Who Should Get COVID, Flu, and RSV Shots This Fall?
This fall, the major U.S. doctors' groups recommend the updated COVID, flu, and RSV shots for a wider group than the FDA label and CDC now cover. AAFP endorses the updated COVID shot for every adult 19 and up. ACOG urges COVID, flu, and RSV vaccination in every pregnancy. AAP kept routine COVID vaccination for babies 6 to 23 months and high-risk kids 2 to 18. If your own physician recommends a shot the FDA label no longer lists you on, the evidence is behind them.
For 2026-27, the FDA approved the updated XFG COVID vaccines only for adults 65 and older and for people under 65 with a qualifying high-risk condition. That covers Pfizer's Comirnaty down to age 5, Moderna's Spikevax down to 6 months and mNEXSPIKE down to 12, and Novavax's Nuvaxovid down to 12. The CDC's advisory committee then reclassified COVID vaccination as an individual decision rather than a universal recommendation, and didn't issue fresh fall guidance for RSV. Flu guidance from July 2025 stands.
The label changed. The evidence didn't.
Where the doctors' groups landed
AAFP, AAP, ACOG, the American College of Physicians (ACP), and the Infectious Diseases Society of America (IDSA) issued their own 2026-27 respiratory-virus guidance, informed by an independent AMA/Vaccine Integrity Project review of 299 studies published between August 2025 and June 2026. On who should get each shot, they went broader than the label.
| Shot | FDA label / CDC 2026-27 | Major medical societies |
|---|---|---|
| Updated COVID-19 (XFG) | Adults 65+; ages 6 months to 64 (ranges vary by product) with a qualifying high-risk condition | AAFP: all adults 19+. ACP: all 65+ and 18-64 at increased risk; others may consider |
| COVID-19 in pregnancy | No routine recommendation; individual decision | ACOG: recommended in every pregnancy, any trimester, and during lactation |
| COVID-19 in children | Narrower schedule, high-risk focus | AAP: routine for infants 6-23 months; single dose for high-risk 2-18 year olds |
| Influenza | Everyone 6 months+ (unchanged) | AAFP, AAP, ACOG: everyone 6 months+ |
| RSV in adults | Adults 75+; some 60-74 at risk | AAFP/IDSA: adults 75+ and adults 50-74 at increased risk |
Where the FDA and CDC pulled back, the societies didn't, because the shots still cleared their bar for benefit in the wider group. On flu, where the two already agreed, they still agree.
What the evidence actually shows
The societies and the federal agencies are reading the same studies. Here's what those studies say.
COVID shot. The 2024-25 vaccines cut COVID hospitalization by roughly a third to a half in adults overall, and by about half in older adults, across large U.S. test-negative and cohort studies. In pregnancy, two doses of an mRNA vaccine cut infant COVID hospitalization in the first six months of life by about half to two thirds, with the strongest protection during Delta and lower but still meaningful protection during Omicron. Babies under six months can't be vaccinated themselves; their protection comes through mom.
RSV shots. In the pivotal trials in adults 60 and older, the three licensed vaccines (Arexvy, Abrysvo, mResvia) cut lower respiratory RSV disease by roughly two thirds to more than four fifths in the first season. Real-world data from the first post-licensure season landed in the same range.
Flu shot. Pooled test-negative studies show the annual flu shot cuts flu-related hospitalization in adults by about 40%, with better protection early in the season than months later. For adults 65 and older, high-dose and adjuvanted vaccines outperform standard-dose by a modest margin, mostly on hospitalization.
None of that proves each shot is right for everyone. It's the basis the societies used to go broader than the label.
The one safety signal worth knowing
Myocarditis after an mRNA COVID vaccine is more common in adolescent and young adult males, and it clusters in the week after dose 2. Rates run on the order of tens to low hundreds per million doses. Most cases involve brief hospital stays and short-term recovery, though small follow-up series show a substantial share still have persistent symptoms or cardiac imaging findings at three months, and long-term prognosis remains uncertain. A healthy young man should weigh that risk against the benefit. It didn't lead the societies to walk back their recommendations for the groups they still cover.
If you're deciding this fall
If you're 65 or older, pregnant, or have a qualifying high-risk condition, the FDA label, CDC, and every major society agree you should get the COVID shot. The split doesn't affect you, and access should be straightforward. If you're a healthy adult under 65 and your physician recommends the updated COVID shot, AAFP's broader position and the underlying trial and real-world data back that call, even though the label no longer names you.
Access is where you'll feel the split. Some pharmacists and insurers may go by the FDA indication rather than the society recommendation, so confirm coverage before you show up. If a pharmacy declines, ask your physician's office to order or administer the shot on the society recommendation.
The federal government narrowed the label. The doctors who treat patients didn't narrow the evidence. For fall 2026, the societies' recommendations are the closer read of what the trial and real-world data show, and a patient whose own physician recommends a shot has that evidence behind them.