New guidance from the American Academy of Pediatrics (AAP) expands the categories of high-risk children eligible for immunization against respiratory syncytial virus (RSV), a leading cause of hospitalization among young children. The change is based on evidence pointing to benefits for a broader group of high-risk children as they enter their second RSV season.
This year's policy statement and accompanying
technical report about RSV, "Recommendations for the Prevention of RSV Disease in Infants and Children, 2026-2027," will be published in the November 2026 Pediatrics. In the same issue, the AAP also will publish the
policy statement and
technical report, "Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027."
The RSV and COVID-19 policies complete the AAP recommendations for the fall respiratory virus season. AAP recently published guidance on influenza (flu) prevention with a
policy statement and
technical report, "Recommendations for Prevention and Control of Influenza in Children, 2026–2027."
AAP recommendations to protect babies against RSV this season
What stayed the same, what changed
The AAP continues to recommend RSV immunization for all infants under 8 months of age born during or entering their first RSV season, unless the infant has documented protection from vaccination of their pregnant parent.
In its updated policy, the AAP
expands the high-risk criteria for administration of RSV immunization in infants and children ages 8 months-19 months entering their second RSV season, as well.
The evidence behind the recommendations
"The evidence is clear: these products work very well to prevent RSV and keep infants out of the hospital," said Sean T. O’Leary, MD, MPH, FAAP, who chairs the RSV immunization subgroup of the AAP Committee on Infectious Diseases. "We’re already seeing real-world impact."
Respiratory syncytial virus spreads easily through the air and through physical contact, and infects the nose, throat and lungs. While it causes mild, cold-like symptoms in most people, it is common and can lead to severe lung infections like bronchiolitis or pneumonia in babies.
RSV has been the leading cause of infant hospitalization in the United States and causes about 50,000 to 80,000 hospitalizations each year in children under 5 years old, according to Centers for Disease Control and Prevention data.
When RSV immunization is recommended for a child's second RSV season
The AAP’s updated second season recommendations are for children ages 8 through 19 months of age who are at high risk for severe disease. These include:
children born preterm at less than 32 weeks gestation, regardless of the need for medication or other support.
children with hemodynamically significant congenital heart disease.
children with anatomic pulmonary abnormalities or neuromuscular disorders that put them at risk for severe RSV disease.
children with Down syndrome or other chromosomal differences placing them at higher risk of severe RSV disease.
Nirsevimab and the RSVPreF vaccine for pregnant people became available in the 2023-’24 season. Another product, Clesrovimab, was licensed last summer.
This year's COVID-19 vaccine recommendations
The AAP also released its guidance on COVID-19 with a policy statement and technical report, recommending that all infants and children 6 through 23 months of age receive 2026–2027 COVID-19 vaccine.
The AAP recommends a single dose of age-appropriate 2026–2027 COVID-19 vaccine for all children and adolescents 2 through 18 years of age at increased risk of severe disease, regardless of prior COVID-19 vaccination status.
The vaccine should also be available to those ages 2-18 who are not considered at increased risk but whose parent or guardian desires their protection from COVID-19. Any available COVID-19 vaccine appropriate by age and health status can be administered and the most updated version of the COVID-19 vaccine that is available should be used.
AAP immunization schedule also updated
The updated AAP
2026 immunization schedule also expands the age indication for the meningococcal ACWY conjugate vaccine MenQuadfi for children as young as 6 weeks of age, down from 2 years old. The Food and Drug Administration (FDA) approved lowering the age following clinical trials and the AAP Committee on Infectious Diseases voted to update its recommendation after reviewing the data.
All policy statements are written by medical experts, reflect the latest evidence in the field, and undergo several rounds of peer review before being approved by the AAP Board of Directors. and published in
Pediatrics.
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