AAFP updates COVID-19, RSV & flu vaccine guidance for 2026–27

Clinical takeaway: Review COVID-19, RSV, and influenza eligibility together during fall visits. Key updates include two doses of the updated 2026–27 COVID-19 vaccine, spaced six months apart, for adults aged 65 years or older; RSV vaccination for immunocompromised adults and adolescents; and a longer seasonal window for maternal RSV vaccination.

The American Academy of Family Physicians (AAFP) has released 2026–27 fall immunization recommendations developed in coordination with the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and Infectious Diseases Society of America (IDSA) through the Vaccine Integrity Project.

COVID-19

AAFP recommends COVID-19 vaccination for all adults aged 19 years or older. Adults aged 65 years or older should receive two doses of the updated 2026–27 vaccine, spaced six months apart. Vaccination also remains recommended during any trimester of pregnancy and during lactation.

For children, AAFP aligns with AAP's guidance: vaccinate all children aged 6–23 months and use a risk-based, single-dose approach for ages 2–18 years. Families of children without risk factors who want protection should still be offered vaccination. Moderately or severely immunocompromised children require two or more doses, depending on their vaccination history. AAP also advises vaccinating as soon as an updated product is available and the child is eligible.

CDC recommendations for the dosing and timing of 2026–27 COVID-19 vaccines are not yet available. The AAFP and AAP recommendations are broader than current FDA indications, which generally limit vaccination in people younger than 65 to those with at least one condition associated with severe COVID-19. Read more: Four FDA-approved COVID-19 vaccines for the 2026–27 season

RSV

One-time RSV vaccination remains recommended for all adults aged 75 years or older and adults aged 50–74 years at increased risk. AAFP now also recommends RSV vaccination for immunocompromised adults and adolescents, aligning with IDSA. No RSV vaccine is currently FDA-approved for people younger than 18; for immunocompromised adolescents, IDSA advises an individualized clinician-family discussion based on the patient’s risk.

For pregnant patients, AAFP advises administering Abrysvo at 32–36 weeks’ gestation during September–March, extending the seasonal window from September–January in its 2025 guidance. Infants younger than 8 months without maternal protection should receive nirsevimab or clesrovimab, while high-risk children entering their second RSV season should receive nirsevimab.

Influenza

Annual influenza vaccination remains recommended for everyone aged 6 months or older. CDC’s interim 2026–27 guidance maintains its July 2025 recommendations, including preferential use of high-dose, recombinant, or adjuvanted vaccines for adults aged 65 years or older. AAFP additionally includes the newly approved mRNA vaccine among the preferred options for this age group, but advises administering any age-appropriate influenza vaccine rather than delaying vaccination if a preferred product is unavailable.

IDSA notes that COVID-19, RSV, and influenza vaccines may be administered at the same visit when indicated. AAFP also recommends annual updated COVID-19 and influenza vaccination for health care professionals.

“Vaccines are one of medicine’s greatest success stories. They prevent serious illness, reduce hospitalizations and long-term complications and save lives,” said AAFP President Sarah Nosal, MD, FAAFP.

Sources: American Academy of Family Physicians. (2026 Sep 2). AAFP announces fall immunization recommendations to protect patients and communities; American Academy of Pediatrics Committee on Infectious Diseases. (2026 Sep 2) Pediatrics. Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026–2027: Policy Statement; American Academy of Pediatrics Committee on Infectious Diseases. (2026 Aug 10) Pediatrics. Recommendations for Prevention and Control of Influenza in Children, 2026–2027: Policy Statement; Infectious Diseases Society of America. (2026 Sep 2). IDSA recommends respiratory vaccines for people with weakened immune systems