AAP recommendations expand second-season RSV protection criteria for children ages 8 to 19 months, alongside updated infant COVID-19 vaccination recommendations.
RT’s Three Key Takeaways:
- Expanded High-Risk Eligibility: The American Academy of Pediatrics updated its guidance to expand high-risk criteria for respiratory syncytial virus immunizations among children ages 8 through 19 months entering their second respiratory virus season, according to an AAP news release.
- Universal Infant Protection: The academy continues to recommend respiratory syncytial virus protection for all infants under 8 months of age entering their first season, unless protected through maternal immunization during pregnancy, according to the AAP policy statement.
- Broad Respiratory Defense: Alongside respiratory syncytial virus guidance, the AAP released 2026–2027 recommendations for COVID-19 and influenza to complete clinical guidance for pediatric respiratory virus care, according to the organization.
The American Academy of Pediatrics (AAP) has released updated clinical recommendations expanding the categories of high-risk infants and children eligible for respiratory syncytial virus (RSV) immunization, according to the organization.
The policy statement, titled “Recommendations for the Prevention of RSV Disease in Infants and Children,” outlines preventive standards for the 2026–2027 season and is scheduled for publication in the November 2026 issue of Pediatrics, according to the AAP.
Under the updated guidance, the AAP continues to recommend RSV immunization for all infants younger than 8 months of age born during or entering their first RSV season, provided the infant does not have documented protection from maternal vaccination during pregnancy, according to the release. Additionally, the guidelines expand high-risk eligibility criteria for children ages 8 through 19 months who are entering their second RSV season and remain vulnerable to severe respiratory complications, according to the academy.
“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.”
Clinical Burden and Preventative Landscape
RSV infects the nose, throat, and lungs, spreading through physical contact and airborne transmission, according to the AAP. While symptoms in many individuals remain mild and cold-like, the virus frequently progresses to serious lower respiratory tract infections such as bronchiolitis and pneumonia in infants. The pathogen remains the leading cause of infant hospitalization across the US, generating between 50,000 and 80,000 pediatric hospitalizations each year in children under 5 years of age, according to Centers for Disease Control and Prevention data cited by the AAP.
For pediatric respiratory care teams and healthcare systems, immunization options have expanded in recent years. Monoclonal antibody nirsevimab and the maternal RSVPreF vaccine initially entered clinical availability ahead of the 2023–2024 season, according to the AAP. An additional monoclonal product, clesrovimab, received licensure last summer, providing clinicians with additional tools for early preventive care, according to the AAP.
Additional Seasonal Respiratory Guidance
The RSV update coincides with the AAP’s release of recommendations for pediatric COVID-19 vaccination for the 2026–2027 season, also published in Pediatrics, according to the organization. The academy recommends that all infants and young children ages 6 through 23 months receive the 2026–2027 COVID-19 vaccine, according to the policy statement. For children and adolescents ages 2 through 18 years at elevated risk for severe disease, the AAP advises a single dose of an age-appropriate 2026–2027 formulation, regardless of earlier vaccination history, while keeping doses available for lower-risk patients whose parents request protection.
Together with previously issued guidance on influenza prevention, the AAP stated that these policies establish a seasonal framework for pediatric respiratory protection. Separately, the updated 2026 immunization schedule lowers the minimum age indication for the meningococcal ACWY conjugate vaccine MenQuadfi to 6 weeks, down from 2 years, following clinical trials and approval from the Food and Drug Administration (FDA), according to the AAP.
