Flu Vaccination Coverage, United States, 2024–25 Influenza Season

At a glance

CDC analyzed data from two large, nationally representative surveys to assess flu vaccination coverage for the 2024–25 flu season among children and adults in the United States.
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Summary

The Centers for Disease Control and Prevention (CDC) recommends annual influenza (flu) vaccination for all people ≥6 months who do not have contraindications1. To assess flu vaccination coverage for the 2024–25 flu season among children and adults in the United States, CDC analyzed data from two large, nationally representative surveys, the National Immunization Survey-Flu (NIS-Flu) and the Behavioral Risk Factor Surveillance System (BRFSS). This report contains CDC's final flu vaccination coverage estimates for the 2024–25 flu season. In the 2024–25 flu season, flu vaccination coverage (≥1 dose of flu vaccine) was 50.2% among children 6 months through 17 years, a decrease of 5.3 percentage points compared with the 2023–24 flu season (55.5%) and a decrease of 13.5 percentage points compared with the 2019–20 season before the COVID-19 pandemic (63.7%). This is the lowest seasonal flu vaccination coverage among children has been across the past 15 seasons. Flu vaccination coverage among adults ≥18 years was 41.9%, a decrease of 3.0 percentage points from the prior season (44.9%). For adults, after an initial increase in flu vaccination coverage in the season immediately following the start of the COVID-19 pandemic, coverage has steadily declined since the 2020–21 season. The last time flu vaccination coverage among adults was lower was seven seasons ago (2017–18, 37.1%). Interpretation of the estimates in this report should take into consideration survey limitations.

An annual flu vaccine is the best way to reduce the risk of illness and serious complications from flu. For most people, September and October are ideal times to get vaccinated against flu; however, vaccination should continue after October as long as influenza viruses are circulating and unexpired vaccine is available. CDC expects influenza viruses to spread along with other viruses this fall and winter, including respiratory syncytial virus (RSV) and the virus that causes COVID-19, and recommends that people stay up-to-date on all vaccinations.

Methods

For this report, CDC analyzed data from the NIS-Flu for children 6 months through 17 years and the BRFSS for adults ≥18 years to estimate national- and state-level flu vaccination coverage for the 2024–25 flu season. The analyses included data collected from interviews completed from September 2024 for BRFSS and October 2024 for NIS-Flu through June 2025, and vaccinations received between July 1, 2024, and the time of interview or by May 31, 2025.

The NIS-Flu is a national random-digit-dialed cellular telephone survey of households2. Respondents ≥18 years knowledgeable about the child's vaccinations (hereafter referred to as "parent" in this report) were asked if their child received a flu vaccination since July 1, 2024, and the month of vaccination; this information was not verified by medical records. Month of vaccination was missing for 18.4% of respondents who indicated their child was vaccinated. For these children, month was imputed using the hot-deck imputation method from other survey respondents who matched the week of interview, age group, state of residence, race and ethnicity, and mother's education of the child with missing data.* Respondents who indicated the child received a flu vaccination were asked the place where the child was vaccinated. The range of the Council of American Survey and Research Organizations (CASRO) monthly response rates for the NIS-Flu for the 2024–25 season was 20.6%–22.8%. The estimates for children are based on n=118,563 completed NIS-Flu interviews.

The BRFSS is a state-based random-digit-dialed cellular and landline telephone survey that collects information on various health conditions and risk behaviors from one randomly selected adult ≥18 years in a household. The BRFSS survey asks if the respondent has received a flu vaccine in the past 12 months and, if so, the month and year of vaccination3. For 9.0% of BRFSS participants who were vaccinated but had a missing month or year of vaccination, month and year were imputed using the hot-deck imputation method from other survey respondents who matched the week of the interview, age group, state of residence, and race/ethnicity of the respondent with missing data. Estimates are not available for the entire 2024–25 flu season for Alabama, California, Indiana, and Mississippi because interview data for January–June 2025 from these states were not available; therefore, estimates for these states represent vaccinations received only through November 2024 and not through May 2025 as for other states. The median state BRFSS response rate for a complete or partially complete interview was 44.8% for September–December 2024 and 44.0% for January–June 2025. The estimates for adults are based on n=268,799 completed BRFSS interviews.

Flu vaccination coverage estimates from both surveys were calculated using Kaplan-Meier survival analysis using the month of the reported flu vaccination to determine cumulative flu vaccination coverage. Coverage estimates for all persons ≥6 months were determined by combining the state-level monthly NIS-Flu and BRFSS estimates weighted by the age-specific populations of each state4. All estimates were weighted and analyzed using SAS and SAS-callable SUDAAN statistical software to account for the complex survey designs. Differences between groups and between 2024–25 and prior season (2023–24) estimates were determined using t-tests with significance at p<0.05. Increases or decreases noted in this report were statistically significant differences.

Results

Overall, the percentage of children receiving ≥1 dose of flu vaccine during the 2024–25 season was 50.2%. This was a decrease of 5.3 percentage points from the 2023–24 season (55.5%) and a decrease of 13.5 percentage points compared with the pre-pandemic 2019–20 season (63.7%, Figure 1). Flu vaccination coverage among children aged 6 months–4 years (57.5%), 5–12 years (51.3%), and 13–17 years (43.4%; Figure 1) had decreases of 6.5, 5.8, and 3.7 percentage points, respectively, compared with the previous season. For additional results by age group, see "Additional Flu Vaccination Coverage Estimates" at the end of the results section.

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Figure 1. Flu Vaccination Coverage by Age Group, Children 6 months-17 years, United States, 2010-2025
Figure 1. Flu Vaccination Coverage by Age Group, Children 6 months-17 years, United States, 2010-2025

As is seen each flu season, there was wide (37.6 percentage points) variability between states in flu vaccination coverage for children, ranging from 31.7% (Mississippi) to 69.3% (District of Columbia) (Figure 2). No jurisdictions had an increase in coverage this season compared with last season, while 28 jurisdictions had drops in coverage ranging from 3.9 to 11.1 percentage points. To view additional state-level final end of flu season vaccination coverage estimates using the same methods described in this report, see the interactive application at FluVaxView Interactive.

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Figure 2. Flu Vaccination Coverage by State, Children 6 months-17 years, United States, 2024-25 Season
Figure 2. Flu Vaccination Coverage by State, Children 6 months-17 years, United States, 2024-25 Season

Flu vaccination coverage was higher for children living in a metropolitan statistical area (MSA) principal city (57.0%) compared with children living in a MSA non-principal city (49.8%) and children living in a non-MSA (37.8%) (Figure 3). Flu vaccination coverage was also higher for children living in a MSA non-principal city (49.8%) compared with children living in a non-MSA (37.8%). Additional results by MSA status are included in the "Additional Flu Vaccination Coverage Estimates" section of this report.

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Figure 3. Flu Vaccination Coverage by MSA, Children 6 months-17 years, United States, 2024-25 Season
Figure 3. Flu Vaccination Coverage by MSA, Children 6 months-17 years, United States, 2024-25 Season

Flu vaccination coverage for the 2024–25 season among non-Hispanic White (White) children, non-Hispanic Black (Black) children, Hispanic children, and non-Hispanic children of other or multiple races decreased by 4.8, 4.8, 6.7, and 5.0 percentage points, respectively, compared with the previous season (Figures 4a and 4b). Hispanic children and non-Hispanic children of other/multiple races had higher flu vaccination coverage than Black children and White children. No other statistically significant pair-wise differences were observed. Flu vaccination coverage estimates for more detailed racial/ethnic groups (Asian, American Indian/Alaska Native) are provided as a table weblink in the "Additional Flu Vaccination Coverage Estimates" section of this report.

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Figure 4a. Flu Vaccination Coverage by Racial/Ethnic Group, Children 6 months-17 years, United States, 2010-2025
Figure 4a. Flu Vaccination Coverage by Racial/Ethnic Group, Children 6 months-17 years, United States, 2010-2025
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Figure 4b. Flu Vaccination Coverage by Racial/Ethnic Group, Children 6 months-17 years, United States, 2010-2025
Figure 4b. Flu Vaccination Coverage by Racial/Ethnic Group, Children 6 months-17 years, United States, 2010-2025

Place of flu vaccination among vaccinated children 6 months through 17 years for the 2024–25 season was most often a doctor's office (61.3%), followed by a pharmacy (14.4%), and clinic/health center (13.7%) (Figure 5). Place of flu vaccination by child age groups can be found in the "Additional Flu Vaccination Coverage Estimates" section of this report.

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Figure 5. Place of Flu Vaccination, Children 6 months-17 years, United States, 2024–25 Season
Figure 5. Place of Flu Vaccination, Children 6 months-17 years, United States, 2024–25 Season

Overall, among adults ≥18 years, flu vaccination coverage was 41.9%, 3.0 percentage points lower than coverage during the 2023–24 season (44.9%; Figure 6). Compared with the 2023–24 season, flu vaccination coverage for 2024–25 among adults 18–49 years, 50–64 years, and adults ≥65 years decreased by 1.6, 4.1, and 5.9 percentage points, respectively (Figure 6).

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Figure 6. Flu Vaccination Coverage by Age Group, Adults 18 years and older, United States, 2010-2025
Figure 6. Flu Vaccination Coverage by Age Group, Adults 18 years and older, United States, 2010-2025

There was wide between-jurisdiction variability in flu vaccination coverage among adults, ranging from 27.3% in Idaho to 58.0% in the Vermont (Figure 7). No jurisdictions had an increase in coverage this season compared with last season, while 28 jurisdictions had drops in coverage ranging from 2.1 to 9.6 percentage points. See FluVaxView Interactive General Population for additional state-level estimates by age-groups and multiple flu seasons.

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Figure 7. Flu Vaccination Coverage by State, Adults 18 years and older, United States, 2024-25 Season
Figure 7. Flu Vaccination Coverage by State, Adults 18 years and older, United States, 2024-25 Season

Flu vaccination coverage during the 2024–25 season among White adults, Black adults, Hispanic adults, and non-Hispanic adults of other or multiple races decreased by 2.9, 4.1, 2.6, and 3.8 percentage points, respectively, compared with the 2023–24 season (Figures 8a and 8b). White adults had higher flu vaccination coverage than Black, Hispanic, and non-Hispanic adults of other or multiple races. Additionally, Hispanic adults had lower flu vaccination coverage than Black adults and non-Hispanic adults of other or multiple races. No other differences were observed. Flu vaccination coverage estimates for more detailed racial/ethnic groups (Asian, American Indian/Alaska Native) are provided as a table weblink in the "Additional Flu Vaccination Coverage Estimates" section at the end of the results section.

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Figure 8a. Flu Vaccination Coverage by Racial/Ethnic Group, Adults 18 years and older, United States, 2010-2025
Figure 8a. Flu Vaccination Coverage by Racial/Ethnic Group, Adults 18 years and older, United States, 2010-2025
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Figure 8b. Flu Vaccination Coverage by Racial/Ethnic Gorup, Adults 18 years and older, United States, 2010-2025
Figure 8b. Flu Vaccination Coverage by Racial/Ethnic Gorup, Adults 18 years and older, United States, 2010-2025

Flu vaccination coverage among all people ≥6 months during the 2024–25 season was 43.8%, 3.4 percentage points lower than coverage in the 2023–24 season (Table 1). Flu vaccination coverage during the 2024–25 season among White people ≥6 months, Black people ≥6 months, Hispanic people ≥6 months, and non-Hispanic people of other or multiple races ≥6 months decreased by 3.3, 4.3, 3.4, and 3.9 percentage points, respectively, compared with the previous season (Table 1). White people had higher flu vaccination coverage than Black, Hispanic, and non-Hispanic people of other or multiple races. Additionally, Black people and non-Hispanic people of other or multiple races had higher coverage than Hispanic people. No other differences were observed.

Table 1. Flu Vaccination Coverage* among All People 6 Months and Older, by Race/Ethnicity, United States, † 2024–25 Season

Race/Ethnicity‡ %§ ± 95% CI|| Difference from the 2023–24 Season ± 95% CI
Overall 43.8 ± 0.5 -3.4 ± 0.7
White only, non-Hispanic 46.4 ± 0.5 -3.3 ± 0.7
Black only, non-Hispanic 40.2 ± 1.3 -4.3 ± 2.0
Hispanic 38.8 ± 1.2 -3.4 ± 1.7
Other or multiple races, non-Hispanic** 43.2 ± 1.4 -3.9 ± 2.1

* Estimates of the percentage vaccinated are based on interviews conducted September (BRFSS) or October (NIS-Flu) 2024 through June 2025 and reported vaccinations from July 2024 through May 2025.

† Excludes U.S. territories.

‡ Race is self-reported; people of Hispanic ethnicity may be of any race.

§ Percentage vaccinated. Percentages are weighted to the U.S. population. Month of vaccination was imputed for respondents with missing month of vaccination data.

|| Confidence interval (CI) half-widths.

Statistically significant difference between the 2024–25 season and the 2023–24 season by t-test (p<0.05).

** Includes Asian, American Indian/Alaska Native, Native Hawaiian or other Pacific Islander, multiracial, and other races.

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Limitations

Several limitations of the estimates produced from the NIS-Flu and BRFSS surveys should be considered when interpreting the results in this report. First, survey weighting adjustments may not eliminate all the possible bias from incomplete sample frames; both surveys exclude households with no telephones, and NIS-Flu excludes households with only landline telephones. Second, response rates for both surveys were low, and flu vaccination coverage may differ between survey respondents and non-respondents; survey weighting adjustments may not adequately control these differences. Third, there may be misclassification of flu vaccination status due to recall errors of parents for NIS-Flu and of respondents for BRFSS56. A study published in 2020 found that parents over-reported flu vaccination by approximately 9 percentage points7. Fourth, errors from incomplete sample frame, nonresponse, and accuracy of reported flu vaccination status might change over time, leading to inaccurate assessment of trends in flu vaccination coverage. Fifth, due to BRFSS interview data not being available for all months from Alabama, California, Indiana, and Mississippi, estimates for these four states represent vaccination coverage through November 2024 rather than through May 2025. However, sensitivity analysis showed that the projected national flu vaccination coverage remains 41.9% assuming these four states have the same relative increase (31.1%) in coverage from end of November 2024 to end of May 2025 as the combination of all states without missing data, indicating missing data from these four states did not impact the national flu vaccination coverage. Sixth, estimates based on the sources in this report have differed from National Health Interview Survey (NHIS) estimates8. NHIS, the data source for evaluating progress toward the Healthy People 2030 flu vaccination coverage objectives, uses a different sampling method than the NIS-Flu and BRFSS, and uses in-person interviews but also relies on self or parental report. A study found that NIS-Flu estimates were generally higher than NHIS estimates over several flu seasons for children.8

The final estimates in this report will differ from the preliminary, in-season estimates on CDC's Weekly Flu Vaccination Dashboard because of different surveys (for adults only [BRFSS vs NIS-Fall Respiratory Virus Module ((NIS-FRVM)]), and different analytic approaches (Kaplan-Meier vs. enhanced estimates). The weekly dashboard estimate for children at the end of April 2025 was 49.2%, whereas the final estimate included in this report is 50.2%; and for adults the dashboard estimate based on NIS-FRVM was 46.7% whereas the final estimate included in this report based on BRFSS is 41.9%. CDC uses enhanced estimates produced weekly by the NIS contractor for the dashboards due to this method allowing for the production of weekly estimates in the absence of respondent-reported exact week of vaccination; Kaplan-Meier cannot be performed in this case because week of vaccination is not collected. Kaplan-Meier estimates are used for the final estimates in this report and utilize the reported month the vaccine was received. For children, the same data source is used for both the weekly dashboard and the final estimates, with the difference being only in the estimation method. For adults, the data source for the weekly dashboard is the NIS-FRVM, for which weekly enhanced estimates can be calculated each week by the NIS contractor, and the data source for the reports of final estimates is BRFSS, which has been used since the 2010–11 season. However, the data from BRFSS are not available until August following each season; thus, not allowing in-season routine monitoring of flu vaccination coverage. Comparisons of estimates from the different data sources have been reported previously9. CDC continues to assess consistency between flu vaccination coverage estimates from different surveys and other data sources and to evaluate the accuracy of estimates from these data sources.

Discussion

In the United States, flu vaccination coverage continues to decline since the onset of the COVID-19 pandemic among children and since the 2021–22 season for adults. During the 2024–25 season, approximately half of children and less than half of adults received a flu vaccination. The last flu season that coverage was lower than this season's level was 15 seasons ago for children and 7 seasons ago for adults. Before the COVID-19 pandemic, flu coverage had been slowly increasing. Downturns in coverage began during and after the pandemic. Flu vaccination coverage levels have not rebounded to pre-pandemic levels and remain below the Healthy People 2030 national target of 70% for flu vaccination of persons ≥6 months.

For children, a 2023 study found that 30.9% of U.S. children had a parent hesitant about flu vaccines10. This paper did not note an increase in parental flu vaccine hesitancy compared with hesitancy reported in 2020 (unpublished data), yet a flu vaccine hesitancy level of almost one-third is quite high; by contrast, the percentage with a parent hesitant about vaccines such as measles, polio, and tetanus was 12.2%10. An important study finding was that 25.1% of non-vaccination against flu was attributable to hesitancy, which implies hesitancy may not be the main driver10. A national poll conducted in August 2024 found that 40% of adults said it is extremely important for parents to have their children vaccinated, which was a decrease from 58% when the question was asked in 2019 and from 64% in 2001, indicating a decrease over time in the importance placed on vaccinating children, at least among some groups of the U.S. population11. Coverage with other childhood vaccines, such as human papillomavirus (HPV) vaccination and vaccines required for school entry, have also decreased since the COVID-19 pandemic, though decreases were smaller than those seen for flu vaccination, and the drop in HPV vaccination among adolescents was mainly for those born in 20081213. The most commonly reported reasons parents have for not vaccinating their child against flu are concern about side effects/safety, belief that the flu vaccine does not work well, and belief that their child is unlikely to get very sick from flu, with <4% reporting cost or access as a reason for non-vaccination14.

While flu vaccination coverage among adults ≥65 years is high compared with adults in other age groups, and had met and exceeded the Healthy People (HP) 2030 goal of 70% during the COVID-19 pandemic (75.2% in the 2020–21 season), coverage among adults ≥65 years has since been steadily decreasing and is now lower than the HP 2030 goal (63.8% vs. 70%). However, while the current report shows an approximately six percentage point decrease in flu vaccination coverage among adults ≥65 years compared with the last season, it should be noted that other data sources have shown smaller or no decreases in coverage in this population compared to the 2023–24 season15. Data from another CDC survey showed that younger adults were more likely to have at least one issue or concern with flu vaccination than adults ≥65 years, with the most commonly reported issue being that they are not worried about getting the flu16. Based on recent publications, small declines have been observed for other adult vaccinations, such as pneumococcal and tetanus vaccines1718.

An annual seasonal flu vaccine is the best way to help reduce the risk of illness and serious complications from flu. For most people, September and October are ideal times to get vaccinated against flu1. However, flu vaccination should continue throughout the flu season as long as influenza viruses are circulating. To avoid missed opportunities for vaccination, the Standards for Adult Immunization Practice recommend that all providers routinely assess individuals' vaccination status at every clinical encounter, strongly recommend approved vaccinations to their patients, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization information system19. During the 2023–24 season, 61.3% of adults who reported that their healthcare provider recommended they get a flu vaccine received a vaccination, but only 43.6% of adults, and 56.7% of adults ≥65 years, reported that their provider recommended flu vaccination20. CDC expects influenza viruses to spread along with other viruses this fall and winter, including RSV and the virus that causes COVID-19, and recommends that people stay up-to-date on all vaccinations21.

Footnotes

*Estimates from the NIS-Flu for the 2022–23 and 2023–24 seasons were recalculated using the same method for imputation of missing vaccination month as was used for the 2024–25 season so that estimates between seasons would be comparable. Estimates for children for the 2022–23 and 2023–24 seasons in this report may differ slightly from estimates posted on Influenza Vaccination Coverage for Persons 6 Months and Older | FluVaxView | CDC and in reports from the prior two seasons.

Authors

Katherine E. Kahn, MPH1,2; Anurag Jain, MS1,2; Tianyi Zhou, MPH1,2; Mei-Chuan Hung, PhD1,2; Anup Srivastav, PhD1,2; Peng-Jun Lu, MD, PhD2; Jennifer L. Kriss, PhD2; Carla L. Black, PhD2; James A. Singleton, PhD2

1Eagle Health Analytics, LLC, Atlanta, GA; 2Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC

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National Center for Immunization and Respiratory Diseases; Immunization Services Division
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