30 Sep 2026 Update to Pediatric Respiratory Vaccine Guidelines (2026-2027)

Influenza Vaccine 

• Annual influenza vaccination is recommended for all children starting at 6 months of age.
• All children aged <5 years are considered high risk for severe influenza, especially those <2 years old.
  • Please refer to Table 2 in the resource below for other high-risk conditions.
• There is no preference for live versus inactivated influenza vaccine.
  • Not all children can receive the live influenza vaccine; there are specific medical contraindications (refer to Table 5).  
• Isolated egg allergy is not a contraindication to any formulation, including those manufactured in an egg-based process.
  • For parents who prefer an egg-free option, Flucelvax is a cell-based vaccine.
• Children aged <9 years who have not received 2 lifetime doses prior to this season should receive 2 doses spaced 4 weeks apart this season.  

Resource: Recommendations for Prevention and Control of Influenza in Children, 2026–2027: Policy Statement | Pediatrics | American Academy of Pediatrics

The following influenza vaccine formulations are available for ordering through the Vaccines for Children (VFC) program: 

COVID-19 Vaccine

COVID-19 vaccination is currently recommended for certain high-risk groups, which include:  

• All children aged 6-23 months due to higher COVID-19-associated hospitalization rates
• Persons at high risk of severe COVID-19 due to immunocompromise or underlying medical conditions (refer to Table 1 in the resource)  
• Residents of long-term care facilities or other congregate settings
• Persons whose household contacts are at high risk for severe COVID-19

Resource: Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027: Policy Statement | Pediatrics | American Academy of Pediatrics

The following COVID-19 vaccine formulations are available for ordering through the VFC program: 

RSV Immunization

• RSV antibody immunization continues to be recommended for all infants <8 months entering their first RSV season, ideally administered in the newborn nursery/NICU prior to discharge.
  • This is for infants whose birthing parents did not receive RSV vaccine during pregnancy, at least 14 days prior to delivery.
• Abrsyvo is available through the VFC program for pregnant people under age 19 years, with the current recommendation to administer the vaccine at 32-36 weeks of gestation between September and March (of note: this recommendation expands the previous September-January recommendation).
• RSV immunization is typically recommended from October to March. In 2025-2026, RSV season extended into April. The Philadelphia Department of Health will alert clinicians if RSV immunization needs to be extended past March.
• Infants and children 8 through 19 months of age at high risk of severe RSV disease entering their second RSV season should receive a second dose of RSV antibody.
  • Note the following expanded high-risk criteria for this group:
    • Preterm birth (<32 weeks’ gestation), regardless of the need for medication or other support
    • Hemodynamically significant congenital heart disease
    • Anatomic pulmonary abnormalities or neuromuscular disorders that increase the risk of severe RSV disease
    • Down syndrome or other chromosomal differences that raise the risk of severe RSV disease
  • Previous high-risk criteria still stand:
    • Chronic lung disease that required medical intervention in the 6 months prior to the start of this season  
    • Severe immunocompromise  
    • American Indian or Alaska Native children
    • Children with cystic fibrosis with severe lung disease or weight-for-length <10 %

Resource: Recommendations for the Prevention of Respiratory Syncytial Virus Disease in Infants and Children: Policy Statement | Pediatrics | American Academy of Pediatrics

The following RSV immunization formulations are available for ordering through the VFC program: