Ask the Expert: Adult Immunization

Ken Schmader, MD

Kenneth Schmader, MD
Professor of Medicine, Division of Geriatrics at Duke University School of Medicine

Q: What vaccines are available to protect older adults?

A: Vaccines that are recommended for all older adults include those that protect against influenza (flu), pneumococcal disease, shingles, COVID-19, tetanus, diphtheria, and pertussis (whooping cough), and respiratory syncytial virus (RSV).  

Older adults with certain health conditions or risk factors, or who are traveling internationally, may need additional vaccinations to protect against other diseases.  

Q: What vaccines do I need?

A: The following vaccines are recommended for all older adults:

  • Flu vaccine
  • Pneumococcal vaccine
  • Shingles vaccine
  • COVID-19 vaccine
  • RSV vaccine
  • Tetanus, diphtheria and pertussis vaccine

These vaccines are recommended for certain groups of people at risk for other vaccine-preventable diseases:

  • Hepatitis A is recommended for adults with liver disease, men who have sex with men, adults who use injection or non-injection drugs, those who are homeless, and those who are traveling to areas with high levels of Hepatitis A.
  • Hepatitis B is recommended for adults with kidney failure or on dialysis, those with liver disease, Hepatitis C or HIV infection, multiple sex partners, those who use injection drugs, are incarcerated, or who are traveling to areas with high levels of Hepatitis B. Hepatitis B vaccine is also considered for older adults with diabetes.
  • Meningococcal vaccine is recommended for adults whose spleen has been removed or damaged (such as in sickle cell disease).
  • Haemophilus influenza type b is also recommended for adults whose spleen has been removed or damaged (such as in sickle cell disease), as well as for adults who have had a bone marrow transplant.
This questionnaire by the Centers for Disease Control and Prevention can help you find which vaccines are recommended for you and your situation.

Q:  What about measles?

A:  People born before 1957 are presumed to be immune and don’t require measles vaccination. However, measles vaccine could be considered in people born before 1957 who are at high risk of exposure through work or travel. People born during or after 1957 who do not have evidence of immunity to measles (through blood tests or immunization records) should be vaccinated.

Q:  How often do I need to be immunized?

A: The tables below show the recommended schedule for older adults. 

Vaccine Schedule for Adults 65 and Older
Vaccine Schedule
Influenza (Flu) 1 dose every year
Tetanus, diphtheria, pertussis (Tdap) 1 dose, then tetanus-diphtheria (Td) booster every 10 years

Shingles     

Zoster recombinant (Shingrix®)*

*A shingles vaccine called zoster vaccine live (Zostavax) is no longer available for use in the United States. If you had Zostavax in the past, you should still get Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix. 

2 doses (2-6 months apart)
COVID-19

2 doses (6 months apart, with a minimum interval of 2 months).

See Get the Basics and Learn More resources for details on the COVID-19 vaccine schedule.

RSV

Single lifetime dose.

See Get the Basics and Learn More resources for details on the RSV vaccine schedule.

Pnemoccocal Vaccine Schedule for Adults 65 and Older
Category Schedule
Adults 50+ who have not previously received any pneumococcal vaccine or their pneumococcal vaccination history is unknown

One dose of PCV20, PCV21, or PCV15

  • If PCV20 or PCV21 is used, pneumococcal vaccination is complete.
  • If PCV15 is used, it should be followed by 1 dose of PPSV23 at least 1 year later.*
Adults 65+ who have received only PPSV23 at any age
  • Administer one dose of PCV20 or PCV21 at least 1 year since the last PPSV23 dose.
Adults 65+ who have previously received only PCV13
  • 1 dose PCV21 or PCV20 at least 1 year after the last PCV13 dose
Adults 65+ who have previously received both PCV13 and PPSV23  Shared clinical decision-making between patient and provider on whether to administer PCV20 or PCV21, or to not get additional pneumococcal vaccines.

*If you have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak, the PCV15 and PPSV23 doses can be given a minimum of 8 weeks apart.

Q: Where can I get immunized?

A: Many of the recommended vaccines are available at doctor’s offices or clinics, pharmacies, community health clinics, and local or state health departments. Many workplaces, schools, and religious centers also offer vaccinations. Ask your healthcare provider for a referral, or contact your state health department.

Q: How much do vaccines cost?

A: The cost of vaccines depends on your insurance coverage.

  • Medicare Part B covers flu, pneumococcal, and COVID-19 vaccines. Medicare Part B also covers Hepatitis B vaccination for people who need this based on other medical problems or risk factors.
  • Medicare Part D covers other recommended adult vaccines, such as RSV, shingles, and tetanus, diphtheria, and pertussis.
  • Medicaid covers recommended vaccines for many adults at no cost. Coverage details may depend on your eligibility and state program. Contact your state Medicaid office or health plan to confirm your benefits.
  • Private health insurance usually covers all recommended vaccines without an additional charge.
  • Free and low-cost vaccines. If you don’t have health insurance or your plan’s costs for vaccines are not affordable for you, you may be able to get vaccines for low or no-cost through federally funded health centers.
  • Your state health department may be able to connect you with free or low-cost vaccination clinics and community programs. Available services vary by location.

Q:  Do vaccines have side effects?

A:  Getting a vaccine is much safer than getting the disease the vaccine prevents. Serious side effects from vaccines are extremely rare. Only 1-2 people out of every 1 million people vaccinated will have a severe allergic reaction. Common side effects are mild and go away quickly on their own. These side effects are a sign that your immune system is responding to the vaccine as it should! Common side effects of vaccines include:

  • Pain, swelling, or redness where the shot was given
  • Mild fever
  • Chills
  • Feeling tired
  • Headache
  • Muscle and joint aches

Q:  What vaccines do I need if I'm traveling out of the country?

A:  Ask your healthcare provider or public health department as early as possible to find out what vaccines you will need. Some vaccines recommended for travel require more than one dose, so they can take time to complete. Your healthcare provider may refer you to a Travel Medicine Clinic. A list of Travel Medicine Clinics can also be found on the Centers for Disease Control and Prevention Travelers’ Health website.

Q:  Should I carry a personal immunization record?

A:  Yes! You should record the specific name and date of all vaccines you receive. This will help you and your healthcare providers make sure that you are up to date with all of the vaccines recommended for you.  Keeping this record with you can also help avoid needless re-vaccination if you change providers, or during health emergencies. Be sure to bring your immunization record to your visits with your healthcare provider so that they can update your record with any new vaccinations you have received.

 

Last Reviewed and Updated: October 2026
By: AGS/HiAF Public Education Committee, HealthinAging.org Content Reviewers

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