Doctors and major medical organizations have released 2026-27 respiratory vaccine recommendations for flu, Covid-19 and RSV as the United States enters another fall respiratory virus season with limited new federal guidance from the CDC.
The recommendations come from the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and Infectious Diseases Society of America. Their guidance was informed by independent evidence reviews conducted by the American Medical Association and the University of Minnesota’s Vaccine Integrity Project.
The effort is designed to provide clinicians, patients and families with evidence-based information at a time when the traditional federal process for reviewing vaccine evidence and issuing recommendations has been disrupted.
The independent reviews published in JAMA on September 2 found that vaccines against influenza, SARS-CoV-2 and RSV continue to provide meaningful protection against serious disease. The reviews also found no new safety concerns in comparative analyses of currently recommended immunizations. JAMA’s respiratory vaccine evidence review
Bruce Gellin, chair of the Vaccine Integrity Project’s board of advisors and a professor of medicine at Georgetown University, said the need for evidence-based guidance has not disappeared even as the federal process has changed.
The situation leaves physicians with a more fragmented policy environment than in previous years. Instead of relying on a single federal recommendation for every population, patients may need to consider guidance from medical organizations based on age, pregnancy status, underlying conditions and other risk factors.
What the 2026-27 respiratory vaccine recommendations say about RSV
The RSV recommendations cover older adults, pregnant people and infants, reflecting the groups considered most vulnerable to severe respiratory syncytial virus disease.
For adults, the medical groups recommend one RSV vaccine dose for everyone age 75 and older and for people ages 50 to 74 who have conditions that increase their risk of severe RSV disease. The vaccine is not considered an annual immunization under these recommendations. People who received an RSV vaccine previously generally do not need another dose for the current season.
Pregnant people are advised to receive the maternal RSV vaccine during the third trimester, between 32 and 36 weeks of pregnancy. The recommended timing has also been expanded this year. The American College of Obstetricians and Gynecologists now recommends that eligible pregnant patients receive Abrysvo from September 1 through March 1 rather than limiting the vaccination period through January 31.
The change reflects the observation that RSV disease activity has been occurring later into the spring and has become more severe, according to Christina Davidson, chief medical officer of ACOG.
For infants, the main form of protection is a monoclonal antibody rather than a conventional vaccine. Babies younger than 8 months should receive the antibody during the RSV season unless their mother received an RSV vaccination during pregnancy.
Children between 8 and 19 months who have specific conditions that place them at increased risk of severe RSV disease are also recommended to receive the antibody. Infants whose mother’s vaccination status is unknown should also receive it under the guidance described by pediatric specialists.
Adults with weakened immune systems are another group identified for RSV vaccination. However, Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, noted that immunosuppressed people face greater risks from RSV and that vaccine effectiveness can be lower in this population.
The latest JAMA evidence review similarly found that RSV immunizations were associated with lower risks of severe RSV disease and RSV-related hospitalization. The review also noted evidence suggesting that protection among older adults may be lower in subsequent seasons. JAMA’s 2026-27 RSV review
Flu and Covid vaccines remain central to fall protection
Influenza vaccination remains broadly recommended. The medical groups advise annual flu vaccination for everyone age 6 months and older unless a medical contraindication applies.
Sarah Nosal, president of the American Academy of Family Physicians, said flu vaccination typically reduces the risk of needing medical care by about 30% to 60%.
For adults 65 and older, enhanced influenza vaccines remain preferred when available. These include high-dose, adjuvanted and recombinant formulations. Patients should not delay vaccination simply because their preferred enhanced product is temporarily unavailable.
The 2026-27 season also introduces a new option. The FDA approved Moderna’s mRNA influenza vaccine, MFLUSIVA, on August 5 for adults age 50 and older. It is the first mRNA-based influenza vaccine approved in the United States. FDA information on MFLUSIVA
The approval does not mean that every adult should automatically receive the new mRNA vaccine. Its FDA-approved indication covers adults 50 and older, while medical organizations continue to provide broader population-specific guidance for seasonal influenza vaccination.
Covid-19 vaccination is also part of the new recommendations. The evidence review published in JAMA found that Covid-19 vaccines were consistently associated with reduced risks of hospitalization and other serious outcomes, including among people at higher risk of severe disease.
The FDA’s 2026-27 updated Covid vaccine approvals are more restricted than some of the recommendations issued by medical organizations. For example, Moderna’s updated MNEXSPIKE vaccine is approved for people 65 and older and for people ages 12 through 64 who have at least one underlying condition that increases their risk of severe Covid-19.
The difference between regulatory authorization and professional medical recommendations is important for patients. FDA approval establishes who can receive a particular product under its approved indication, while professional organizations may issue clinical recommendations based on their assessment of evidence for specific populations.
The American Medical Association and Vaccine Integrity Project say their evidence review found that the latest research continues to support the safety and effectiveness of respiratory immunizations for the populations in which they are recommended. American Medical Association vaccine review
For families, pediatric guidance remains particularly important. The American Academy of Pediatrics continues to publish recommendations covering influenza, Covid-19 and RSV for children and adolescents, with annual flu vaccination recommended for children beginning at 6 months of age. American Academy of Pediatrics vaccine guidance
The timing of vaccination also matters. Flu vaccines are generally administered before influenza activity becomes widespread, while RSV prevention is tied more closely to the seasonal period and, for pregnancy, to the timing of delivery. Patients with specific health conditions may need individualized advice from their clinicians.
Major pharmacies have begun making flu and RSV immunizations available, while updated Covid-19 vaccines are becoming available following their recent FDA approvals. Medical groups also said insurers have indicated that respiratory virus immunizations will continue to be covered.
The new recommendations therefore give physicians another framework for discussing vaccination with patients during the 2026-27 respiratory season, particularly for children, older adults, pregnant people and those with conditions that increase the risk of severe respiratory illness.
