The American College of Cardiology (ACC) just released new clinical guidance, Adult Immunizations as Part of Cardiovascular Care: 2026 ACC Concise Clinical Guidance. This 2026 version updates and replaces the 2025 version. The 2026 update provides guidance regarding the influenza, COVID-19, pneumococcal, RSV, and zoster vaccines. 

Below, we’ve outlined the recommendations included in the 2026 respiratory vaccine recommendations for patients with heart disease guidance summary. Notably, in this year’s recommendations, the RSV vaccine recommendation changed from ≥60 to ≥50 years. Additional clarity was added to the influenza recommendation, stating a preference for high-dose, recombinant, or adjuvanted formulations for adults ≥65 years. The COVID-19 recommendation was also updated, stating that clinicians should ensure initial series completion and the current season updated vaccine is administered. To view the 2026 guidance update in its entirety, view the full-text version.

Respiratory Vaccine Recommendations for Patients with Heart Disease from the 2026 ACC Guidance

Annually Recurring

  • Influenza: Annual, initiate at ≥6 months. Nasal vaccine not recommended for patients >50 years. Prefer high-dose, recombinant, or adjuvanted formulations for adults ≥65 years.
  • COVID-19: Updated annually, initiate at ≥6 months. Ensure initial series completed and current season updated vaccine administered.

One-Time or Series

  • Pneumococcal: One dose, initiate in adults ≥19 years. PCV20 or PCV21 preferred. Alternative vaccines require two vaccinations.
  • RSV: One dose, initiate in adults ≥50 years. Single lifetime dose currently recommended.
  • Zoster: Two-dose series, initiate in adults ≥50 years. Recombinant zoster vaccine. Administer dosed two to six months apart.

Other Vaccines

  • Other: Refer to current CDC schedule for adult patients. Multiple additional vaccines are recommended by the CDC for all adults regardless of heart disease status.

The ACC guidance emphasizes that adverse health effects from vaccination are exceedingly rare and are far outweighed by the demonstrated benefits, notably in patients living with heart disease. 

Check out our other cardiology-related content and be sure to sign up for alerts to stay informed on the latest published guidelines and articles.