---
title: "AAFP issues 2026 fall recommendations for COVID-19, flu and RSV amid competing guidance"
id: "news-news-medical-economics-6b84049cecf5ea17b463a7ed"
canonical_url: "https://medichelpline.com/news/news-news-medical-economics-6b84049cecf5ea17b463a7ed"
content_type: "medical_news_article"
category: "Public Health"
source_name: "Medical Economics"
source_url: "https://www.medicaleconomics.com/view/aafp-issues-fall-vaccine-recommendations-amid-competing-guidance"
published_at: "2026-09-02T18:55:11.000Z"
license: "CC-BY-NC-4.0 / Informational Use"
---
# AAFP issues 2026 fall recommendations for COVID-19, flu and RSV amid competing guidance
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- **Category:** [Public Health](https://medichelpline.com/news/public-health.md)
- **Reporting Source:** Medical Economics
- **Original Source URL:** [Read Original Article](https://www.medicaleconomics.com/view/aafp-issues-fall-vaccine-recommendations-amid-competing-guidance)
- **Published At:** 2026-09-02T18:55:11.000Z
## Executive Summary & Key Highlights
- The American Academy of Family Physicians (AAFP) released fall 2026 immunization recommendations for **COVID-19**, **influenza** and **RSV**, coordinated with AAP, ACOG and IDSA as part of the Vaccine Integrity Project. - AAFP advises annual influenza vaccination for everyone aged 6 months and older; adults 65+ should preferentially receive an enhanced influenza product but should not delay vaccination to obtain one. - Updated COVID-19 vaccination is recommended for all adults 19 and older, with extra emphasis on adults 65+, those at increased risk of severe infection, and people never previously vaccinated; adults 65+ should get a second dose six months after the first. - For children, AAFP recommends COVID-19 vaccination for ages 6–23 months and a risk-based single-dose approach for ages 2–18, aligned with AAP; vaccination is recommended in any trimester and during lactation, aligning with ACOG. - AAFP supports CDC/ACIP RSV guidance for a one-time vaccine for adults 75+ and for high-risk adults 50–74, and recommends RSV vaccination for immunocompromised adults and adolescents; pregnant patients should receive RSV vaccine at 32–36 weeks. - Infants under 8 months without maternal protection should receive long-acting monoclonal antibodies **nirsevimab** or **clesrovimab** rather than RSV vaccination; high-risk infants 8–19 months entering a second season should receive nirsevimab. - Insurance coverage and Vaccines for Children (VFC) procurement remain tied to ACIP recommendations adopted by the CDC; society-issued guidance does not automatically trigger coverage or VFC purchasing. - Practice-level barriers include upfront vaccine purchasing costs, inconsistent reimbursement, lack of payment for immunization counseling CPT codes 90482–90484, and fragmentation when pharmacies vaccinate outside registries. - The Vaccine Integrity Project review identified hundreds of eligible studies and reported vaccine effectiveness estimates across diseases; the review and societies’ guidance are available on AMA and AAFP websites. - Technical guidance for implementing the recommendations into immunization information systems and EHRs is being prepared by the American Immunization Registry Association and is expected by mid-September.
## In-Depth Reporting & Editorial Analysis
## AAFP issues coordinated fall immunization guidance for 2026 season 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.” ## Key recommendations for influenza, COVID-19 and RSV AAFP's recommendations address seasonal influenza, updated COVID-19 vaccination and RSV prevention across age groups and special populations. Influenza - The academy recommends annual influenza vaccination for everyone aged **6 months and older** without a medical contraindication. - Adults **65 and older** should preferentially receive an enhanced influenza product (high dose, adjuvanted, recombinant or mRNA) when one is available, but AAFP advises not delaying vaccination to obtain an enhanced product. COVID-19 - Updated COVID-19 vaccination is recommended for **all adults 19 and older**, with particular emphasis on adults 65 and older, people at increased risk of severe disease, and those who have never received a COVID-19 vaccine. - AAFP advises adults 65 and older to receive a **second dose six months** after the first updated vaccine dose. - For children, the academy recommends vaccination for ages **6 to 23 months** and a risk-based single-dose approach for ages **2 to 18**, which AAFP says aligns with AAP. - Vaccination is recommended in any trimester of pregnancy and during lactation, consistent with ACOG guidance. RSV - AAFP supports CDC guidance recommending a **one-time RSV vaccine** for adults **75 and older** and for adults **50 to 74** who are at increased risk. The academy also recommends RSV vaccination for **immunocompromised** adults and adolescents, aligning with IDSA. - Pregnant patients should receive RSV vaccination at **32 to 36 weeks** during the September–March window. - For infants under **8 months** who lack maternal protection, AAFP recommends long-acting monoclonal antibodies **nirsevimab** or **clesrovimab** rather than vaccination. High-risk infants and children **8 through 19 months** entering a second season should receive nirsevimab. 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. ## Evidence summarized by the Vaccine Integrity Project 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: - Updated COVID-19 vaccination was 53% effective against hospitalization among adults 65 and older during the 2025–2026 season. - Among children 9 months through 4 years, vaccination was associated with a 76% reduction in COVID-19–related emergency department visits. - An analysis found influenza vaccination provided 31% protection against influenza-associated hospitalization in older adults. Across eight influenza seasons, vaccine effectiveness against laboratory-confirmed influenza-associated death among children and adolescents was 80%. - RSV vaccination among adults 60 and older showed single-season effectiveness estimates of 69% to 83% against RSV-related hospitalization. - Nirsevimab effectiveness in infants ranged from 63.6% to 93% against RSV-related hospitalization within 6 to 12 months depending on timing. - A cohort study of U.S. veterans reported RSV vaccine effectiveness of 81.1% over the first six months and 48.5% at 12 to 18 months. 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. ## Coverage, procurement and legal context 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. ## Operational challenges for practices 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. ## Implementation into clinical systems and next steps 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. ## What the article does not report 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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