Several leading medical organizations have released updated recommendations for flu, COVID-19, and respiratory syncytial virus (RSV) vaccines for the 2026-27 respiratory season. The guidance, available through the Vaccine Integrity Project, is especially important for people with rheumatoid arthritis (RA), particularly those taking medicines that weaken immune defenses.

RA is an autoimmune disease in which the immune system mistakenly attacks the joints, causing inflammation. Having RA itself doesn’t mean a person has a weakened immune system, but RA and some of its treatments can affect infection risk.

Some RA treatments, including certain disease-modifying antirheumatic drugs (DMARDs), can weaken immune defenses or reduce responses to vaccines. This makes individualized vaccination decisions especially important.

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Vaccines train the immune system to recognize and fight specific viruses. This can help your body respond more quickly if you’re exposed to them.

There isn’t one vaccine plan that’s right for everyone with RA. Your age, treatment plan, immune function, vaccination history, and other health conditions can all influence which vaccines are recommended and when you should receive them.

The Vaccine Integrity Project, working with the American Medical Association, reviewed the latest evidence on flu, COVID-19, and RSV immunizations for the 2026-27 respiratory season. The findings helped inform recommendations from several leading medical organizations, including:

• American Academy of Family Physicians
• American Academy of Pediatrics
• American College of Obstetricians and Gynecologists
• Infectious Diseases Society of America (IDSA)

The review included 299 studies published mostly between August 2025 and June 2026. It found that flu, COVID-19, and RSV immunizations continued to provide meaningful protection against hospitalization, severe illness, and death.

The amount of protection can vary based on the virus, the vaccine or immunization, the season, and a person’s health. For people with RA, vaccination decisions should take into account factors such as age, immune function, and medicines that affect the immune system.

For the 2026-27 respiratory season, COVID-19 and flu vaccines have updated formulations. There are also three RSV vaccines for adults. These vaccines differ in how they are made and which age groups or risk groups they are approved for.

COVID-19 Vaccines

The U.S. Food and Drug Administration (FDA) has approved four COVID-19 vaccine options. All four vaccines are given by injection.

The IDSA recommends that people with weakened immune systems discuss whether an additional COVID-19 vaccine dose is appropriate. A second seasonal dose may be given two to six months after the first, depending on individual circumstances.

Flu Vaccines

All U.S. flu vaccines for the 2026-27 season are trivalent, meaning they are designed to protect against three influenza viruses.

Most people need one flu vaccine dose each season. Some children may need a second dose based on their age, vaccination history, or individual health circumstances. For people with RA, flu vaccination timing may need to be coordinated with certain medicines, including methotrexate or rituximab.

People who are immunocompromised shouldn’t receive the live-attenuated nasal flu vaccine FluMist, per guidance from the U.S. Centers for Disease Control and Prevention (CDC) and IDSA.

RSV Vaccines

There are three FDA-approved adult RSV vaccines. FDA approval and recommendations for who should receive these vaccines differ by age and risk factors.

For adults, the CDC recommends a single dose of RSV vaccine for everyone age 75 and older and for adults ages 50 through 74 who are at increased risk of severe RSV illness.

For people with weakened immune systems, including some people taking immunosuppressive RA medicines, the IDSA recommends RSV vaccination starting at age 18. The RSV vaccine isn’t currently given every year.

For people who are immunocompromised, the benefits of vaccination generally outweigh the risks. Current evidence shows that flu, COVID-19, and RSV immunizations can reduce hospitalization, severe illness, and death. People with weakened immune systems may not respond as strongly to vaccines, but vaccination can still provide protection.

Vaccines can cause side effects, but serious side effects are uncommon. Your healthcare team can explain what to expect and help you weigh the benefits and risks based on your:

• Treatment plan
• Immune function
• Age
• Previous reactions
• Other health conditions

The right vaccine and timing can vary for people with RA. Some RA medicines suppress the immune system or reduce the body’s response to vaccines.

It’s important to ask not only which products are available, but which type, dose, and timing make sense for you.

Your healthcare team may consider:

Some vaccines may not be appropriate for people taking immunosuppressive RA medicines. For example, the nasal spray flu vaccine is a live vaccine and should not be used in people with weakened immune systems.

Timing Around Treatments

Timing may also matter. The American College of Rheumatology (ACR) recommends discussing a two-week pause in methotrexate treatment after the flu vaccine when RA is well controlled. The ACR also recommends coordinating the timing of certain vaccines with rituximab treatment. These decisions depend on disease activity and should be made with your rheumatology team.

Your rheumatology team can recommend the best timing based on your treatment and immune function. Don’t delay, skip, or change RA treatment to get vaccinated unless your rheumatology team recommends it.

People with weakened immune systems may not develop as strong a response to vaccines as people with healthy immune systems. That doesn’t mean vaccination has no benefit.

The Vaccine Integrity Project found that respiratory-virus immunizations continued to reduce severe outcomes among people with immunocompromising conditions, although protection varied.

In many cases, COVID-19, flu, and RSV vaccines can be given at the same visit.

Whether that makes sense for you may depend on your treatment schedule, previous vaccinations, expected side effects, and other health needs. Ask your rheumatology team whether getting more than one vaccine at the same appointment is appropriate.