Updated RSV guidance in 2026: Which older adults should get vaccinated, who can wait, and why

If you want the practical answer first, here it is: get one RSV vaccine if you are 75 or older and have not had it already. If you are 50 to 74, the shot is mainly for people at higher risk of severe RSV because of certain medical problems, frailty, or nursing home residence. If you are otherwise healthy and younger than 75, current CDC guidance says you can usually wait. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

Quick answer box: Who should get an RSV shot in 2026?

Yes: all adults 75 and older who have not already received an RSV vaccine. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
Yes: adults 50 to 74 who are at increased risk of severe RSV illness. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
Usually wait: healthy adults 50 to 74 without risk factors. Immunize.org, which translates CDC and ACIP policy into plain language for clinicians and the public, says these adults should wait until a high-risk condition develops or until they turn 75. ([immunize.org](https://www.immunize.org/ask-experts/topic/vaccine-recs-adults-rsv/))
One dose for now: RSV vaccination is not annual. If you already had one RSV shot, CDC says you should not get another routine dose at this time. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
Best timing: in most of the continental United States, the best window is usually August through October, though eligible adults can be vaccinated at other times. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

The simple decision tree

Age 75 or older? Get one RSV shot if you have not had it before. CDC now recommends this for everyone in that age group because age itself is a major risk factor for severe RSV. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

Age 50 to 74? Ask whether you have a high-risk condition or another factor that raises the chance that RSV could land you in the hospital. If yes, vaccination is recommended. If no, current guidance generally says you can wait and revisit the question later. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

Already got an RSV shot in a prior season? You are considered vaccinated. CDC says RSV vaccination is a single dose for now, not a yearly shot like flu vaccine. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

Why CDC changed course

The guidance most people see in 2026 is the result of two earlier policy shifts. First, in June 2024, the CDC’s Advisory Committee on Immunization Practices, or ACIP, moved away from broad shared decision-making for healthy adults 60 to 74. Instead, it recommended routine vaccination for everyone 75 and older and risk-based vaccination for adults 60 to 74. ACIP said the benefits of vaccination did not clearly outweigh the potential harms in adults 60 to 74 who had no risk factors for severe RSV disease. ([cdc.gov](https://www.cdc.gov/mmwr/volumes/73/wr/mm7332e1.htm))

Then, in April 2025, ACIP voted to lower the starting age for high-risk adults from 60 to 50. That recommendation was later adopted as official CDC policy in June 2025. That is why the current CDC page now says adults 50 to 74 at increased risk should get one dose. ([cdc.gov](https://www.cdc.gov/acip/vaccine-recommendations/index.html))

What did not change is just as important: CDC did not recommend RSV vaccination for all adults 50 and older. For healthy adults under 75, the recommendation remains narrower. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

What counts as high risk in everyday terms

CDC’s list is broader than many people realize. For adults 50 to 74, the RSV shot is recommended if you have risk factors such as: ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

chronic heart disease, such as heart failure or coronary artery disease ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
chronic lung disease, including COPD, emphysema, asthma, interstitial lung disease, or cystic fibrosis ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
end-stage kidney disease or dialysis dependence ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
diabetes that is complicated by organ damage, kidney disease, nerve damage, eye damage, or treatment with insulin or an SGLT2 inhibitor ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
moderate or severe immune compromise ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
severe obesity, defined by CDC as a body mass index of 40 or higher ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
neurologic or neuromuscular conditions that make it harder to clear the airway or cough effectively ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
chronic liver disease or chronic blood disorders such as sickle cell disease or thalassemia ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))
frailty, or residence in a nursing home or other long-term care setting ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

CDC also leaves room for clinician judgment. A healthcare professional may recommend vaccination for other chronic conditions or situations that make severe RSV harder to manage. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

What one dose seems to do

The best real-world evidence so far suggests the main benefit is reducing serious RSV illness and hospitalization, not preventing every infection. A 2026 JAMA study looked at 6,958 adults age 60 and older who were hospitalized with acute respiratory illness at 26 hospitals in 20 states over two RSV seasons. It was a test-negative case-control study, which is an observational design, not a randomized trial. ([jamanetwork.com](https://jamanetwork.com/journals/jama/fullarticle/2838490))

Across the two seasons, the study estimated that one RSV dose was 58% effective against RSV-associated hospitalization. Effectiveness was estimated at 69% when vaccination happened in the same season and 48% when vaccination happened in the prior season; the difference between those estimates was not statistically significant. ([jamanetwork.com](https://jamanetwork.com/journals/jama/fullarticle/2838490))

That is encouraging, but it is not the final word. Protection in the study appeared lower among immunocompromised adults and among adults with cardiovascular disease. The authors estimated effectiveness at 30% in immunocompromised adults and 56% in people with cardiovascular disease, compared with higher estimates in healthier comparison groups. The study also could not assess Moderna’s mResvia because uptake was too low. ([jamanetwork.com](https://jamanetwork.com/journals/jama/fullarticle/2838490))

In plain language: one dose appears to help across at least two RSV seasons, but experts still do not know exactly when some adults might benefit from revaccination in the future. ([jamanetwork.com](https://jamanetwork.com/journals/jama/fullarticle/2838490))

Why it is not annual yet

CDC currently recommends one dose only for eligible older adults. The agency says surveillance and evaluation are still ongoing to determine whether additional doses will be useful later on. That makes RSV different from flu vaccination, which is yearly. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

This uncertainty about how often people might eventually need revaccination was one reason ACIP narrowed its earlier, broader recommendation for healthy adults in their 60s and early 70s. ([cdc.gov](https://www.cdc.gov/mmwr/volumes/73/wr/mm7332e1.htm))

Safety and side effects: what to know without overreacting

Common side effects are usually mild to moderate and include pain where the shot was given, fatigue, headache, muscle aches, joint aches, and sometimes nausea, depending on the product. CDC says RSV vaccines may be given at the same visit as other routine adult vaccines, although side effects may be a bit more common when vaccines are coadministered. ([cdc.gov](https://www.cdc.gov/vaccine-safety/vaccines/rsv.html))

The more serious safety issue readers may have heard about is Guillain-Barré syndrome, or GBS, a rare neurologic condition. FDA now requires a warning in the prescribing information for Pfizer’s Abrysvo and GSK’s Arexvy. In a postmarketing observational study among Medicare beneficiaries 65 and older, FDA estimated about 9 excess GBS cases per million doses for Abrysvo and about 7 excess cases per million doses for Arexvy. FDA also said the available evidence is still insufficient to prove a causal relationship and that the benefits of vaccination continue to outweigh the risks. ([fda.gov](https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-requires-guillain-barre-syndrome-gbs-warning-prescribing-information-rsv-vaccines-abrysvo-and))

CDC’s vaccine safety page makes the same overall point for the groups currently recommended to be vaccinated: older adults at highest risk are still more likely to benefit from protection against RSV hospitalization and death than to be harmed by this rare possible side effect. ([cdc.gov](https://www.cdc.gov/vaccine-safety/vaccines/rsv.html))

Practical advice: when to get it, where to get it, and why many people still have not

CDC says eligible adults can receive any of the FDA-licensed RSV vaccines available for their age group, and CDC does not prefer one brand over another. In most of the continental United States, late summer to early fall, usually August through October, is the best time to get vaccinated before RSV starts spreading more widely. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

If you are also due for flu or COVID-19 vaccination, CDC says RSV vaccine can be given during the same visit. That can be convenient for people who have trouble getting to multiple appointments, though some may prefer to separate shots to make side effects easier to sort out. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

Many eligible adults still remain unvaccinated. CDC’s RespVaxView dashboard estimated that as of January 2026, RSV vaccine coverage was 40.9% among adults 75 and older and 30.9% among adults 50 to 74 at increased risk. ([cdc.gov](https://www.cdc.gov/respvaxview/dashboards/vaccination-behavioral-social-drivers.html))

For Medicare beneficiaries, Medicare says the RSV shot is covered under Part D, and people with Part D pay nothing for the vaccine when it is ACIP-recommended. Medicare says you can get it in places such as a doctor’s office or local pharmacy. ([medicare.gov](https://www.medicare.gov/coverage/respiratory-syncytial-virus-rsv-shot?utm_source=openai))

What this means for readers

If you are 75 or older, the decision is straightforward: if you have not had an RSV shot yet, CDC says you should get one. If you are 50 to 74, the key question is whether you have high-risk health conditions, frailty, or nursing home residence. If you are a healthy adult under 75, current guidance generally says you can wait. ([cdc.gov](https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/adults.html))

The bigger picture is simple: RSV vaccination in 2026 is targeted, not one-size-fits-all. The goal is to protect the people most likely to end up seriously ill or hospitalized, while researchers keep tracking how long protection lasts and whether repeat doses will make sense later. ([cdc.gov](https://www.cdc.gov/mmwr/volumes/73/wr/mm7332e1.htm))

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.