AAP expands RSV immunization recommendations for high-risk children

The American Academy of Pediatrics (AAP) has expanded recommendations for respiratory syncytial virus (RSV) immunization among children aged 8 through 19 months at increased risk of severe disease as they enter their second RSV season.^1,2

The updated policy statement, published online September 2, 2026, in Pediatrics, maintains the AAP recommendation for RSV immunization for all infants younger than 8 months who are born during or entering their first RSV season unless they have documented protection from RSV vaccination of their pregnant parent. The guidance also broadens the high-risk criteria for older infants and children entering their second season.

“The evidence is clear: these products work very well to prevent RSV and keep infants out of the hospital,” Sean T. O’Leary, MD, MPH, FAAP, chair of the RSV immunization subgroup of the AAP Committee on Infectious Diseases, said in an AAP statement. “We’re already seeing real-world impact.”

RSV commonly causes mild, cold-like symptoms but can result in lower respiratory tract infections, including bronchiolitis and pneumonia, in young children. According to the AAP press release, RSV causes approximately 50,000 to 80,000 hospitalizations annually among US children younger than 5 years.

Which children are newly included in the second-season RSV guidance?

Beginning with the 2026-2027 RSV season, the AAP expanded the criteria for children aged 8 through 19 months considered at high risk of severe RSV disease.

The expanded groups include children born preterm at less than 32 weeks, 0 days’ gestation, regardless of whether they require medication or other support; children with hemodynamically significant congenital heart disease; children with anatomic pulmonary abnormalities or neuromuscular disorders that increase their risk for severe RSV disease; and children with Down syndrome or other chromosomal differences that place them at higher risk.

Other groups meeting high-risk criteria include children with chronic lung disease attributable to prematurity or other significant neonatal conditions who required specified medical support during the 6 months before the second RSV season; children with severe immunocompromise; certain children with cystic fibrosis; and American Indian or Alaska Native children.

The AAP recommends second-season immunization for eligible children regardless of maternal RSV vaccination status or whether the child previously received nirsevimab or clesrovimab during the first RSV season. The guidance specifies that eligibility is based on chronological rather than corrected age for children born preterm.

Which RSV immunization products does the AAP recommend?

Nirsevimab and clesrovimab are recommended for prevention of RSV lower respiratory tract infection among eligible infants younger than 8 months. Both are monoclonal antibodies administered as a single dose. The AAP does not express a preference between licensed products when they are appropriate for a child’s age and health status.

For children aged 8 through 19 months entering their second RSV season, only those who meet high-risk criteria should receive immunization. Nirsevimab is currently the only RSV immunization product indicated for children who remain vulnerable during their second season.

When should pediatricians administer RSV immunization?

For most of the continental United States, the AAP recommends administering RSV monoclonal antibodies from October 1 through March 31. Timing may differ in areas with different or less predictable RSV seasonality, and local or regional surveillance data may inform adjustments.

Infants born shortly before or during RSV season should receive immunization within the first week after birth, ideally during the birth hospitalization. Eligible infants born outside RSV season should receive immunization shortly before the season begins or as early as feasible during the season.

The AAP also recommends simultaneous administration of RSV immunization with age-appropriate routine childhood vaccines. Previous RSV infection does not eliminate the recommendation for nirsevimab or clesrovimab because reinfection can occur during the same season.

For most infants younger than 8 months whose pregnant parent received RSVpreF vaccine at least 14 days before delivery, additional RSV immunization is not needed, although the policy identifies circumstances in which clinicians may consider it based on individual risk.

“Talk with your pediatrician if you have any questions,” O’Leary said.

References

1. American Academy of Pediatrics. American Academy of Pediatrics Issues Recommendations for RSV Immunizations 2026-2027. American Academy of Pediatrics. Press release. September 2, 2026. Accessed September 2, 2026. https://www.aap.org/en/news-room/news-releases/aap/2026/american-academy-of-pediatrics-issues-recommendations-for-rsv-immunizations-2026-2027/

2. American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for the prevention of RSV disease in infants and children: policy statement. Pediatrics. Published online September 2, 2026. doi:10.1542/peds.2026-079047.