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 also important for people with primary biliary cholangitis (PBC), particularly those with advanced liver disease or weakened immune systems.

PBC is an autoimmune disease that damages the small bile ducts in the liver. Over time, this damage can lead to fibrosis (liver scarring) and, in some people, cirrhosis, which is advanced liver scarring.

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PBC itself doesn’t necessarily weaken the immune system. However, advanced liver disease or immune-suppressing medicines, such as those used after a liver transplant, can affect 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.

There isn’t one vaccine plan that’s right for everyone with PBC. Your age, liver health, 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 PBC, especially those with advanced liver disease, this protection may be particularly important because respiratory infections can lead to serious complications.

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 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 PBC who have received a liver transplant or take immune-suppressing medicines, the timing of the flu vaccine may need to be coordinated with treatment.

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 weakened immune systems, including some people with PBC who take immune-suppressing 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 PBC. Factors such as the extent of liver damage, whether you’ve had a liver transplant, and whether you take medicines that suppress the immune system can influence vaccine decisions.

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 CDC guidance for people with chronic liver disease and factors such as:

• Which PBC treatments you’re receiving and whether any affect immune function
• Whether your immune system is suppressed and your response to vaccination may be reduced
• Whether you’ve had a liver transplant, which can affect when you should be vaccinated or whether you need additional doses
• Your age, other health conditions, and previous vaccination history
• Which vaccines and doses you’ve already received, including whether an additional COVID-19 dose may be appropriate

Some vaccine types may not be appropriate for people with PBC who are immunocompromised. 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 if you’re preparing for a liver transplant or taking medicines that suppress your immune system. When possible, getting recommended vaccines before a liver transplant can help your body respond better to them.

Your liver care team can recommend the best timing based on your treatment and immune function. Don’t delay, skip, or change PBC 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 liver care team whether getting more than one vaccine at the same appointment is appropriate.

7 Questions To Ask Your Liver Care Team About Seasonal Vaccines

1. Which flu, COVID-19, and RSV vaccines do you recommend for me?
2. Does my current PBC treatment affect which vaccines I should receive?
3. Is there a best time to get vaccinated within my treatment schedule?
4. Do I need an additional COVID-19 vaccine dose?
5. Should I receive an RSV vaccine this season?
6. Can I receive more than one vaccine at the same appointment?
7. Does a previous liver transplant change my vaccine schedule?