The American Academy of Family Physicians (AAFP) published fall 2026 recommendations for COVID-19, influenza and RSV on Sept. 2, 2026. The academy said it developed the guidance in coordination with the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG) and the Infectious Diseases Society of America (IDSA) through the Vaccine Integrity Project. AAFP released adult, adolescent and child schedules in March; its childhood schedule aligns with AAP's.
AAFP noted that multiple immunization schedules remain in circulation because a federal narrowing of the childhood schedule made in January was stayed by a federal judge in March and is now on appeal. That legal situation has left the pre-June 2025 schedule as the operative federal schedule in some contexts. AAFP said it aims to provide clear recommendations amid “changing guidance.”
AAFP's recommendations address seasonal influenza, updated COVID-19 vaccination and RSV prevention across age groups and special populations.
Influenza
COVID-19
RSV
Health care personnel are recommended to receive annual updated influenza and COVID-19 vaccines because of repeated occupational exposure and contact with patients at high risk of severe disease.
The Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research and Policy, conducted three reviews covering influenza, COVID-19 and RSV and identified 299 eligible studies, primarily published between August 2025 and June 2026. The reviews were published in JAMA and provided to the societies to inform their recommendations.
Selected findings reported in the review include:
The project’s review identified no new safety signals for the three immunizations in comparative studies it examined. The review did not identify eligible studies reporting on the effectiveness of clesrovimab; later trial data on clesrovimab were published after the review’s search window closed.
CDC preliminary burden estimates for the 2025–2026 season were cited: influenza was associated with an estimated 390,000 to 800,000 hospitalizations; for RSV, CDC’s preliminary estimates were 2.8 million to 5.8 million outpatient visits, 170,000 to 340,000 hospitalizations and 9,900 to 25,000 deaths.
AAFP highlighted that federal insurance coverage and Vaccines for Children (VFC) procurement remain tied to Advisory Committee on Immunization Practices (ACIP) recommendations that the CDC director adopts and that appear on CDC immunization schedules. Section 2713 of the Public Health Service Act, added by the Affordable Care Act, requires applicable health plans to cover ACIP recommendations adopted by the CDC without cost sharing. The VFC program similarly depends on an ACIP VFC resolution before the CDC contracts for a vaccine.
Society-issued recommendations from AAFP, AAP, ACOG or IDSA do not themselves trigger coverage mandates or VFC purchasing. A Congressional Research Service report on the 2026 childhood schedule found that federal and state laws reference ACIP or CDC recommendations and noted the federal policy consequences of the January schedule change remain unclear if it takes effect.
AHIP announced in May that member health plans will continue covering all ACIP-recommended immunizations with no cost sharing through the end of 2027, but that statement is a voluntary commitment from a trade association rather than a legal mandate.
AAFP President Sarah C. Nosal, M.D., FAAFP, emphasized practice-level barriers that affect vaccine delivery. Practices typically must purchase vaccine doses up front before administration. That financial burden, combined with lower capital compared with large health networks and pharmacies, limits what many primary care offices can stock. Nosal noted that the majority of childhood vaccines are administered in primary care offices and expressed concern about limited vaccine availability in smaller practices.
Three CPT codes for immunization counseling on days when no vaccine is administered (90482–90484) took effect on Jan. 1, 2026, allowing clinicians to document counseling work. However, Nosal said CMS has not reimbursed those codes and most private payers were also not paying for them as of her August comments. AAFP said it is engaged in advocacy to secure payment for that work.
Fragmentation of records is another operational issue. Not all states require that adult vaccinations be entered into registries, and pharmacy-based vaccination that occurs outside registries can result in incomplete records, missed or duplicate doses, and difficulty reconciling vaccination histories across sites of care.
The American Immunization Registry Association is translating the societies’ influenza, RSV and COVID-19 recommendations into structured technical guidance for immunization information systems, electronic health records and other clinical systems. An implementation note posted alongside the recommendations on the AMA website said that guidance is expected by mid-September and encouraged organizations to reference those resources before building independent technical logic.
AAFP and the partner societies have posted their recommendations and a consolidated printable reference on the AMA website, and AAFP has published schedules and shared clinical decision-making guides on its site. AAFP urged physicians to use those resources as the most up-to-date source of guidance.
The source article does not provide itemized costs for vaccine doses to practices, specific reimbursement rates, or a timetable for when CPT codes 90482–90484 might be reimbursed by CMS or private payers. It also does not detail state-by-state registry requirements or the exact technical specifications that the American Immunization Registry Association will issue in mid-September.
For clinicians and practices, the societies’ joint guidance and the Vaccine Integrity Project reviews are available on AMA and AAFP web pages for reference and local implementation planning.
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