Influenza, COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2024

Abstract

The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza and COVID-19 vaccination for all persons aged ≥6 months, including adults aged ≥18 years. ACIP also recommends a single lifetime dose of respiratory syncytial virus (RSV) vaccine for adults aged ≥75 years and for those aged 60–74 years who are at increased risk for severe RSV disease. Data from the National Immunization Survey-Adult COVID Module, a random-digit–dialed cellular telephone survey of U.S. adults aged ≥18 years, are used to monitor influenza, COVID-19, and RSV vaccination coverage. By the week ending November 9, 2024, an estimated 34.7% of adults aged ≥18 years reported having received an influenza vaccine, and 17.9% reported having received a COVID-19 vaccine for the 2024–25 respiratory virus season; 39.7% of adults aged ≥75 years, and 31.6% of adults aged 60–74 years at increased risk for severe RSV, had ever received an RSV vaccine. Coverage varied by jurisdiction and demographic characteristics and was lowest among younger adults and those without health insurance. Although early season estimates indicate that many adults are unprotected from respiratory virus infections, many appeared open to vaccination: overall, approximately 35% and 41% of adults aged ≥18 years reported that they definitely or probably will receive or were unsure about receiving influenza and COVID-19 vaccines, respectively, and 40% of adults aged ≥75 years reported that they definitely or probably will receive or were unsure about receiving RSV vaccine. 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. 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.

Introduction

Influenza virus, SARS-CoV-2, and respiratory syncytial virus (RSV) typically circulate in the United States each year during the fall through early spring (1–3). These viruses can cause serious illness, particularly in adults aged ≥65 years, persons with certain medical conditions, and persons from some racial and ethnic minority populations (4,5). The Advisory Committee on Immunization Practices (ACIP) has recommended annual influenza vaccination since 2010 for all persons aged ≥6 months (1). In June 2024, ACIP recommended that all persons aged ≥6 months receive an updated 2024–2025 COVID-19 vaccine (2), and that all adults aged ≥75 years and those aged 60–74 years at increased risk for severe RSV receive a single lifetime dose of RSV vaccine* (3). CDC monitors coverage with these vaccines and makes these data available during the respiratory virus season for use in planning vaccination activities.^† Data from the National Immunization Survey-Adult COVID Module, a random-digit–dialed telephone survey, were reviewed to assess influenza, COVID-19, and RSV vaccination coverage early in the fall respiratory virus season.

Methods

Data Source

The National Immunization Survey-Adult COVID Module (NIS-ACM) is a random-digit–dialed cellular telephone survey of adults aged ≥18 years in all 50 states, the District of Columbia, and selected local areas and U.S. territories.^§ Data are weighted to represent the noninstitutionalized U.S. population.^¶ The survey includes questions about receipt of COVID-19, influenza, and RSV vaccines, vaccination intent, behavioral and social drivers of vaccination, and sociodemographic characteristics.** Respondents were asked if they had received an influenza vaccine since July 1, 2024, a COVID-19 vaccine since August 22, 2024, or had ever received an RSV vaccine. For affirmative responses, respondents were asked the month and year of vaccination.^††

Data Analysis

Data collected during the weeks ending September 7–November 9, 2024, are included in this analysis.^§§ Vaccination coverage estimates were calculated for weekly data collection periods using a nondecreasing composite estimation procedure with completed interviews from the current week combined with all previous weeks^¶¶ (6). Estimates of vaccination intent were based on interviews conducted each respective week and adjusted to the cumulative coverage estimate for that week. Influenza and COVID-19 vaccination coverage were estimated among adults aged ≥18 years; RSV vaccination coverage was estimated among adults aged ≥75 years and those aged 60–74 years at increased risk for severe RSV disease.*** Differences were determined using t-tests with p-values <0.05 considered statistically significant. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.^†††

Results

Overall Vaccination Coverage and Intent

As of November 9, 2024, cumulative estimated coverage with 2024–2025 influenza and COVID-19 vaccines among adults aged ≥18 years was 34.7% and 17.9%, respectively. Estimated RSV vaccination coverage was 39.7% among adults aged ≥75 years and 31.6% among those aged 60–74 years at increased risk (Figure 1).

For the week ending November 9, among adults aged ≥18 years, 14.5% and 13.5% reported that they definitely will be vaccinated against influenza and COVID-19, respectively; among adults aged ≥75 years, 7.2% reported that they definitely will be vaccinated against RSV. An additional 20.5%, 27.1%, and 32.8% reported they probably will be vaccinated or were unsure whether they will be vaccinated, against influenza, COVID-19, and RSV, respectively. Together these estimates indicate that approximately 35% of adults aged ≥18 years were open to receiving influenza vaccine, 41% of adults aged ≥18 years were open to receiving COVID-19 vaccine, and 40% of adults aged ≥75 years were open to RSV vaccination. Across all weeks, the highest percentage who were unvaccinated and reported they probably will get vaccinated or were unsure was for RSV vaccine (range = 31.7%–38.6% among those aged ≥75 years and 33.8%–45.0% among those aged 60–74 years). The percentage of adults who reported that they probably or definitely will not get vaccinated for the week ending November 9 was highest for COVID-19 (41.6%) and lowest for RSV (20.3% among those aged ≥75 years and 14.8% among those aged 60–74 years).

Influenza vaccination coverage for the current season (week ending November 9, 2024) among adults aged ≥18 years (34.7%) was 0.9 percentage points higher than coverage during the corresponding period during the 2023–24 season (week ending November 11, 2023 [33.8%]) and among those aged ≥65 years, was 3.7 percentage points higher (58.6% versus 54.9%) (Supplementary Figure, https://stacks.cdc.gov/view/cdc/170357). Likewise, COVID-19 vaccination coverage among adults aged ≥18 years was 4.7 percentage points higher in the 2024–25 season (17.9%) than the 2023–24 season (13.2%) and among adults aged ≥65 years, was 13.7 percentage points higher (38.5% versus 24.8%).^§§§ RSV vaccination coverage increased somewhat from the end of June 2024, when ACIP made the new RSV vaccine recommendation, to the week ending November 9; among adults aged ≥75 years, coverage increased 9.6 percentage points (from 30.1% to 39.7%) and among adults aged 60–74 years at increased risk, coverage increased 8.7 percentage points (from 22.9% to 31.6%).

Vaccination Coverage and Intent by Demographic Characteristics and Jurisdiction

Coverage with all vaccines was lowest among uninsured persons, and high percentages of those without insurance reported that they probably or definitely will not receive influenza vaccine (43.6%) or COVID-19 vaccine (44.3%) (Figure 2) (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/170358). Coverage and intent to be vaccinated were generally higher among adults living in urban and suburban areas compared with those living in rural areas. Coverage with influenza and COVID-19 vaccines increased with age. Coverage with influenza vaccine was more than twice as high among adults aged ≥65 years (58.6%) as it was among those aged 18–29 years (23.1%). COVID-19 vaccination coverage among adults aged ≥65 years (38.5%) was more than five times that among those aged 18–29 years (7.2%). Among adults with any disability (versus those with no disability), RSV vaccination coverage was lower (33.1% versus 41.8% among those aged ≥75 years and 23.7% versus 34.2% among those aged 60–74 years at increased risk for severe RSV).

Vaccination coverage was generally higher among non-Hispanic Asian (Asian) and non-Hispanic White (White) adults, than among non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic American Indian or Alaska Native (AI/AN) adults. The percentage of persons reporting that they probably or definitely will not get vaccinated with COVID-19 vaccine was higher among White adults than among Black and Hispanic adults.

Vaccination coverage varied by jurisdiction, ranging from 17.0% (Puerto Rico) to 50.5% (Maryland) for influenza vaccine, and from 5.2% (Puerto Rico) to 33.9% (Vermont) for COVID-19 vaccine (Table). RSV vaccination coverage estimates were not available at the jurisdiction level because of small sample sizes but varied by U.S. Department of Health and Human Services (HHS) region, with highest coverage among those aged ≥75 years in HHS Region 10 (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/170359).

Discussion

As of November 9, 2024, self-reported receipt of influenza, COVID-19, and RSV vaccines among U.S. adults was low, particularly for certain demographic groups such as younger adults and those without insurance, and in some jurisdictions; RSV vaccination coverage has increased by only approximately 9–10 percentage points since ACIP’s June 2024 recommendation. As of mid-October, influenza vaccination coverage was approximately equal to what it was at the same time during the 2023–24 influenza season but was 4.2 percentage points lower than it was at the same time during the 2022–23 influenza season (7).

Approximately 41% of adults aged ≥18 years and 40% of adults aged ≥75 years had not received COVID-19 and RSV vaccines, respectively, but reported that they definitely or probably plan to receive or are unsure about receiving the vaccines, suggesting they are open to vaccination. A health care provider recommendation for and offer of vaccination are strongly associated with receipt of vaccination (8). Data from another CDC survey showed that a large proportion of adults open to RSV vaccination expressed concerns about lack of knowledge about RSV and the RSV vaccine, and lack of a provider recommendation for vaccination. Unvaccinated adults who were open to receiving 2024–2025 COVID-19 and influenza vaccines expressed concerns about side effects, being too busy, or not having gotten around to getting vaccinated (9). Making vaccinations available in provider offices, pharmacies, workplaces, and other convenient locations at convenient times, along with a strong provider recommendation for vaccination, could increase vaccination coverage. CDC has developed health care provider toolkits to empower providers with knowledge to make a strong recommendation for vaccination.^¶¶¶

CDC’s Bridge Access Program provided COVID-19 vaccines for adults without health insurance and those whose insurance did not cover all COVID-19 vaccination costs, but this program ended in August 2024. CDC is providing limited funding for uninsured adults to obtain free 2024–2025 COVID-19 vaccines from public health safety net providers.**** A national Vaccines for Adults program could help close the gap for adult immunization access by expanding access to all recommended routine and outbreak vaccines for under- and uninsured adults.

Programmatic measures that helped reduce disparities in coverage with the primary COVID-19 vaccination series, such as making vaccines available free of charge, use of trusted messengers, and bringing vaccines into communities through nontraditional settings (10), might increase equitable access to vaccination and decrease disparities for these recommended vaccines. CDC partners with community-based organizations, health care providers, and other trusted messengers to build vaccine confidence and awareness, including through the Partnering for Vaccine Equity (P4VE) program.^†††† Communication and education campaigns,^§§§§ such as Wild to Mild, Get My Flu Shot, and Risk Less. Do More., include various materials and resources to promote vaccination.

CDC makes vaccination coverage estimates rapidly available during the respiratory virus season.^¶¶¶¶ In addition to data from the NIS-ACM, vaccination data are available from multiple sources and include coverage among children, pregnant persons, and Medicare beneficiaries, and national projected vaccination in pharmacies and medical offices. Jurisdiction- and HHS region–level estimates of influenza, COVID-19, and RSV vaccination coverage and intent stratified by demographic factors, and behavioral and social drivers of vaccination are available on CDC’s RespVaxView dashboard.***** End-of-season influenza vaccination coverage estimates for children and adults beginning with the 2010–11 influenza season are available on FluVaxView.^{†††††}

Limitations

The findings in this report are subject to at least four limitations. First, response rates for NIS-ACM were relatively low (<25%), although similar to those in other NIS surveys.^§§§§§ Data were weighted to mitigate possible bias resulting from an incomplete sample frame (i.e., exclusion of households with no phone service or only landline telephones) or nonresponse, but some selection bias might persist. Second, all responses were self-reported; vaccination receipt and month and year of receipt of most recent dose might be subject to recall or social desirability bias. Third, NIS-ACM had relatively small sample sizes for the age groups recommended to receive RSV vaccine, limiting ability to report RSV vaccination coverage or intent estimates for some sociodemographic groups and by jurisdictions. Finally, the survey sampled noninstitutionalized U.S. adults; thus, adults who were incarcerated or who live in long-term care or nursing home facilities^¶¶¶¶¶ might not be represented in the sample, although residents of nursing homes who have and use a personal mobile device are eligible to participate in the survey.

Implications for Public Health Practice

Early season estimates of vaccination coverage among U.S. adults with influenza, COVID-19, and RSV vaccines are low and indicate that many adults lack the protection from respiratory virus infections afforded by vaccines. However, many unvaccinated adults reported that they definitely or probably will get vaccinated or were unsure, suggesting they are open to vaccination. Vaccination is recommended to continue while viruses are circulating during the 2024–25 respiratory virus season. Health care providers and immunization programs still have time to expand outreach and promote vaccination activities to improve vaccination coverage, especially before persons gather with friends and family during the winter holidays. Immunization programs and vaccination partners are encouraged to use CDC data dashboards and tools, as well as other data sources available to them, such as immunization information system data, to identify undervaccinated populations and better understand vaccination patterns, attitudes and behaviors, and systemic barriers to vaccination to help tailor vaccination activities to improve coverage and health equity.