AAP broadens RSV prevention guidelines to include older infants and toddlers for first time in recent update

The American Academy of Pediatrics has expanded its protective guidance against respiratory syncytial virus for infants and young children, reflecting new evidence on the effectiveness of recent preventive products and adjusting risk categories for the upcoming 2026-27 season.

The American Academy of Pediatrics has broadened its guidance on preventing respiratory syncytial virus in children, widening the group of older infants and toddlers considered high risk while keeping protection in place for the youngest babies. The updated policy, due to appear in the November 2026 issue of Pediatrics, covers the 2026-27 respiratory virus season and reflects what the academy describes as growing evidence that newer preventive products are reducing severe illness and hospital admissions.

According to the academy, all infants younger than eight months should still receive RSV protection when they are entering their first season, unless they were already protected through maternal vaccination during pregnancy. The revised guidance also expands eligibility for children aged eight to 19 months who are entering a second RSV season and remain vulnerable to serious complications. Sean T O’Leary, who chairs the academy’s RSV immunisation subgroup, said the evidence shows the products “work very well to prevent RSV and keep infants out of the hospital” and added, “We’re already seeing real-world impact.”

RSV remains one of the most important causes of severe respiratory disease in young children. The virus spreads through close contact and respiratory droplets, and while many infections look like an ordinary cold, it can progress to bronchiolitis or pneumonia in infants. The academy says the illness is the leading cause of infant hospitalisation in the United States, with the Centres for Disease Control and Prevention estimating between 50,000 and 80,000 paediatric hospitalisations a year among children under five. Preventive options have also grown, with nirsevimab and the maternal RSVPreF vaccine introduced ahead of the 2023-24 season, and clesrovimab licensed last summer.

The RSV update was released alongside the academy’s 2026-27 recommendations for COVID-19 vaccination in children. The group says infants and young children aged six to 23 months should receive the season’s COVID-19 vaccine, while children and teenagers aged two to 18 years who face higher risk of severe disease should get one age-appropriate dose regardless of prior vaccination history. For lower-risk children, the academy said vaccination should remain available for families who want it. Together with earlier influenza guidance, the recommendations are meant to give paediatricians a clearer seasonal framework for respiratory protection, while the academy has separately lowered the minimum age for the MenQuadfi meningococcal vaccine to six weeks after clinical trials and regulatory approval.