Which Vaccines Do Adults Over 65 Need and Why?

The vaccines adults over 65 are usually advised to get include yearly flu and updated COVID-19 shots, a pneumococcal vaccine, an RSV vaccine for many older adults, two doses of recombinant shingles vaccine, and a tetanus-diphtheria-pertussis booster. Aging weakens the immune response, so infections that are mild in younger people can lead to pneumonia, hospital stays and lost independence. This article explains each vaccine, why it matters, and what to ask your clinician.

Which vaccines do adults over 65 need? The core list

Most older adults are advised to talk with their clinician about six vaccines or vaccine groups. The national adult immunization schedule is reviewed and updated regularly, so exact ages, doses and timing can change. Your clinician or pharmacist can check the current version against your health history. MedlinePlus (NIH) explains how vaccines work and why staying current matters in adulthood, not only in childhood.

Some people also need hepatitis B, hepatitis A, or other vaccines because of a health condition, a job or travel. That is covered further down.

Why age changes the vaccine list

As people get older, the immune system tends to respond less strongly and less quickly to germs. Researchers call this immune aging. Several factors contribute, and the mechanism is not fully understood. Chronic conditions such as heart disease, lung disease, diabetes and kidney disease can add to the risk. Infections may also lead to a loss of strength, a fall, or a decline in thinking and daily function that does not fully recover.

Older adults can also have weaker responses to vaccines themselves. That is why some vaccines for this age group come in stronger formulas or with an added ingredient that boosts the immune response, and why vaccines that only needed one dose earlier in life may now be given as a series.

Older adults may not run a fever when they are sick, which can delay recognition of an infection. Our article on why infections do not always cause a fever in older adults explains this. Vaccination lowers the chance of getting very sick in the first place.

Flu vaccine: a yearly shot with age-specific options

Flu viruses change from year to year, and protection from a shot can fade, so the vaccine is updated and given each season. For adults 65 and older, the national schedule has generally preferred formulas made for this age group, such as a high-dose, an adjuvanted, or a recombinant vaccine, over standard-dose shots. If your pharmacy offers only a standard-dose shot, ask your clinician or pharmacist what they advise, since getting a flu shot is usually better than going without one. MedlinePlus (NIH) describes the flu shot, who should get it, and common side effects.

The vaccine does not always prevent flu. In many cases it may make illness milder and reduce the chance of serious complications such as pneumonia or worsening heart and lung conditions.

COVID-19 vaccine

COVID-19 can cause severe illness in older adults, particularly those with other medical conditions. Vaccine formulas are updated to match circulating variants, and eligibility guidance has changed over time. Ask your clinician or pharmacist which updated vaccine is currently recommended for you and how long to wait after a recent infection or a previous dose. MedlinePlus (NIH) also covers post-COVID conditions, which can follow an infection even in people who were not hospitalized.

Pneumococcal vaccine: protection against a common cause of pneumonia

Pneumococcus is bacteria that can cause pneumonia, bloodstream infection and meningitis, and it is a common cause of bacterial pneumonia in older adults. MedlinePlus (NIH) explains pneumonia, including how it is diagnosed and treated. Several pneumococcal vaccines exist, and the best choice depends on your age, health conditions and the pneumococcal vaccines you have already received. Bring your vaccine record, or ask your pharmacy or state immunization registry for it, so your clinician can tell you whether you are due.

The vaccine reduces the chance of certain pneumococcal infections but does not protect against every cause of pneumonia. Older adults who have trouble swallowing face a different pneumonia risk, which our article on aspiration pneumonia in older adults covers.

RSV vaccine: not only a children's virus

Respiratory syncytial virus is often thought of as a childhood illness, but it can cause serious lung infections in older adults, especially those with heart disease, lung disease or a weakened immune system. MedlinePlus (NIH describes RSV infections and their symptoms. RSV vaccines are recommended for many adults in older age groups. Eligibility has been updated as more evidence became available, so ask your clinician whether you qualify and whether one dose is enough.

The product labels for the RSV vaccines include a caution about a small possible increased risk of Guillain-Barre syndrome, a rare nerve condition. Tell your clinician if you have had Guillain-Barre syndrome before so they can weigh this with you.

Shingles vaccine: two doses, even after shingles

Shingles happens when the chickenpox virus, which stays in the body after childhood chickenpox, reactivates. It causes a painful blistering rash and can lead to long-lasting nerve pain called postherpetic neuralgia, which becomes more common with age. MedlinePlus (NIH) explains the chickenpox virus that underlies shingles.

The recombinant shingles vaccine is given as two doses. Adults who have had shingles, or who received an older shingles vaccine, may still be advised to get it. Sore arm, fatigue, muscle aches and low fever are fairly common for a day or two after the shot, and people sometimes plan around the second dose for that reason. Ask your clinician about timing.

Tetanus, diphtheria and whooping cough boosters

Tetanus protection fades over time, so the schedule calls for a booster, usually every 10 years, and sooner after some deep or dirty wounds. A Tdap booster adds whooping cough protection. Older adults can pass whooping cough to infants who are too young to be fully vaccinated, so grandparents are often encouraged to be up to date. If you cannot remember your last booster, ask your clinician whether to get one.

Other vaccines some older adults need

• Hepatitis B: may be advised if you have diabetes, chronic liver disease, kidney disease, or other risk factors.
• Hepatitis A: may be advised for chronic liver disease, certain travel, or other exposures.
• MMR or chickenpox vaccines: usually reserved for people without evidence of immunity. These are live vaccines, so tell your clinician if you have a weakened immune system before getting one.
• Travel vaccines: depend on where you are going. Plan a visit with your clinician well before the trip.

Chronic kidney disease can change which vaccines and doses are advised. MedlinePlus (NIH) covers kidney failure if you want background on how it affects the body.

Safety: what to expect after the shot

Common reactions are mild and short-lived: soreness, redness or swelling where the shot was given, tiredness, headache, muscle aches and sometimes a low fever. Many people notice more reaction after the shingles and RSV vaccines. Reactions often fade in a day or two. MedlinePlus (NIH) explains vaccine safety and how side effects are monitored.

Serious allergic reactions are uncommon but are the reason clinics often ask you to stay briefly after a shot. Tell the person vaccinating you about any past severe allergic reaction to a vaccine or its ingredients, current illness, blood thinners, a weakened immune system, or a history of Guillain-Barre syndrome. They can help decide whether a vaccine is appropriate and which type fits you.

Practical tips for getting up to date

• Ask your pharmacy or clinic for your vaccine history and bring it to your next visit. A health checkup is a good time to review it.
• Several vaccines can often be given at the same visit, in different arms or sites. Ask your clinician which combinations suit you.
• Insurance coverage differs by vaccine and plan, and by whether it is given at a pharmacy or an office. Ask your plan or pharmacist before the visit.
• If you take medicines that lower immune function, ask your prescriber whether timing around treatment matters. Do not change the timing or dose of a prescription on your own.
• Keep a card or phone note with the date and product name for each dose.

When illness happens despite vaccination

No vaccine prevents every infection. If you develop a cough, shortness of breath, new confusion, or you simply feel much worse than usual, get evaluated even if you have been vaccinated. Clinicians combine history, examination and testing to decide the cause. The emergency list below describes the signs that need an ambulance and those that need care the same day.

When to Seek Medical Care