AAP Issues Updated Guidance on RSV Prevention and COVID-19 Vaccination for Children

The American Academy of Pediatrics (AAP) has released updated clinical recommendations for the prevention of respiratory syncytial virus (RSV) and the administration of COVID-19 vaccines for children as the fall respiratory virus season approaches. The guidelines recommend monoclonal antibodies to protect infants and young children against RSV, alongside vaccines to safeguard younger and higher-risk children against COVID-19. These recommendations come as major medical organizations work to fill the void left by the federal government’s lack of updated vaccine guidance.

The American Academy of Pediatrics (AAP) has updated its clinical recommendations for the prevention of respiratory syncytial virus (RSV) and the use of COVID-19 vaccines in children.

Based on a comprehensive technical review of the current evidence, the AAP Committee on Infectious Diseases recommends immunization with a monoclonal antibody—specifically nirsevimab (Beyfortus) or clesrovimab (Enflonsia)—for all infants younger than 8 months who are born during or entering their first RSV season, provided they do not have documented protection from maternal vaccination.

Additionally, the committee recommends RSV immunization for children aged 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 approved for preventing RSV in children who remain vulnerable during their second RSV season.

A review of the latest evidence also supports expanding the criteria for high-risk RSV immunization to include:

• Children born preterm, at less than 32 weeks, 0 days’ gestation, regardless of the need for medication or other support.
• Children with hemodynamically significant congenital heart disease (defined as a defect that can result in symptoms and/or cardiac chamber dilation).
• Children with anatomic pulmonary abnormalities or neuromuscular disorders that increase their risk of severe RSV disease.
• Children with Down syndrome or other chromosomal differences that elevate their risk of severe RSV disease.

“The evidence is clear: These products are highly effective at preventing RSV and keeping infants out of the hospital,” stated Sean O’Leary, MD, MPH, of the AAP Committee on Infectious Diseases. “We are already observing significant real-world impact.”

The release of these recommendations comes as major medical organizations step in to address the gap in federal vaccine guidance. Earlier this year, concerns arose that progress in protecting young children against RSV would be reversed following the drastic reduction of universally recommended childhood immunizations by HHS Secretary Robert F. Kennedy, Jr.

Regarding COVID-19 vaccines, the AAP Committee on Infectious Diseases recommends that all infants and children aged 6 to 23 months without contraindications receive the 2026–2027 COVID-19 vaccine.

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

A single dose of an age-appropriate vaccine is advised for children and adolescents aged 2 to 18 years—regardless of prior COVID-19 vaccination status—who fall into the following categories:

• Those at high risk of severe COVID-19.
• Residents of long-term care facilities or other congregate settings.
• Those who have never been vaccinated against COVID-19.
• Those with household contacts who are at high risk for severe COVID-19.

For children and adolescents aged 2 years and older who are not considered at increased risk of severe COVID-19, a single dose of an age-appropriate vaccine should be offered if the parent or guardian desires protection for their child.

The AAP emphasized that any available COVID-19 vaccine appropriate for a child’s age and health status can be administered, and the most current formulation available should be utilized. Last week, the FDA approved four updated COVID-19 vaccines for the 2026–2027 season, targeting the SARS-CoV-2 variant that dominated the previous season.

With the Centers for Disease Control and Prevention (CDC) issuing no official recommendations, major medical organizations have worked to provide necessary clinical guidance. In addition to the AAP’s updated RSV and COVID-19 guidance, the Infectious Diseases Society of America, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians have also released fall respiratory virus vaccination recommendations.

The CDC’s Advisory Committee on Immunization Practices did not convene its March or June meetings this year due to a legal challenge filed by the AAP and other medical groups in response to the January announcement regarding the reduction of universally recommended childhood vaccines. A federal court decision has currently paused any changes to pediatric vaccine recommendations.

As the AAP released its own childhood immunization schedule this past winter—which continues to recommend routine vaccination for protection against 18 diseases—the organization announced that it no longer endorses the CDC’s schedule.

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