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 spondyloarthritis, particularly those taking medicines that weaken their immune defenses.

Axial spondyloarthritis, which includes ankylosing spondylitis, is a type of inflammatory arthritis that affects the spine. Having spondylitis doesn’t automatically mean your immune system is weakened.

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Some spondyloarthritis treatments, including certain biologic medicines, can suppress the immune system and affect your infection risk and vaccine decisions.

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 spondyloarthritis. 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:

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 spondyloarthritis, vaccination decisions should take into account factors such as age, treatment, and immune function.

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’re made and which age groups or risk groups they’re 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 receiving a second dose of the COVID-19 vaccine two to six months after the first dose.

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 spondyloarthritis, the American College of Rheumatology (ACR) recommends flu vaccination even during active disease or immunosuppressive treatment. However, some medications may need to be discussed with a rheumatologist.

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.

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 spondyloarthritis whose immune systems are weakened by treatment, the IDSA recommends RSV vaccination starting at age 18. Having spondyloarthritis alone doesn’t mean you are immunocompromised.

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:

The right vaccine and timing can vary for people with spondylitis. Some medicines used for inflammatory rheumatic diseases, such as spondyloarthritis, can suppress the immune system and affect how strongly the body responds 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 vaccine types may not be appropriate for people with spondyloarthritis who take immunosuppressive medicines. For example, the nasal spray flu vaccine is a live vaccine and isn’t recommended for people who take immunosuppressive medication.

Timing Around Treatments

Timing may also matter. The American College of Rheumatology conditionally recommends discussing a two-week pause in methotrexate after flu vaccination if spondyloarthritis activity allows. Decisions to pause treatment 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 spondyloarthritis treatment to get vaccinated unless your healthcare 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.