Vaccination rates for influenza and respiratory syncytial virus (RSV) among nursing home residents improved significantly in the 2025-2026 season following the implementation of mandatory reporting requirements to the CDC’s National Healthcare Safety Network (NHSN). Resident influenza vaccination reached 82% nationally, up from 76% the prior year, while the newly tracked RSV vaccination rate reached 64% in its first season of widespread availability.

Impact of Reporting Requirements

Beginning January 1, 2025, nursing homes were required to report weekly influenza and RSV vaccination data to NHSN, building on COVID-19 reporting infrastructure established during the pandemic. Public health officials credit the reporting mandate with driving improvements, as facilities faced accountability for their vaccination rates.

CMS has indicated it may incorporate vaccination rates into the Five-Star Quality Rating System in future years, creating additional incentive for facilities to prioritize respiratory illness prevention. Facilities with strong vaccination programs report using the data to identify and address coverage gaps proactively.

RSV Vaccination Rollout

The 2024 FDA approval of RSV vaccines for adults 60 and older created new opportunities for protecting nursing home residents from a pathogen that has long caused significant morbidity in long-term care settings. RSV causes an estimated 6,000-10,000 deaths annually among adults 65 and older, with nursing home residents at particularly high risk.

First-year RSV vaccination rates of 64% exceeded expectations, driven by strong recommendations from facility medical directors and pharmacist-administered vaccination programs. However, coverage varied significantly by region, with rates exceeding 75% in the Northeast but falling below 55% in parts of the South and Mountain West.

Staff Vaccination Challenges

While resident vaccination rates improved, staff vaccination remains a challenge. Healthcare worker influenza vaccination in nursing homes reached only 68%, well below the 90% target set by public health agencies. RSV vaccines are not yet routinely recommended for younger adults, leaving staff as potential vectors for introducing respiratory pathogens to facilities.

Mandatory staff vaccination policies remain controversial following contentious COVID-19 vaccine mandate battles. Most facilities have adopted vaccine encouragement rather than mandate approaches, offering incentives, education, and convenient vaccination access. Some states have implemented healthcare worker vaccination requirements, though enforcement varies.

Clinical Integration

Facilities report that integrating respiratory vaccination into routine clinical workflows improves coverage rates. Best practices include automated EHR alerts that identify unvaccinated residents, standing orders that allow nursing staff to administer vaccines without individual physician orders, pharmacy partnerships that provide on-site vaccination clinics, and family education that addresses vaccine hesitancy.

The co-administration of multiple vaccines (influenza, RSV, COVID-19, pneumococcal) during a single encounter has proven effective at maximizing coverage while minimizing resident burden. CDC guidance supports co-administration, though some residents and families express concern about receiving multiple vaccines simultaneously.

Outbreak Prevention

Improved vaccination rates have correlated with reduced respiratory illness outbreak activity in early reports from the 2025-2026 season. CDC data shows that nursing home influenza outbreaks through January 2026 are tracking 15% below the five-year average, though it remains too early to attribute causation definitively.

Facilities are increasingly adopting comprehensive respiratory illness prevention strategies that combine vaccination with enhanced infection control practices, including improved ventilation, hand hygiene monitoring, and rapid testing protocols for symptomatic individuals.