The American Academy of Pediatrics released its evidence-based US childhood and adolescent immunization schedule—distinct from current Advisory Committee on Immunization Practices guidance—with updated recommendations in Red Book Online.

The schedule provides updated guidance for influenza, respiratory syncytial virus (RSV), and COVID for patients from birth through aged 18 years. The Academy noted that its schedule differs from recent recommendations from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, particularly regarding COVID vaccination for infants and younger children.

For COVID, the AAP recommended vaccination for all patients aged 6 through 23 months and a single age-appropriate dose for those aged 2 through 18 years who are at higher risk, reside in congregate settings, are previously unvaccinated, or have high-risk household contacts. Vaccination may also be offered to other patients aged 2 through 18 years at parental request using the most current formulation.

For RSV, the AAP recommended passive immunization with the monoclonal antibodies nirsevimab and clesrovimab and stated that palivizumab is no longer recommended. Immunization is advised for infants younger than 8 months who are born during or entering their first RSV season when their mother did not receive an RSV vaccine, when vaccination status is unknown, or when birth occurred less than 14 days after maternal vaccination. A second-season dose is recommended for patients aged 8 through 19 months at high risk, including those with chronic lung disease, immunocompromise, or cystic fibrosis and other specified groups.

For influenza, the AAP recommended annual vaccination beginning at 6 months and early antiviral treatment for hospitalized patients, those with serious or worsening symptoms, or those at elevated risk for complications.

The 2024 to 2025 season was characterized as high severity, with the Centers for Disease Control and Prevention reporting 267 pediatric deaths through August 2, 2025; 43.6% occurred in children without a high-risk condition. Historically, up to 80% of pediatric influenza deaths occurred in unvaccinated or incompletely vaccinated children, with the highest vulnerability in patients aged younger than 5 years, particularly those younger than 2 years.

For COVID, the AAP recommended vaccination for all patients aged 6 through 23 months and a single age-appropriate dose for those aged 2 through 18 years who are at higher risk, reside in congregate settings, are previously unvaccinated, or have high-risk household contacts. Vaccination may also be offered to other patients aged 2 through 18 years at parental request using the most current formulation.

Additional updates include guidance on pentavalent meningococcal vaccine, a revised starting age for human papillomavirus vaccine, and removal of a hepatitis vaccine that is no longer available. The AAP urged insurer coverage of all vaccines included in the schedule and noted a parent-facing schedule will be available on HealthyChildren.org.

Source: American Academy of Pediatrics