ACOG Releases 2026-27 Respiratory Virus Season Immunization Recommendations for Pregnant and Postpartum Individuals

Washington, DC-Today, the American College of Obstetricians & Gynecologists (ACOG) released guidance that continues to strongly recommend vaccination against COVID-19, RSV, and influenza ahead of the 2026-27 respiratory virus season for all women who are pregnant, postpartum, or contemplating pregnancy. ACOG's three separate guidance documents on vaccination for each virus reinforce the overall importance of maternal immunization and are based on the latest safety and efficacy data.

"Vaccination is standard preventive care, and complications can occur in pregnancy as a result of not being vaccinated that are completely preventable ," said ACOG President Camille A. Clare, MD, MPH, CPE, FACOG. "Unfortunately, we are living in challenging times when it comes to the large amount of vaccine misinformation and disinformation that exists today, so even more responsibility falls to ob-gyns to combat that and make sure patients know the facts."

ACOG continues to collaborate with the Vaccine Integrity Project (VIP), which has completed a rigorous, updated vaccine evidence review for 2026-27 that has helped inform recommendations from its participating medical organizations, including ACOG, the American Academy of Pediatrics, the American Academy of Family Physicians, and the Infectious Diseases Society of America. In addition to participating in today's coordinated vaccine recommendation release, ACOG is also partnering with the American Medical Association this year on several activities to help boost vaccine confidence among patients.

COVID-19

Research continues to demonstrate that vaccination reduces the risk of severe disease in pregnancy, hospitalization, and adverse outcomes such as stillbirth and preterm birth, according to ACOG's latest Practice Advisory: "COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care." However, in the 2025-26 respiratory virus season, only 11.1% of pregnant women got vaccinated for COVID-19, down 25.7% from the previous year. Additional data show that the lowest vaccination rates are among Hispanic and Black pregnant women, reflecting the continued existence of inequities in access, distribution, and uptake.

ACOG's strong recommendation for vaccination and the updated booster doses for those contemplating pregnancy and individuals who are pregnant, postpartum, or lactating is now based on more than five years of research and millions of administered doses. The evidence has found no increased risk of miscarriage, stillbirth, preterm birth, small-for-gestational-age birth, or birth defects.

"It has been well established that COVID-19 vaccination does not cause pregnancy loss even when administered in the first trimester," said Mark Turrentine, MD, FACOG, lead author of the guidance. "This has been further reinforced by yet another study published this year examining data from the CDC's vaccine pregnancy registry. The true risk to pregnant people and their pregnancies is from COVID-19 infection, especially for those with preexisting health conditions. Vaccination remains the best way to mitigate that risk."

There are currently four COVID-19 FDA-approved vaccines that people may choose from, all of which are safe in pregnancy.

RSV

One of the most notable changes to the guidance on RSV vaccination is that ACOG now recommends that pregnant individuals receive a single dose of the bivalent RSV PreF vaccine Abrysvo from September 1 through March 1, instead of through January 31. According to the Practice Advisory: "Maternal Respiratory Syncytial Virus Vaccination," recent RSV disease seasons have occurred later in the spring and have become more severe, so the extension of the eligibility window will help clinicians provide pregnant people and their infants with additional protection. Current data show that 41.6% of eligible pregnant individuals have received the maternal RSV vaccine.

The bivalent RSV PreF vaccine continues to be the only vaccine approved by the FDA for use in pregnancy. However, unlike the COVID-19 and influenza vaccines that can be administered during any trimester and during each pregnancy, pregnant people should only receive the RSV vaccine once, as there is no data on effectiveness in any subsequent pregnancies.

ACOG recommends the vaccine be administered between 32 0/7 and 36 6/7 weeks of gestation for those who do not have a planned delivery within two weeks. If for any reason the vaccine is not administered during pregnancy, infants should receive one of the two available monoclonal antibodies, clesrovimab or nirsevimab, at birth.

"All pregnant patients should take RSV seriously," said Brenna Hughes, MD, FACOG, lead author of the Practice Advisory. "Every year we see as many as 80,000 children under the age of five being hospitalized because of RSV, and the highest rate is among babies that are 6 months old or younger. It is imperative that either patients are vaccinated or infants receive one of the monoclonal antibodies. We recommend that clinicians consider which option is most readily available and easily accessible when counseling patients."

Influenza

Vaccination for influenza remains an essential part of prepregnancy, prenatal, and postpartum care, according to ACOG's Practice Advisory: "Influenza in Pregnancy: Prevention and Treatment." Pregnant and postpartum individuals still have a significantly higher risk of developing serious complications from infection compared with nonpregnant people and therefore should be vaccinated generally between September and April as soon as the vaccines are available, before the onset of influenza circulation in their community.

This year, ACOG's guidance contains a table with recommendations for appropriate usage for all the FDA-approved influenza vaccines. Although the table includes the new mRNA vaccine that was approved last month, mRNA-1010 is not approved for use in pregnancy, and there is currently no data on its use for lactating individuals. The inactivated or recombinant influenza vaccines remain the only vaccines that are recommended for use in pregnancy in any trimester.

"As physicians, we cannot overemphasize the importance of passive immunity for newborns when it comes to influenza, COVID-19, and RSV," said lead guidance author Kevin Ault, MD, FACOG. "Maternal vaccination protects infants from serious illness and hospitalization in their first few months of life when they are unable to be vaccinated. Maternal flu vaccination after birth does provide antibodies through breast milk, but the infant does not get the full benefit of passive protection from vaccine-induced maternal antibodies that would have been transferred through the placenta."

ACOG's Practice Advisories note that all vaccines for COVID-19, RSV, and influenza approved for use in pregnancy can be administered at the same time with no impact on efficacy. Coadministered vaccination is safe for pregnant people and has the added benefit of increasing rates of vaccine uptake.

"An ob-gyn remains one of the most trusted messengers for pregnant patients when it comes to vaccination," said Dr. Clare. "And when the vaccines are available in the office at the time that the patient is being counseled, the odds of vaccine acceptance and receipt are five to 50 times higher. So, the opportunity is there to change our current trajectory and prevent the devastating consequences that come from not being protected."

Read Practice Advisories "COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care," "Maternal Respiratory Syncytial Virus Vaccination," and "Influenza in Pregnancy: Prevention and Treatment."