Two policy statements from the American Academy of Pediatrics landed today, both worth reading in full.
On respiratory syncytial virus, the recommendation for first-season protection is unchanged in principle: immunise every infant under 8 months of age born during or entering their first RSV season, unless that infant has documented protection from maternal vaccination in pregnancy. The change is at the second season. The AAP has expanded the high-risk criteria that qualify infants and children aged 8 through 19 months for immunisation entering their second RSV season, on the basis of a review of the evidence set out in an accompanying technical report. If you have been working from the previous, narrower criteria, some children you were excluding now qualify.
On COVID-19, the 2026-2027 recommendations are age-tiered. All infants and children 6 through 23 months without contraindications should receive the 2026-2027 vaccine. Children and adolescents 2 through 18 years at increased risk of severe COVID-19 should receive a single dose regardless of previous vaccination. For those 2 through 18 not at increased risk, a single dose should be offered where a parent or guardian wants it — a permissive rather than routine recommendation. Any age-appropriate vaccine may be used, and the most updated formulation available should be given.
Both documents are American, and neither maps directly onto Indian practice, where RSV immunisation is not routinely available and paediatric COVID vaccination policy is set nationally. The transferable content is different. RSV seasonality in much of India tracks the monsoon rather than a temperate winter, so 'entering their first RSV season' has to be interpreted locally. And the AAP's shift towards defining who is at increased risk of severe disease, rather than vaccinating by age alone, is the framework worth borrowing — that list of conditions is the same list wherever you practise.
- Re-check the second-season RSV criteria; the high-risk list for 8 to 19 months has been widened.
- Infants protected by maternal RSV vaccination in pregnancy do not need first-season immunisation.
- COVID vaccination is now routine for 6 through 23 months and risk-based for 2 through 18 years.
- For children 2 to 18 not at increased risk, the recommendation is to offer on request, not to advise routinely.
- Apply the risk-based framework locally; RSV seasonality in India follows the monsoon, not a temperate winter.
The statistics, in plain English
These are policy statements, which state what should be done; the evidence sits in the accompanying technical reports rather than in the statements themselves. That structure is worth knowing, because a policy statement gives you the recommendation without the strength of evidence behind each part of it. The AAP is explicit that the COVID recommendations may change as variants emerge, which is a signal that these are seasonal operational guidance rather than settled science.
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