AAP Releases RSV Prevention, COVID Vax Recommendations for Fall

The American Academy of Pediatrics (AAP) updated its recommendations for the prevention of respiratory syncytial virus (RSV) and the use of COVID vaccines in kids.

Based on a technical report detailing the current evidence on RSV prevention, the AAP Committee on Infectious Diseases recommended immunization with a monoclonal antibody — either nirsevimab (Beyfortus) or clesrovimab (Enflonsia) — for all infants younger than 8 months who are born during or entering their first RSV season, unless they have documented protection from maternal vaccination.

The committee also recommended RSV immunization for those ages 8 to 19 months who are at high risk of severe RSV disease and entering their second RSV season. (Currently, nirsevimab is the only product indicated for prevention of RSV in kids who remain vulnerable in their second RSV season.)

Notably, a review of current evidence supported expanding the high-risk criteria for RSV immunization to include the following:

• Children born preterm, at <32 weeks, 0 days’ gestation, regardless of the need for medication or other support
• Children with hemodynamically significant congenital heart disease (i.e., a defect that can result in symptoms and/or cardiac chamber dilation)
• 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 that put them at higher risk of severe RSV disease

“The evidence is clear: These products work very well to prevent RSV and keep infants out of the hospital,” said Sean O’Leary, MD, MPH, of the AAP Committee on Infectious Diseases, in a statement. “We’re already seeing real-world impact.”

After HHS Secretary Robert F. Kennedy, Jr. drastically reduced the number of universally recommended childhood immunizations earlier this year, experts worried that progress in protecting young kids against RSV would be reversed.

Based on the current evidence for COVID vaccines, the AAP Committee on Infectious Diseases recommended that all infants and children ages 6 to 23 months with no contraindications receive the 2026-2027 COVID vaccine.

In addition, children and adolescents ages 6 months to 18 years who are moderately or severely immunocompromised should receive two or more doses of an age-appropriate vaccine, depending on previous vaccination status.

A single dose of an age-appropriate vaccine for children and adolescents ages 2 to 18 years — regardless of prior COVID vaccination status — was advised in the following groups:

• Those at high risk of severe COVID
• Residents of long-term care facilities or other congregate settings
• Those who have never been vaccinated against COVID
• Those whose household contacts are at high risk for severe COVID

Finally, children and adolescents 2 years and up who are not considered at increased risk of severe COVID should be offered a single dose of an age-appropriate COVID vaccine if their parent or guardian wants their child to be protected against COVID.

The AAP emphasized that any available COVID vaccine, appropriate for age and health status, can be administered, and that the most updated version of the COVID vaccine that is available should be used. Last week, the FDA approved four updated COVID vaccines for the 2026-2027 season targeting the SARS-CoV-2 variant that dominated last season.

Major medical organizations have been keen to help fill the gap in vaccine recommendations, given that the CDC has not issued any. The AAP published an updated policy statement on influenza prevention last month, and the Infectious Diseases Society of America, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians have also issued guidance on fall respiratory virus shots.

The CDC’s Advisory Committee on Immunization Practices didn’t hold its March or June meetings this year amid a legal challenge — by the AAP and other medical groups — stemming from the CDC’s announcement that it was reducing the number of universally recommended childhood vaccines in January. A federal court decision has staved off any changes to pediatric vaccine recommendations for now.

As the AAP rolled out its own childhood immunization schedule this past winter — which continues to recommend routine immunization for protection against 18 diseases — the organization said it no longer endorses the CDC’s version.