Updated RSV Vaccine Guidance for 2026: Which Older Adults Should Get the Shot—and Why

The bottom line for 2026

For the 2025–2026 respiratory syncytial virus (RSV) season, U.S. health officials have clarified who should receive the RSV vaccine:

All adults age 75 and older are now routinely recommended to receive a one-time RSV vaccine.
Adults ages 60–74 should receive the vaccine if they have specific risk factors that increase their chance of severe RSV disease.

This updated guidance from the Centers for Disease Control and Prevention (CDC), based on recommendations from the Advisory Committee on Immunization Practices (ACIP), replaces earlier “shared decision-making” language for some groups and provides clearer age cutoffs for clinicians and patients.

Why RSV matters more than many people realize

RSV is often thought of as a childhood infection. But in older adults, it can lead to serious lower respiratory tract disease, including pneumonia and worsening of chronic heart or lung conditions.

According to CDC data summarized in its RSV guidance and ACIP reports in MMWR, tens of thousands of U.S. adults age 65 and older are hospitalized each year with RSV. The risk rises sharply with age and with chronic medical conditions.

Severe RSV in older adults can cause:

Shortness of breath and low oxygen levels
Pneumonia
Exacerbations of COPD or asthma
Heart failure flare-ups
Prolonged weakness and functional decline after hospitalization

For many families, RSV becomes a major event not just because of the infection itself, but because it can accelerate loss of independence in frail older adults.

What changed in the 2025–2026 guidance?

When RSV vaccines were first approved by the U.S. Food and Drug Administration (FDA) in 2023, ACIP recommended vaccination for adults 60 and older based on shared clinical decision-making. That meant patients and clinicians discussed individual risk and made a case-by-case choice.

Since then, ACIP has reviewed additional clinical trial data, real-world effectiveness data, and post-marketing safety monitoring. Based on that review, CDC guidance now states:

Routine vaccination for adults 75 and older.
Vaccination for adults 60–74 who have increased risk for severe RSV disease.

This shift provides clearer direction, especially for clinicians caring for older adults, and prioritizes those at highest risk.

Which adults 60–74 are considered higher risk?

According to CDC clinical guidance for older adults, people ages 60–74 should receive the RSV vaccine if they have conditions or circumstances that raise their risk for severe disease. These include:

Chronic lung disease (such as COPD or severe asthma)
Chronic heart disease (including heart failure or coronary artery disease)
Diabetes with complications
Chronic kidney or liver disease
Moderate or severe immune compromise
Severe obesity
Residence in a nursing home or long-term care facility

Adults who are medically frail or who have multiple chronic conditions may also benefit, even if not explicitly listed.

What evidence supports these recommendations?

The RSV vaccines for older adults—such as GSK’s Arexvy and Pfizer’s Abrysvo—were approved after large randomized controlled trials involving thousands of adults age 60 and older. These trials showed significant protection against RSV-associated lower respiratory tract disease during the first RSV season after vaccination.

ACIP evidence reviews published in MMWR also examined:

How well protection persisted into a second season
Real-world data on hospitalizations
Safety signals, including rare inflammatory neurologic conditions

Protection against severe RSV disease appears strongest in the first season after vaccination and may decrease over time. At this point, CDC recommends a single dose, not annual revaccination. Ongoing studies are evaluating durability and whether booster doses will be needed in future years.

As with any vaccine, monitoring continues. ACIP weighed the benefits—reduced hospitalizations and severe disease—against rare but potential risks when making its age- and risk-based recommendations.

Is the RSV vaccine given every year?

No. Current CDC guidance recommends one dose for eligible older adults. It is not considered an annual vaccine like the flu shot.

Researchers are still studying how long protection lasts. Future recommendations could change if evidence shows waning protection that meaningfully affects severe outcomes.

Can it be given with flu or COVID-19 vaccines?

Yes. CDC guidance states that RSV vaccine can be given at the same visit as influenza or COVID-19 vaccines. Some people may experience temporary side effects like arm soreness, fatigue, headache, or muscle aches.

For people who prefer to separate vaccines to better distinguish side effects, spacing doses by a week or two is reasonable, but not required.

Who should wait or talk with a clinician first?

People should speak with a healthcare professional if they:

Have had a severe allergic reaction to a prior dose or vaccine component
Are currently moderately or severely ill
Have a history of certain neurologic conditions and want to discuss risks and benefits

As always, vaccination decisions should be individualized, especially for adults with complex medical histories.

What does this mean for Medicare and cost?

Under current federal policy, vaccines recommended by ACIP are generally covered without cost-sharing for Medicare beneficiaries under Part D.

According to Medicare coverage guidance, RSV vaccination for eligible adults should be covered with no out-of-pocket cost for most beneficiaries. Private insurance plans are also typically required to cover ACIP-recommended vaccines without cost-sharing, though network and pharmacy rules may vary.

Availability may differ by region or provider supply, especially early in the RSV season. Pharmacies, primary care clinics, and some public health clinics offer RSV vaccination.

How this affects families and caregivers

For families caring for older adults—especially those over 75 or living in long-term care—this updated guidance provides clearer direction. RSV outbreaks in nursing homes can lead to rapid spread and severe illness.

Vaccination can be one layer of protection, along with:

Good hand hygiene
Staying home when sick
Improving indoor ventilation during respiratory virus season
Keeping up to date on flu and COVID-19 vaccination

For medically vulnerable adults, preventing one hospitalization can mean avoiding a cascade of complications that sometimes follow severe respiratory illness.

What remains uncertain

Several questions are still being studied:

How long protection lasts beyond two RSV seasons
Whether booster doses will eventually be recommended
How vaccine effectiveness compares across different health conditions

CDC and ACIP continue to review new evidence each year. Recommendations may evolve as longer-term data accumulate.

What this means for readers

If you are 75 or older, RSV vaccination is now routinely recommended for you.

If you are 60–74 and have chronic heart or lung disease, diabetes with complications, immune compromise, severe obesity, or live in long-term care, you are likely a candidate.

If you are healthy and under 75, talk with your clinician about your individual risk.

RSV is not just a “bad cold” in older adults. For those at highest risk, vaccination may reduce the chance of hospitalization and serious complications. A short conversation with your healthcare provider this season can help clarify what’s right for you.

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.