AAP expands RSV protection to older children with specific health conditions amid later, more severe season

The American Academy of Paediatrics has broadened its RSV vaccination guidelines to include children aged 8 to 19 months with certain health conditions, recognising ongoing risks in the second RSV season as the season shifts later and becomes more severe.

The American Academy of Paediatrics has widened its advice on respiratory syncytial virus protection to cover more children who are entering their second RSV season, saying new evidence shows some young patients remain at meaningful risk even after infancy. In updated guidance published in Pediatrics, the academy now recommends immunisation for children aged 8 months to 19 months who have congenital heart disease, certain lung or neuromuscular disorders, Down syndrome, some chromosomal conditions, or were born before 32 weeks’ gestation and do not need ongoing medical support.

Andrew Racine, the AAP president, said during a briefing that high-risk children should receive a second dose “regardless of whether their mother was immunized when they were pregnant and regardless of whether or not that infant received an RSV immunization during their first RSV season.” The academy said the changes reflect evidence that while RSV hospitalisations generally fall after the first year of life, some children continue to face a substantially higher risk.

According to the AAP’s technical report, children with chronic conditions affecting multiple organ systems had more than twice the rate of hospitalisation in their second RSV season as in their first. The new advice also extends to children with certain forms of cystic fibrosis, chronic lung disease that has required recent medical support, and all Native American and Alaska Native children.

For babies in their first RSV season, the academy continues to recommend a monoclonal antibody unless protection was already provided by maternal vaccination during pregnancy. The AAP said most infants hospitalised with RSV have no underlying high-risk medical condition, underscoring why first-season protection remains the main public health priority.

The update comes as other medical groups adjust their seasonal guidance in response to a later RSV pattern. The American College of Obstetricians and Gynaecologists has extended the recommended window for the maternal RSV vaccine ABRYSVO from September 1 through March 1, rather than ending on January 31, after saying the disease season is now arriving later in the spring and appears more severe than in past years. Christina Davidson, ACOG’s chief medical officer, said the longer eligibility window should give pregnant patients and infants more protection.