The American Academy of Paediatrics (AAP) has updated its recommendations for the prevention of respiratory syncytial virus (RSV) and COVID-19 in infants and children, incorporating recent evidence on vaccine efficacy, safety, and disease burden. The revised guidance broadens the eligibility criteria for RSV immunization in high-risk paediatric populations while reinforcing COVID-19 vaccination for young children and those at increased risk of severe disease.1
For RSV prevention, the AAP recommends immunization for all infants younger than 8 months of age who are born during or entering their first RSV season, provided they have not already received adequate passive protection through maternal RSV vaccination during pregnancy. The scenario in India is different at present. Indian Academy of Paediatrics (IAP)-ACVIP does not recommend use of Nirsevimab in all infants as strong epidemiological data is still lacking.2 Maternal immunization has been shown to confer transplacental antibodies that significantly reduce severe RSV-associated lower respiratory tract infection during early infancy. However at present maternal RSV vaccine is not licensed in India and there is no recommendation regarding giving the vaccine.2
The updated policy also expands the group of children eligible for RSV immunization during their second RSV season (8–19 months of age). Eligible children now include those born prematurely, irrespective of ongoing respiratory support or medication requirements, as well as children with hemodynamically significant congenital heart disease, structural pulmonary abnormalities, neuromuscular disorders that impair airway clearance, Down syndrome, and other chromosomal disorders associated with increased susceptibility to severe RSV disease.
Regarding COVID-19 prevention, the AAP recommends administration of the 2026–2027 age-appropriate COVID-19 vaccine to all infants and children aged 6–23 months who have no contraindications.3 Furthermore, a single dose of the updated vaccine is advised for children aged 2–18 years with conditions that place them at higher risk of severe COVID-19, regardless of their previous COVID-19 vaccination history. IAP has not listed COVID 19 vaccine as a part of routine immunization in children, it is considered to be a non-routine or emergency based depending on the prevailing epidemiological situations.
These updated recommendations reflect growing real-world evidence demonstrating that RSV immunization substantially reduces RSV-related hospitalization and severe lower respiratory tract disease in infants. By expanding eligibility for high-risk children and maintaining targeted COVID-19 vaccination strategies, the AAP aims to further reduce morbidity and improve protection against these important respiratory pathogens in paediatric populations.
References:
1. American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for the Prevention of Respiratory Syncytial Virus Infections in Infants and Children. Pediatrics. 2026. doi:10.1542/peds.2026-079047.
2. Shastri DD, Dhir SK, Rajsekhar B, Nayak S, Kumar CM, Agarwal A, et al. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP): Recommended Immunization Schedule (2025) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr. 2025.
3. American Academy of Paediatrics Committee on Infectious Diseases. Recommendations for the Use of COVID-19 Vaccines in Infants and Children, 2026–2027. Paediatrics. 2026.
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