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PENNSYLVANIA DEPARTMENT OF HEALTH
2025 – PAHAN – 808 – 09 – 26 - ADV
Preparedness for the 2025-2026 Respiratory Season
This transmission is a “Health Advisory” which provides important information for a specific incident or situation; may not require immediate action.
HOSPITALS: PLEASE SHARE WITH ALL MEDICAL, PEDIATRIC, NURSING AND LABORATORY STAFF IN YOUR HOSPITAL; EMS
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MEMBERSHIP;
LONG-TERM CARE FACILITIES: PLEASE SHARE WITH ALL MEDICAL, INFECTION CONTROL, AND NURSING STAFF IN YOUR FACILITY
Key Actions
• Encourage Vaccination: Vaccines can prevent severe illness. Encourage patients, health care personnel (HCP), and long-term care facility (LTCF) residents and visitors to receive any respiratory vaccines recommended for their age group, including influenza, COVID-19, respiratory syncytial virus (RSV), and pneumococcal vaccines. Individuals should confirm with their insurance and pharmacy if the vaccines are covered and available.
• Monitor Community Transmission: Use the Pennsylvania Department of Health (DOH) respiratory virus dashboard and the Centers for Disease Control and Prevention (CDC) data to guide masking, visitation policies, and other infection control measures based on local virus activity.
• Reporting: All positive influenza and RSV antigen and PCR tests must be reported to PA-NEDSS. Some county health departments also mandate reporting positive COVID-19 results. Voluntary reporting of COVID-19 from the rest of the state is strongly encouraged. All respiratory virus outbreaks must be reported by phone to your local public health jurisdiction or by calling 877-PA-HEALTH (877-724-3258).
• Variant and Novel Influenzas: Remain alert for variant and avian influenza. Evaluate and test symptomatic individuals with exposure to sick animals or other case-patients. Forward subtype-negative influenza A samples immediately to the state lab for further testing.
• Respiratory Outbreaks in Long-Term Care Facilities (LTCFs): Consider expanded respiratory panel testing to identify co-circulating viruses. An updated Respiratory Virus Toolkit contains guidance for responding to outbreaks, and is available at: LTCF | Department of Health | Commonwealth of Pennsylvania.
If you have any questions, please call PA DOH at 877-PA-HEALTH (877-724-3258) or your local health department.
Summary:
This advisory provides vaccination guidance, surveillance tools, outbreak management
resources, and reporting requirements for health care providers to use to help protect
Pennsylvanians during the respiratory virus season. As the 2025-2026 season begins, we are
already seeing an increase in COVID-19 transmission, and we expect to see influenza and RSV
transmission increasing soon.
Introduction:
As we enter the 2025-2026 respiratory virus season, the DOH urges all health care providers and
facilities to take proactive measures to mitigate the impact of respiratory infections including
influenza, RSV, and COVID-19.
Vaccinate for influenza, COVID-19, RSV and pneumococcal disease
Encourage vaccination for respiratory viruses to all eligible patients and staff. These vaccines can
be safely administered simultaneously. Vaccine eligibility and availability information can be
found below.
Influenza: Recommend annual vaccination for all persons 6 months and older. For the first time,
an intranasal live attenuated flu vaccine is available for at-home delivery and self or caregiver
administration. FluMist Home is approved for people aged 2-49 years. More information and
online ordering can be found here. Additionally, the recombinant, high dose inactivated, and
adjuvanted inactivated flu vaccines are preferentially recommended for people 65 and older.
People who are under- or uninsured may be able to receive influenza vaccine at a DOH state
health center.
COVID-19: Vaccine eligibility is narrower this season due to federal policy changes. The 2025-
2026 COVID vaccine is available now for people 6 months to 64 years old at high-risk and
anyone over 65. The complete list of qualifying high-risk conditions is here; it includes asthma,
cancer, diabetes, heart disease, pregnancy, and many others. Official recommendations for
COVID vaccine were developed by the American Academy of Family Physicians, and can be
found at: AAFP Announces Fall Immunization Recommendations, Reaffirming Commitment to
Vaccine Safety and Public Health | AAFP
Unfortunately, vaccine supply is uncertain. People should confirm availability and eligibility with
their provider or pharmacy and insurer before going for a COVID-19 vaccine.
RSV: Although studies have shown this vaccine to be effective at reducing infection,
hospitalizations and deaths,1, 2, 3, 4, 5 most eligible persons did not receive it last season. The RSV
vaccine is NOT an annual vaccine. For this respiratory virus season, the RSV vaccine is
recommended for people in the following groups who did not previously receive it:
• All adults 75 and older
• Adults 50-74 at increased risk of severe RSV
• Pregnant persons at 32-36 weeks gestation
Infants 8 months and younger who are not protected via maternal vaccination and are entering
their first RSV season are eligible to receive the RSV monoclonal antibody immunizations.
Pneumococcal vaccine: Children 5 and younger and adults 50 and older should receive
pneumococcal vaccines. Consult pneumococcal vaccine recommendations for timing and
dosage guidance.
Monitor community transmission using the DOH Respiratory Virus Dashboard
Track local respiratory virus activity using the DOH Respiratory Virus Dashboard and CDC
resources like the National Respiratory and Enteric Virus Surveillance System (NREVSS) and
Respiratory Illnesses Data Channel | Respiratory Illnesses | CDC. Use these data to implement
appropriate measures like masking, visitation policies, or limiting group activities.
Laboratory-confirmed influenza and RSV cases are reportable, including those diagnosed
using point-of-care (POC) tests. Reporting of COVID-19 is mandated in some PA counties,
and voluntary reporting is strongly encouraged in all counties
• Laboratory-confirmed cases of influenza and RSV, including those diagnosed using POC
tests in clinical and LTCF settings, should be reported to PA-NEDSS. Clinicians do not need
to report tests performed at a commercial or hospital laboratory, as those should be reported
directly to DOH by the lab.
• There are multiple options to ease reporting burden for providers, especially during peak
season.
o Clinics and facilities may upload spreadsheets of individual cases to PA-NEDSS.
Reach out to RA-DHNEDSS@pa.gov to have this functionality added and include your
facility name in the ‘subject’ line. Do not send spreadsheets of individual cases via
email.
o Reports of positive tests may also be sent to PA-NEDSS through the CDC
SimpleReport platform.
o Lastly, providers may use the aggregate reporting tool in PA-NEDSS to report the
number of flu and RSV cases identified per week at their facility.
• If using the aggregate reporting tool, note that hospitalizations and deaths associated with
influenza and RSV should be individually entered into PA-NEDSS to provide detailed data on
severe outcomes. These severe cases should not be included in aggregate reporting counts
as that would lead to double-counting of the case.
• Reporting of positive COVID-19 test results is mandated in some PA counties. Voluntary
reporting is strongly encouraged in all other counties. Refer to your local public health
reporting requirements and comply accordingly.
• Outbreaks of all respiratory infections must be reported. Outbreaks, including those of
COVID-19, influenza, RSV, and all other respiratory infections, in any setting, must be
reported by phone to your local public health jurisdiction. An outbreak of respiratory viral
illness in a health care setting is defined as any unusual cluster or an increase above
baseline. In LTCFs, specific definitions apply and are outlined below under the heading
Respiratory Virus Outbreak Definitions for LTCFs. Please be mindful that reporting to other
entities, including state facility licensure offices and federal agencies such as the Centers for
Medicare and Medicaid Services (CMS), may also be necessary. Therefore, it is crucial to
stay informed about and adhere to any specific federal, state, or local reporting requirements.
For further assistance, please contact DOH at 877-PA-HEALTH (877-724-3258) or your local
public health jurisdiction.
Variant and novel Influenza remain a threat; improve education and remain vigilant
In 2024, four cases of variant influenza (H1N2v) associated with swine exposure were reported in
Pennsylvania, the highest number since 2012. Additionally, avian influenza (H5N1) remains a
concern with some infected wild birds still being identified. Although there are currently no poultry
or dairy farms affected by avian influenza, and no cases of variant influenza were identified in
several months, it is incredibly important that clinicians remain vigilant. Since March 2024, there
were 70 human cases of H5N1 in the U.S., primarily associated with poultry, and the first U.S.
death occurred, outside Pennsylvania, in January 2025. Six of these cases were detected by
routine influenza surveillance programs.
To stay vigilant, clinicians should:
• Recognize symptoms of variant and avian influenza and ask about animal exposure:
Symptoms in humans include respiratory illness, gastrointestinal symptoms, and
conjunctivitis. Severity can vary. Some cases have presented primarily with conjunctivitis. As
we enter the respiratory season, it’s important to ask patients about their exposure to
domestic and wild animals.
• Two classes of people should be evaluated for H5N1 or variant flu:
o Symptomatic people with known exposure to an H5N1 or variant-infected animal, flock,
herd, or person in the 10 days before illness onset.
o Hospitalized patients with severe respiratory illness, with no identified cause, AND with
exposure to raw milk, sick or dead birds, sick or dead animals, dairy cows or swine, in
the 10 days prior to illness onset. These patients should be tested for influenza A, and
subtyped if possible.
• Samples to submit to the state public health lab:
o Specimens from severely ill patients (in intensive care) who tested positive for
influenza A but for whom subtyping was not done.
o Specimens positive for influenza A but subtyping was not successful, or influenza A
positive specimens that are subtype influenza A (H1) but not specifically identified as
influenza A(H1)pdm09 or A (H1N1) on tests designed to provide an influenza subtyping
result and confirmed upon retest.
Tools for managing respiratory outbreaks in LTCFs:
Vaccinate residents, health care personnel, and visitors
• When possible, encourage vaccination against influenza, COVID-19, RSV, and
pneumococcal disease for all eligible residents, health care personnel (HCP), and visitors.
• If possible, provide vaccinations onsite.
• These vaccines can be safely administered simultaneously.
Testing, including identifying multi-pathogen outbreaks
• Test symptomatic HCP and residents to detect and manage outbreaks.
• Use point-of-care (POC) or laboratory-based PCR or antigen tests to confirm respiratory
infections.
• Prioritize testing for patients in high-risk groups and patients with severe or progressive
illness.
• When community transmission is high, if an outbreak is ongoing, or if the source was not
identified by other routine testing, consider expanded testing (e.g., multiplex panels that test
for 15+ pathogens), which may identify co-circulating respiratory viruses or co-infections.
• Information to assist health care providers about when to consider respiratory virus testing is
available at Information for Clinicians on Influenza Virus Testing, Clinical Overview of RSV |
RSV | CDC and Testing for COVID-19 | COVID-19 | CDC.
• For HCP, testing should occur if they develop symptoms, and exclusion from work should
follow guidance outlined in PA HAN 806.
Therapeutics and Chemoprophylaxis
Therapeutic treatments and chemoprophylaxis are essential for controlling outbreaks.
• Therapeutics: Timely treatment of influenza and COVID-19 with antivirals can reduce the
severity and/or duration of illness. Administer antiviral treatment promptly for residents at high
risk of complications, following CDC guidelines.
• Chemoprophylaxis: To prevent the spread of an influenza outbreak, administer antiviral
medications such as oseltamivir to non-ill patients, residents and HCP. Chemoprophylaxis is
not available for COVID-19. See toolkit for more details.
Respiratory Virus Outbreak Definitions for LTCFs
• Outbreaks should be reported by calling your local public health jurisdiction within 24 hours.
• The DOH Respiratory Virus Outbreak toolkit contains guidance for management of LTCF
outbreaks of influenza, RSV and other respiratory viruses, now including COVID-19. The
toolkit and other resources can be found here: LTCF | PADOH.
• For the 2025-2026 season, a LTCF non-influenza respiratory virus outbreak is defined as:
o 2 residents testing positive for the same laboratory-confirmed respiratory virus (RSV,
COVID-19, rhinovirus, etc.) within 72 hours, OR
o 1 resident with a lab-confirmed infection + 1 resident with acute respiratory illness
symptoms within 72 hours.
• Ill HCPs should not be counted when determining if a facility has an outbreak. This updated
definition supersedes the LTCF outbreak definition previously published in PA HAN 701, and
is only for the purpose of reporting to local public health and the DOH Bureau of
Epidemiology. Outbreak definitions for other agencies may differ.
DOH Resources:
Viral Testing Respiratory Swab Collection and Shipping | Department of Health | Commonwealth
of Pennsylvania
Avian Influenza (H5N1) | Department of Health | Commonwealth of Pennsylvania
LTCF | Department of Health | Commonwealth of Pennsylvania
LTCF: Respiratory Virus Outbreak Toolkit
Vaccine Education and Recommendations:
How to Debunk Misinformation and Bolster Vaccine Confidence
Talking with Vaccine Hesitant Parents
Vaccine Confident Toolkit – American College of Preventive Medicine Practice | ACPM
Vaccine Update for Healthcare Professionals | Children's Hospital of Philadelphia
AAP recommends all young and high-risk children get vaccinated against COVID-19, diverging
from CDC policy | AAP News | American Academy of Pediatrics
AAFP Announces Fall Immunization Recommendations, Reaffirming Commitment to Vaccine
Safety and Public Health | AAFP
ACOG Releases Updated Maternal Immunization Guidance for COVID-19, Influenza, and RSV |
ACOG
PA DOH General Immunization Guidance
Individuals interested in receiving future PA-HANs can register at:
https://ondemand.mir3.com/han-pa-gov/login/.
References...continued. https://www.pa.gov/content/dam/copap...esp%20Prep.pdf