Ask the Geriatrician: Adult Immunization

Kerry Hildreth, MD

Kerry Hildreth, MD
University of Colorado Anschutz Medical Campus

Q: What vaccines are available to protect older adults?

A: Vaccines that are recommended for all older adults include those that protect against influenza (the flu), pneumococcal disease, shingles, tetanus, diphtheria, and pertussis (whooping cough). 

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 vaccines
  • Shingles 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 50-64 years old
Vaccine Schedule
Influenza (Flu) 1 dose every year
Pneumococcal vaccines  

     Pneumococcal conjugate PCV13 (Prevnar®)

1 dose                                        (depending on medical conditions)

     Pneumococcal polysaccharide PPSV23 (Pneumovax®)

1-2 doses                                  (depending on medical conditions) 
Tetanus, diphtheria, pertussis (Tdap) 1 dose, then tetanus-diphtheria (Td) booster every 10 years
Shingles vaccines  

     Zoster recombinant (Shingrix®) (Preferred) OR

2 doses (2-6 months apart)
     Zoster live (Zostavax®) 1 dose
Vaccine Schedule for Adults 65 and Older
Vaccine Schedule
Influenza (Flu) 1 dose every year
Pneumococcal vaccines  
     Pneumococcal conjugate PCV13 (Prevnar®) 1 dose
     Pneumococcal polysaccharide PPSV23 (Pneumovax®) 1 dose
Tetanus, diphtheria, pertussis (Tdap) 1 dose, then tetanus-diphtheria (Td) booster every 10 years
Shingles vaccines  
     Zoster recombinant (Shingrix®) (Preferred) OR 2 doses (2-6 months apart)
     Zoster live (Zostavax®) 1 dose

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 and pneumococcal 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 vaccines against shingles, and against tetanus, diphtheria, and pertussis.

(See https://www.medicare.gov/ for more information.)

Medicaid covers some vaccines for adults. There may be a copay or fee for getting vaccinated, depending on what state you live in and the doctor you see to get vaccinated. Contact your state Medicaid office for more information.

Military insurance (TRICARE) covers all of the CDC-recommended vaccines. Depending on your plan, and where you receive the vaccine, there may be a copay or a fee for getting vaccinated.

(See https://tricare.mil/immunizations for more information.)

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 can also help you find resources for low- or no-cost vaccinations through local community centers, schools, and religious centers.

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 Updated July 2019