvania, we do a monthly respiratory leadership report, and those are data that we look at on a regular basis to understand uptake of vaccine.

Q: There was a report coming out of Canada that there might be some vaccine strain mismatch, but then there were reports coming out of the United Kingdom that the vaccine actually does match, and I know you said it’s a little too early — but early reports in the media also suggested the H3N2 may be more virulent. Do you have any information about this?
Karen Martin (CSTE): We don’t have enough information to answer that. I’ve heard those reports, as well, and certainly that’s what makes the subtyping and the ability to look at these viruses more closely — either in labs in the states or by sending them to CDC — important. I know that, from the influenza that has been reported at the state [level] (and we also got some short updates from CDC even while they were on shutdown), of the A’s, [H3N2] has been low numbers, but [there has been] some H1 as well as some H3. But, again, too early to say what kind of vaccine match it is.

Q: Is there any data on the mix by brand of COVID-19 vaccines that people are choosing? I think you may have your state data on that. Do you know what COVID-19 vaccine people are vaccinating with right now: Is it the protein vaccine from Sanofi Novavax, or is it one of the mRNA vaccines by Pfizer or Moderna?
Lisa McHugh (CSTE): In our state, that’s under a different bureau. We have a Bureau of Immunizations who manages that. I do know that, again, that information is being recorded in our immunization systems, and so I think they’re able to look at that a little bit, if it’s accurately recorded in our systems. It’s probably available, I just don’t know the full extent to which it’s available. It’s collected by someone else in our department.

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IQVIA Respiratory Viral Vaccine Coverage Data – Anurag Sahu, MS, Consultant, Commercial Solutions & Insights Hub at IQVIA

Anurag Sahu, MS, gave an update about respiratory viral vaccine coverage.

Immunity in Focus: US Trends in Adult Immunization – Anurag Sahu, MS
IQVIA is a health services company specializing in clinical research, data analytics, and real-world evidence generation, among other topics. This presentation addressed adult vaccination trends for influenza, COVID-19, and RSV. IQVIA’s data is drawn from a variety of sources, including patient-level claims data from both private and public payers (including Medicare, Medicaid, and commercial insurers in all 50 states) and retail pharmaceutical sales.

Adult Vaccination Trends Up to July 2025
The IQVIA study included a final cohort of ~60M adults. Notable trends from the 2024-2025 season are as follows:

  • Influenza: There was a sharp increase in influenza vaccination during the peak of the COVID-19 pandemic (June 2020 – May 2021), when the rate surged to ~70%. However, as the pandemic faded, the influenza vaccination rates have stabilized below 60%.
    • Vaccination rates for influenza are higher for older adults (65+ years of age).
    • Vaccination rates for influenza increased for those covered by private payers and decreased for those covered by public payers in the 2024-2025 season compared with the 2023-2024 season.
  • COVID-19: Vaccination rates for COVID-19 declined almost 3 percentage points among those 18+ years of age in the 2024-2025 season as compared with the 2023-2024 season.
    • Vaccination rates for COVID-19 were higher for public insurance compared with private insurance.
  • RSV: The vaccination rate for RSV among people 50+ years of age declined in the 2024-2025 season as compared to the 2023-2024 season; the 75+ age group have the highest vaccination rates among older adults.
    • Vaccination rates for RSV are higher under private insurance compared with public insurance.
  • The vaccination rate for RSV among pregnant people ages 35 to 49 increased by a few percentage points in the 2024-2025 season as compared to the 2023-2024 season.
    • Vaccination rates for RSV among pregnant people were higher under private insurance compared with public insurance.

National Prescription Audit (NPA) Data
According to these data, measured in the August-September time frame during 2025 and 2026, the changes from the 2025 season moving into the 2026 season are as follows:

  • COVID-19 vaccinations dropped by 50%.
  • Influenza vaccinations dropped by 10%.
  • RSV vaccinations dropped by 24%.

QUESTIONS & ANSWERS

Q: Your data goes through July, but there’s more recent data that you all are collecting. We’ve seen some of the data from, for example, manufacturing partners on influenza coverage rates. There’s a question about the fact that we had high pediatric mortality: With your most recent snapshot of influenza pediatric coverage rates, do you know if the coverage rates are about the same? Are they going up or are they lower than they were compared to last year at the same period?
Anurag Sahu (IQVIA): Yes, this presentation was about the adult vaccination trends, but we do have reports that also have the pediatric market, so I’ll have to check to see where the vaccination rates and the uptake stand.

Q: Do you think RSV vaccination is down in older adults because they received the vaccine in the first year available? In other words, is the decline because the vaccine is only recommended as one vaccine, and that’s why you’re seeing the decline?
Anurag Sahu (IQVIA): Yes, that might be one of the reasons. The current recommendation is taking one vaccine. (But we update the patient code every year, as well, [so, if 75+ is the recommendation, every year we have people who are moving from 74 to 75, so we track that to ensure that we have the latest trends.] But, it is possible that [the current] one-dose recommendation, [is an explanation for the] decline [in RSV vaccination for] older adults. [So, we do apply business rules to ensure that we account for the fact that an adult who’s already received one dose of RSV vaccine will not get a second dose under the current recommendation.] Comment (Dr. Kathy Edwards): Booster recommendations for RSV vaccination in older adults may need to be ultimately made; the current recommendation is for only one dose.

Q: Are you able to get a sense from your data whether the increase in uptake for the RSV vaccine in the  75+ age group could be because of the potential unpredictability of vaccine recommendations?
Anurag Sahu (IQVIA): I think this is something we won’t be able to track from a data point of view, but I think Nandini would be the correct person to answer this. From a data point of view, I’m not sure whether we’ll be able to track the unpredictability of the recommendations.
Q/Comment: I think what we’re saying is that the data doesn’t break it down that way. So there’s always correlation, but because the data doesn’t break it down the way, you can’t say causation. Dr. Moore, do you think that older adults are a little bit worried about access and, therefore, are running out to get their RSV vaccines?
Kelly Moore (Immunize): My local pharmacy tells me that they are covered up with people coming in for vaccination, but I live in a part of Nashville that’s very highly pro-vaccine. I think it’s because Kathy Edwards and Bill Schaffner and Keipp Talbot all live in the neighborhood, so everybody goes out and gets vaccinated around here, but I can’t speak for the rest of the nation, unfortunately.
Q/Follow-up: Any chance you can subtract the population that was vaccinated last year from the denominator for the following year for RSV? It goes back to this idea that you could correct for the fact that there are people who already got their one dose and, therefore, would not be eligible for a second dose but might appear in your denominator.
Anurag Sahu (IQVIA): We do ensure that we are not counting patients multiple times; and we ensure that whoever has received the vaccine once, we count them once only. So, this is something we do take care of while preparing the data.
Q/Follow-up: The next time when we get you all back to present, maybe we can have a slide about methodology so that folks can understand how you handle the RSV question.

Q: It looks like racial and ethnic disparities in vaccination coverage are growing. Is that correct?
Anurag Sahu (IQVIA): Yes, we do see that from the slides.

Q: Could the poor uptake of flu, COVID-19, and RSV vaccines be due to hesitancy from misinformation in the external environment?
L.J Tan (Immunize): I think there’s certainly a lot of suggestive data about the fact that there is some hesitancy in the adult population [regarding COVID-19 vaccination] that is bleeding over into the [flu] coverage rates, as well. If we have any manufacturers on the call, do any of you want to comment about some of the IQVIA data — for example, the recent pediatric influenza coverage rates or, potentially, the RSV single-dose data, as well? [No manufacturers were on the call.]

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Announcements
  • There will be no Summit Weekly Update meeting on December 4, as December 4 and 5 will be the dates of the ACIP meeting.
  • Save the date for the 2026 National Adult and Influenza Immunization Summit in-person meeting: May 19 – 21, 2026 at the Crowne Plaza Atlanta Perimeter at Ravinia in Atlanta, GA.
    • The meeting page (https://www.izsummitpartners.org/2026-naiis/) will open for registration in early 2026.
    • Recommendations for items for the agenda for this meeting are welcome, by email to NAIIS.
    • Nominations for the Immunization Champion Awards (the Immunization Neighborhood Champion and the Laura Scott Flu Award) are welcome, and there will be a scientific poster session that will be open to submissions.

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