AAP Releases 2026-2027 Childhood Flu Recommendations

The American Academy of Pediatrics' (AAP) Committee on Infectious Diseases has published its annual policy statement on influenza prevention and control for the 2026-2027 season, recommending routine vaccination for all children 6 months of age and older without medical contraindications. The statement, along with an accompanying technical report, updates vaccine composition, treatment, and chemoprophylaxis guidance ahead of the coming respiratory illness season.¹

The recommendations arrive at a moment for pediatric immunization policy. On August 10, 2026, President Trump signed an executive order, "Delivering Gold Standard Childhood Vaccine Recommendations for Americans," narrowing the universally recommended childhood vaccine list to 11 immunizations and shifting influenza, along with hepatitis A, hepatitis B, rotavirus, and COVID-19 vaccines, into a shared clinical decision-making category between families and providers.²

The AAP responded the same day, with Andrew D. Racine, MD, PhD, FAAP, AAP president, saying the order "is not only disheartening but dangerous."³

What's New for the 2026-2027 Season

Several changes distinguish this season's guidance from prior years. All influenza vaccines licensed in the United States this season are trivalent, and their strain composition has been updated to reflect current World Health Organization and FDA recommendations for the Northern Hemisphere. Afluria is no longer available, and recommendations for immunizing immunocompromised children have been revised to align with guidance from other professional societies.¹

On January 9, 2026, the FDA advised influenza vaccine manufacturers to update prescribing information after 2 postmarketing observational studies identified an increased risk of febrile seizures on the first day following vaccination with standard-dose trivalent and quadrivalent vaccines in children 6 months through 4 years of age.¹ The AAP noted the attributable risk is low, estimated at 1 excess febrile seizure per 22,624 doses of trivalent vaccine.¹

Treatment and chemoprophylaxis guidance has also been clarified, emphasizing that chemoprophylaxis is not generally indicated for infants younger than 3 months. A generic formulation of baloxavir tablets became available beginning this season. Separately, the FDA approved an mRNA influenza vaccine, mFLUSIVA, on August 5, 2026, for adults 50 years and older. The AAP noted it is not indicated for use in children.¹

Vaccination Coverage and High-Risk Groups

Despite the AAP's standing recommendation, influenza vaccination coverage among children remained low during the 2025-2026 season. Through May 16, 2026, only 49.4% of children 6 months through 17 years of age had been vaccinated, similar to the previous year, with disparities noted by age, race and ethnicity, poverty status, urbanicity, and maternal educational status.¹

The policy statement emphasizes that children younger than 5 years, particularly those younger than 2, along with children with chronic pulmonary, cardiovascular, kidney, hepatic, hematologic, metabolic, or neurologic conditions and those who are immunocompromised, face increased risk of influenza-related hospitalization and complications. The AAP also cited data on racial and ethnic disparities in severe outcomes. Across 10 influenza seasons, Black, Hispanic, and American Indian/Alaska Native children experienced higher rates of influenza-associated hospitalization and intensive care unit admission, and influenza-associated in-hospital deaths were 3- to 4-fold higher among Black, Hispanic, and Asian/Pacific Islander children compared with White children.¹

The number of recommended doses is unchanged from prior seasons. Children 9 years and older need 1 dose regardless of history, and younger children need 2 doses, spaced at least 4 weeks apart, unless they have received at least 2 lifetime doses before the current season. The AAP recommends vaccination be completed by the end of October for optimal protection and states that any licensed product appropriate for age and health status may be used, with no preference given to a specific formulation.¹

Antiviral Treatment and Testing Guidance

The AAP recommends prompt antiviral treatment, ideally initiated as soon as possible, for any child hospitalized with suspected or confirmed influenza, any child with severe or progressive disease, and any child younger than 5 years or otherwise in a high-risk group, regardless of vaccination status or how long symptoms have been present. Oseltamivir remains the AAP's preferred antiviral for influenza A and B based on its cumulative safety and efficacy data in children, though the academy's recommendations for use in infants differ somewhat from FDA labeling.¹

Testing guidance directs pediatric clinicians to test when results will affect clinical management, such as decisions about starting antivirals, avoiding unnecessary antibiotics, or implementing infection-control measures, and calls for nucleic acid amplification testing in hospitalized patients when influenza is circulating in the community.¹

A Widening Divide Over Federal Vaccine Policy

The influenza statement comes after escalating conflict between the AAP and federal health officials over vaccine policy. The executive order signed August 10 builds on a December 2025 presidential memorandum and a May 2026 order directing the Department of Health and Human Services (HHS) to align the US immunization schedule more closely with those of peer countries, and it directs the HHS Task Force on Safer Childhood Vaccines to report within 90 days on offering single-antigen alternatives to combination vaccines and reassessing vaccine timing.²

In his statement, Racine argued the order lacked new scientific justification, saying dozens of studies show no link between vaccines and autism.³

"On-time immunization keeps our kids and our communities healthy and thriving," Racine said, encouraging parents with questions to consult their child's pediatrician.³

The tension is not new. In January 2026, the AAP released its own childhood immunization schedule independent of the CDC for the first time since the 2 organizations agreed to a single universal schedule in 1993.²

Sean O'Leary, MD, MPH, FAAP, chair of the AAP Committee on Infectious Diseases and lead author of the current influenza statement, said at the time, “We have to ignore everything about vaccines that is coming from our federal government."²

What It Means for Pharmacists

The divergence between AAP and federal guidance carries direct operational consequences for pharmacy practice, since vaccine administration authority and insurance coverage in many states are tied to the federal immunization schedule.²

In July 2026, the American Pharmacists Association and 8 partner organizations sent a joint letter to HHS Secretary Robert F. Kennedy Jr. warning that a revised Advisory Committee on Immunization Practices charter could delay recommendations pharmacists rely on for scope of practice and billing, citing data showing pharmacies administered 62% of adult influenza vaccines, 96% of RSV vaccines, and 89% of COVID-19 vaccines during the 2025-2026 season.²

The AAP noted that the CDC has not yet issued its own flu vaccine recommendations for the coming season, meaning the AAP and other medical societies are proceeding with independent, evidence-based guidance. The academy said flu vaccines are still expected to be covered by commercial insurance and remain available through the Vaccines for Children program.²

For pharmacists, that means influenza immunization workflows, counseling points, and billing practices for the 2026-2027 season should currently follow the AAP's newly published recommendations while federal guidance remains unresolved.

REFERENCES

1. American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2026-2027: policy statement. Pediatrics. 2026. doi:10.1542/peds.2026-078778

2. Gallagher A. Trump signs order narrowing childhood vaccine recommendations. Drug Topics. August 10, 2026. Accessed August 12, 2026. https://www.drugtopics.com/view/trump-signs-order-narrowing-childhood-vaccine-recommendations

3. Racine AD. AAP statement in response to executive order on vaccines. News release. American Academy of Pediatrics. August 10, 2026. Accessed August 12, 2026. https://www.aap.org/en/news-room/news-releases/aap/2026/aap-statement-in-response-to-executive-order-on-vaccines/