Vaccines Recommended for Older Adults

Vaccination remains an important part of preventive healthcare throughout adulthood. As people get older, some infections become more likely to cause severe illness, hospitalization, complications, or loss of independence.

Several vaccines are specifically recommended for older adults because the risk of certain infections increases with age. Other vaccines may be recommended because of chronic diseases, weakened immunity, occupation, travel, or other individual risk factors.

In the United States, recommendations from the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) provide an evidence-based framework for adult vaccination.

For older adults, important vaccines include those against influenza, COVID-19, shingles, pneumococcal disease, respiratory syncytial virus (RSV), tetanus, diphtheria, and pertussis. Other vaccines may be appropriate depending on a person’s health and vaccination history.

Disclaimer: This article is for informational purposes only and does not replace medical advice. Vaccination recommendations can change over time and may differ between countries. Always check the current recommendations in your country and discuss your individual vaccination needs with a healthcare professional.

Why are vaccines important for older adults?

The immune system changes naturally with aging. This process, sometimes called immunosenescence, can reduce the body’s ability to respond effectively to some infections.

Older adults are therefore more likely to experience complications from diseases such as influenza, pneumococcal infections, shingles, and respiratory infections.

Vaccination can reduce the risk of several vaccine-preventable diseases and their complications.

Vaccines are especially important for older adults with chronic conditions because illnesses such as diabetes, heart disease, lung disease, and kidney disease can increase the risk of severe infection.

Which vaccines should older adults receive?

The exact vaccination schedule depends on age, previous vaccinations, medical conditions, and other risk factors.

According to current CDC adult immunization recommendations, important vaccines for older adults include:

• influenza;
• COVID-19;
• shingles (recombinant zoster vaccine);
• pneumococcal vaccines;
• respiratory syncytial virus (RSV);
• tetanus, diphtheria, and pertussis;
• varicella, when indicated;
• measles, mumps, and rubella, when indicated;
• hepatitis A or hepatitis B, when indicated;
• other vaccines based on medical conditions, occupation, or travel.

The CDC recommends determining vaccination needs according to age first, followed by medical conditions and other individual indications.

Influenza vaccine

Influenza, commonly called the flu, can be more serious in older adults than in younger people.

Complications can include pneumonia, hospitalization, worsening of chronic diseases, and, in severe cases, death.

For this reason, annual influenza vaccination is recommended for older adults.

The CDC recommends one influenza vaccine dose every year for adults. For people aged 65 and older, certain influenza vaccines, including high-dose or adjuvanted vaccines, are preferred when available.

Why is a high-dose flu vaccine sometimes preferred for older adults?

The immune response to vaccination can become weaker with age.

High-dose and adjuvanted influenza vaccines are designed to produce a stronger immune response in older adults.

The CDC therefore prefers high-dose inactivated influenza vaccine, recombinant influenza vaccine, or adjuvanted influenza vaccine for adults aged 65 and older when available.

COVID-19 vaccine

COVID-19 can be more severe in older adults, particularly in people with underlying medical conditions.

Vaccination remains an important tool for reducing the risk of severe disease and hospitalization.

The number and timing of COVID-19 vaccine doses depend on the current vaccine formulation, age, previous vaccination, and individual risk factors.

Because COVID-19 recommendations can change as new vaccine formulations become available, older adults should follow the most recent recommendations from their country’s public health authorities.

In the U.S. adult schedule, adults aged 65 and older have had recommendations for additional updated COVID-19 vaccination doses because of their higher risk of severe disease.

Shingles vaccine

Shingles, also known as herpes zoster, is caused by reactivation of the varicella-zoster virus.

The risk of shingles increases with age.

One of its most troublesome complications is postherpetic neuralgia, a condition that can cause persistent nerve pain for months or even years after the skin rash has disappeared.

The CDC recommends the recombinant zoster vaccine (RZV, Shingrix) for adults aged 50 and older.

The usual schedule consists of two doses, generally given 2 to 6 months apart.

Can older adults get shingles even if they had chickenpox?

Yes.

After chickenpox, the varicella-zoster virus remains dormant in the body and can reactivate later in life, causing shingles.

Having had chickenpox does not eliminate the need for shingles vaccination.

The recombinant zoster vaccine is recommended based on age and other factors rather than requiring laboratory confirmation of previous chickenpox infection.

Can someone who already had shingles get vaccinated?

Yes.

A previous episode of shingles does not eliminate the recommendation for vaccination.

The vaccine can help reduce the risk of future episodes and complications.

Pneumococcal vaccines

Pneumococcal bacteria can cause serious infections such as:

• pneumonia;
• meningitis;
• bloodstream infections;
• other invasive pneumococcal diseases.

The risk of serious pneumococcal disease increases with age and certain medical conditions.

Current U.S. recommendations include pneumococcal conjugate vaccines such as PCV15, PCV20, and PCV21, with the appropriate vaccine and schedule depending on age and previous vaccination history.

The exact pneumococcal schedule can be complicated because it depends on which vaccine a person has already received.

For this reason, older adults should provide their vaccination history when discussing pneumococcal vaccination with a healthcare professional.

Does every older adult need a pneumococcal vaccine?

Pneumococcal vaccination is broadly recommended for older adults, but the specific vaccine and schedule depend on vaccination history and other factors.

Adults who have never received a pneumococcal conjugate vaccine may follow a different schedule from someone who previously received PCV13 or PPSV23.

This is one reason why it is important not to assume that every person needs the same number of pneumococcal vaccine doses.

RSV vaccine

Respiratory syncytial virus, or RSV, is a respiratory virus that can cause significant illness in older adults.

RSV infection can lead to pneumonia, hospitalization, and worsening of underlying heart or lung disease.

Current CDC recommendations include RSV vaccination for adults aged 75 and older.

Adults aged 60 through 74 may also be recommended to receive the vaccine when they are at increased risk of severe RSV disease because of medical conditions or other risk factors.

Risk factors can include certain:

• chronic lung diseases;
• cardiovascular diseases;
• immune system disorders;
• chronic kidney disease;
• diabetes;
• other conditions associated with severe RSV disease.

RSV vaccination is generally a one-time seasonal vaccination rather than an annual vaccine like influenza.

Tetanus, diphtheria, and pertussis vaccine

Adults need ongoing protection against tetanus and diphtheria.

The CDC recommends that adults receive a Tdap vaccine at least once if they have not previously received it as an adult or if their vaccination history is incomplete.

After that, Td or Tdap boosters are generally recommended every 10 years. Tdap or Td may also be recommended for wound management depending on the type of injury and vaccination history.

Pertussis, also known as whooping cough, can cause severe respiratory disease, particularly in vulnerable individuals.

Keeping Tdap vaccination up to date can therefore provide protection against three diseases at the same time.

Measles, mumps, and rubella vaccine

The MMR vaccine protects against:

• measles;
• mumps;
• rubella.

For many older adults, routine MMR vaccination is not necessary if there is reliable evidence of immunity or previous vaccination.

However, vaccination may be recommended in specific situations, such as for certain healthcare workers or people without evidence of immunity.

The CDC adult schedule specifically includes additional considerations for healthcare personnel.

Older adults should not automatically receive MMR vaccination simply because they are over a certain age.

Varicella vaccine

The varicella vaccine protects against chickenpox.

Adults without evidence of immunity may need a two-dose series.

The CDC schedule recommends two doses for adults who lack evidence of immunity, with specific considerations based on age and individual circumstances.

However, the recombinant shingles vaccine is a different vaccine and is not a substitute for varicella vaccination in adults who are susceptible to chickenpox.

Hepatitis B vaccine

Hepatitis B can cause acute and chronic liver disease and may eventually lead to cirrhosis or liver cancer.

Hepatitis B vaccination is recommended for many adults based on age and risk factors.

For older adults, vaccination may be particularly appropriate when there are specific medical or behavioral risk factors.

Examples include certain chronic liver conditions, diabetes, occupational exposure, or other circumstances associated with increased risk.

The adult vaccination schedule should therefore be reviewed according to individual risk rather than assuming that age alone determines the need for hepatitis B vaccination.

Hepatitis A vaccine

Hepatitis A vaccination is generally recommended for adults with specific risk factors rather than universally for all older adults.

It may be appropriate for people who:

• travel to countries where hepatitis A is common;
• have certain chronic liver diseases;
• have specific occupational or exposure risks;
• belong to other groups for whom vaccination is recommended.

Travel plans are therefore an important part of reviewing an older adult’s vaccination history.

Vaccination for older adults with chronic diseases

Having a chronic disease does not generally mean that an older adult should avoid vaccination.

In fact, chronic diseases can increase the risk of severe complications from certain infections.

Conditions that may affect vaccination recommendations include:

• diabetes;
• heart disease;
• chronic lung disease;
• chronic kidney disease;
• liver disease;
• cancer;
• weakened immune system;
• organ transplantation.

The CDC adult schedule specifically recommends reviewing vaccination needs according to medical conditions and other indications in addition to age.

Older adults with weakened immune systems need special consideration

Some older adults have weakened immune systems because of disease, cancer treatment, organ transplantation, or medications that suppress immune function.

In these situations, vaccination can be especially important, but the timing and type of vaccine may need to be adjusted.

Live vaccines may be contraindicated in some people with significant immune suppression.

For example, the recombinant shingles vaccine is specifically recommended for adults with certain immunocompromising conditions, while live vaccines require additional precautions.

Older adults should never stop an immunosuppressive medication on their own in order to receive a vaccine.

Can older adults receive several vaccines during the same visit?

In many situations, multiple vaccines can be administered during the same healthcare visit.

This can make it easier to bring an older adult’s vaccination status up to date and reduce the number of appointments needed.

However, the appropriate timing depends on the vaccines, medical conditions, previous vaccination, and current recommendations.

A healthcare professional can determine which vaccines should be given and whether any doses need to be separated.

What if an older adult has lost their vaccination record?

A missing vaccination record does not necessarily mean that vaccination has to be abandoned.

The first step is to look for available records through previous healthcare providers, pharmacies, electronic health records, or local immunization registries when available.

If vaccination history remains uncertain, a healthcare professional can determine whether additional vaccination is appropriate.

The CDC adult schedule specifically provides guidance for adults whose vaccination history is incomplete or unknown.

Does an older adult need to repeat all vaccines?

Not necessarily.

Different vaccines have different schedules.

Some require periodic booster doses, while others involve a limited series that provides long-term protection.

For example:

• influenza vaccination is generally annual;
• shingles vaccination consists of a two-dose series;
• RSV vaccination is generally a one-time vaccination for eligible adults;
• tetanus-containing vaccines require periodic boosters;
• pneumococcal vaccination depends on the vaccine and previous vaccination history.

For this reason, vaccination decisions should be based on an individual’s records rather than simply repeating every vaccine.

Vaccines for older adults: a practical checklist

When reviewing an older adult’s vaccination status, consider:

• Annual influenza vaccine
• Current COVID-19 vaccination
• Shingles vaccine
• Pneumococcal vaccination
• RSV vaccine when indicated
• Tetanus and diphtheria protection
• Tdap vaccination
• Hepatitis B vaccination when indicated
• Hepatitis A vaccination when indicated
• MMR vaccination when indicated
• Varicella vaccination when indicated
• Other vaccines based on travel, occupation, or medical conditions

This checklist is a starting point and does not replace an individualized vaccination review.

Frequently asked questions about vaccines for older adults

What is the most important vaccine for older adults?

There is no single vaccine that is most important for everyone.

The vaccines an older adult needs depend on age, vaccination history, medical conditions, and risk factors.

Influenza, COVID-19, shingles, pneumococcal disease, RSV, and tetanus-containing vaccines are particularly important considerations in older adults.

Should older adults get the flu vaccine every year?

Yes.

Annual influenza vaccination is recommended for adults, including older adults. For people aged 65 and older, certain influenza vaccines are preferred when available.

Do older adults need a shingles vaccine?

Yes.

In the United States, the CDC recommends the recombinant shingles vaccine for adults aged 50 and older, including people who have previously had shingles.

How many doses of the shingles vaccine are needed?

The standard shingles vaccination series consists of two doses, usually administered 2 to 6 months apart.

People with certain immunocompromising conditions may follow a shorter interval when appropriate.

Should older adults get an RSV vaccine?

Adults aged 75 and older are recommended to receive an RSV vaccine.

Adults aged 60 through 74 may also be recommended to receive it if they have an increased risk of severe RSV disease.

Do older adults need a pneumococcal vaccine?

Pneumococcal vaccination is recommended for older adults, but the specific vaccine and schedule depend on age, previous vaccination, and medical conditions.

Current U.S. recommendations include conjugate vaccines such as PCV20 and PCV21, as well as other pneumococcal vaccines in specific circumstances.

How often should older adults receive a tetanus booster?

Adults generally need a tetanus- and diphtheria-containing booster every 10 years after completing the primary series.

Tdap can be used instead of Td for a booster in appropriate situations.

Can an older adult receive vaccines while taking several medications?

Often, yes.

However, some medications, particularly those that suppress the immune system, can affect which vaccines are appropriate or when they should be administered.

Older adults should provide a complete list of medications to their healthcare professional before vaccination.

Conclusion

Vaccination remains an important part of preventive healthcare as people age.

For older adults, important vaccines include influenza, COVID-19, shingles, pneumococcal disease, RSV, and tetanus-containing vaccines. Other vaccines, such as hepatitis A, hepatitis B, MMR, and varicella, may be appropriate depending on individual risk factors and vaccination history.

The most important step is not to assume that every older adult needs exactly the same vaccines.

Instead, vaccination should be reviewed according to:

• age;
• previous vaccination;
• chronic diseases;
• immune status;
• medications;
• occupation;
• travel;
• and other individual risk factors.

If you are unsure which vaccines you have received, have lost your vaccination records, or have a chronic medical condition, discuss your vaccination history with a healthcare professional.

Keeping vaccinations up to date can help reduce the risk of serious infections and support healthier aging.