The American Academy of Pediatrics issued updated recommendations on the prevention of respiratory syncytial virus (RSV) and the use of COVID vaccines. The guidance outlines specific immunization protocols for infants and children across various age groups and risk categories.

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 children ages 8 to 19 months who are at high risk of severe RSV disease and entering their second RSV season. Nirsevimab is the only product indicated for prevention of RSV in kids who remain vulnerable in their second RSV season.

The organization expanded the high-risk criteria for RSV immunization to include several specific medical conditions and demographics. These expansions include children born preterm at less than 32 weeks gestation, regardless of the need for medication or other support. The criteria now also cover children with hemodynamically significant congenital heart disease.

Additionally, the guidelines include children with anatomic pulmonary abnormalities or neuromuscular disorders that put them at risk for severe RSV disease. The expansion further includes children with Down syndrome or other chromosomal differences that put them at higher risk of severe RSV disease.

Sean O'Leary, MD, MPH, of the AAP Committee on Infectious Diseases, commented on the effectiveness of these interventions. "The evidence is clear: These products work very well to prevent RSV and keep infants out of the hospital," he said. He added, "We're already seeing real-world impact."

Regarding coronavirus prevention, 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. The FDA approved four updated COVID vaccines for the 2026-2027 season targeting the SARS-CoV-2 variant that dominated the previous season. 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.

The recommendations differentiate dosage requirements based on immune status and risk factors. The AAP recommended that children and adolescents ages 6 months to 18 years who are moderately or severely immunocompromised receive two or more doses of an age-appropriate COVID vaccine, depending on previous vaccination status. For other groups, the AAP advised a single dose of an age-appropriate COVID vaccine for children and adolescents ages 2 to 18 years who are at high risk of severe COVID, residents of long-term care facilities or other congregate settings, those who have never been vaccinated against COVID, or those whose household contacts are at high risk for severe COVID.

For children without elevated risk profiles, the guidance offers optional protection. The AAP stated that 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 CDC has not issued any vaccine recommendations for the current period. This absence of federal guidance occurs as the CDC's Advisory Committee on Immunization Practices did not hold its March or June meetings this year during a legal challenge by the AAP and other medical groups. The legal challenge stems from the CDC's announcement in January that it was reducing the number of universally recommended childhood vaccines. HHS Secretary Robert F. Kennedy, Jr. reduced the number of universally recommended childhood immunizations earlier this year.

A federal court decision has staved off any changes to pediatric vaccine recommendations for now. In response to the regulatory shifts, the AAP rolled out its own childhood immunization schedule this past winter. The AAP childhood immunization schedule continues to recommend routine immunization for protection against 18 diseases. The AAP said it no longer endorses the CDC's version of the childhood immunization schedule.

Other medical organizations have also provided direction for the upcoming season. The Infectious Diseases Society of America, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians have issued guidance on fall respiratory virus shots. The AAP published an updated policy statement on influenza prevention last month.

Why It Matters

The divergence between the American Academy of Pediatrics and the Centers for Disease Control and Prevention marks a shift in how pediatric immunization guidance is disseminated. With the CDC unable to convene its advisory committee due to legal challenges regarding reduced vaccine mandates, the AAP has assumed a primary role in defining standard care for respiratory viruses. This situation affects clinical decision-making for providers who rely on authoritative schedules for routine patient care.

The expanded criteria for RSV and the detailed stratification for COVID vaccines provide a framework for protecting vulnerable populations during a period of federal uncertainty. By maintaining recommendations for 18 diseases and issuing specific guidance for high-risk infants and immunocompromised children, the AAP aims to ensure continuity of preventive care. The real-world impact noted by committee members suggests these measures are actively influencing hospitalization rates and disease outcomes.