Adult Vaccines Over 65: Flu, Shingles, RSV & More
If you are 65 or older, staying current with vaccines is a top priority. Learn which shots you need, when to get them, and how to protect against serious respiratory and bacterial infections.
The Centers for Disease Control and Prevention (CDC) recommends that adults aged 65 and older stay up to date on specific vaccines to protect against flu, shingles, RSV, pneumonia, and other diseases. The schedule typically involves an annual influenza shot, a two-dose shingles series, a one-time RSV vaccine, and a multi-dose pneumonia series. For most seniors, the optimal time to start these vaccinations is in late summer and early fall, ideally between August and October, to ensure immunity before the winter respiratory season peaks.
For more information, see CDC adult immunization schedule from the CDC.
Which vaccines are essential for adults over 65?
Several vaccines are specifically indicated for this age group due to the natural decline in immune function that occurs with aging. The CDC and the Advisory Committee on Immunization Practices (ACIP) outline the following core protections for adults 65 and older:
- Influenza (Flu): Required annually for every adult. Seniors over 65 are eligible for high-dose or adjuvanted vaccines, which may provide stronger protection than the standard version.
- Shingles (Herpes Zoster): The CDC recommends the two-dose shingles vaccine for all adults 50 and older. The shots should be administered two to six months apart.
- RSV (Respiratory Syncytial Virus): The CDC recommends a single dose of the RSV vaccine for all adults 75 and older. For adults 50 through 74, vaccination is recommended if they are at increased risk of severe illness, such as those with chronic heart or lung disease.
- Pneumococcal (Pneumonia): Adults over 65 are recommended to receive the pneumococcal vaccine. Depending on prior vaccination history, this may involve one or two different types of shots (PCV and PPSV) to provide broad protection against bacterial pneumonia.
- Tdap (Tetanus, Diphtheria, Pertussis): If you have not yet received Tdap, you should get it, followed by a Td booster every 10 years to protect against whooping cough and tetanus.
What are the specific risks if I skip these vaccines?
Without vaccination, seniors face a significantly higher risk of hospitalization and death from respiratory infections. Shingles, for example, can cause long-term nerve pain known as postherpetic neuralgia, affecting roughly one in three people who develop the rash. Similarly, RSV, which often causes mild cold-like symptoms in younger adults, can lead to severe pneumonia in older populations, particularly those with underlying health conditions.
When is the best time to get these shots?
Timing your vaccines correctly is crucial to maximize your immune response before pathogens become prevalent.
When should I get the flu shot?
The CDC advises getting the flu vaccine as soon as it becomes available, usually in September or October. Early vaccination ensures that your body has time to build immunity before the flu season typically begins in November and can last through May. Because flu strains mutate annually, the vaccine composition changes every year, making annual vaccination mandatory.
When is the ideal window for the RSV vaccine?
While you can receive the RSV vaccine at any time of year, the CDC identifies late summer and early fall as the best period. In the continental United States, this typically corresponds to August through October. This timing allows your body to develop protection before RSV circulation usually starts in the fall. It is important to note that the RSV vaccine is not annual; a single dose provides protection for at least two years, so you do not need to get it every year.
Can I get multiple vaccines on the same day?
Yes, you can receive multiple vaccines during a single visit. The CDC notes that the RSV vaccine can be co-administered with the flu, shingles, and pneumonia vaccines. However, providers must consider that receiving multiple shots at once may increase the frequency of mild side effects, such as pain at the injection site or temporary fever.
What are the specific RSV vaccine recommendations for seniors?
Respiratory Syncytial Virus is a leading cause of hospitalization in older adults. The FDA has licensed three RSV vaccines for use in adults: GSK's Arexvy, Moderna's mResvia, and Pfizer's Abrysvo. There is no preference among these options; the CDC recommends whichever is available.
Who qualifies for the RSV vaccine if they are under 75?
For adults between the ages of 50 and 74, the CDC recommends vaccination only if you have an increased risk of severe RSV illness. Risk factors include:
- Chronic cardiovascular disease, such as heart failure or coronary artery disease.
- Chronic lung or respiratory disease, including COPD, emphysema, or asthma.
- End-stage renal disease or dependence on hemodialysis.
- Diabetes mellitus complicated by chronic kidney disease.
- Residing in a nursing home or long-term care facility.
Adults in this age group who do not have these risk factors may still receive the vaccine after a risk-benefit discussion with their healthcare provider.
How does the pneumonia vaccine schedule work for over-65s?
Pneumococcal disease can cause pneumonia, meningitis, and bloodstream infections. The CDC recommends that all adults 65 and older receive the pneumococcal vaccine if they have not been previously vaccinated. The schedule often involves a two-part process: first, a conjugate vaccine (PCV20 or PCV13), followed later by a polysaccharide vaccine (PPSV23), depending on which products were used. For example, if you receive PCV20, you typically do not need the PPSV23 booster. If you received PCV13, you need the PPSV23 booster at least one year later. Your doctor will determine the specific sequence based on your medical history.
What are the common side effects of these vaccines?
Side effects are generally mild and resolve within a few days. For the flu, RSV, and pneumonia vaccines, you might experience soreness, redness, or swelling at the injection site. Other common reactions include fatigue, headache, muscle or joint pain, and a mild fever. For the shingles vaccine, soreness and muscle aches are frequent. While rare, severe allergic reactions can occur, which is why you should report any adverse events to your provider or through the Vaccine Adverse Event Reporting System (VAERS).
Frequently Asked Questions
Do I need a booster for the RSV vaccine every year?
No. The CDC currently recommends a single dose of the RSV vaccine. Protection lasts for more than one year, so if you have already received the shot, you should not get another one at this time. The CDC is monitoring how long the protection lasts and may update guidelines in the future.
Is the shingles vaccine safe for people with a weakened immune system?
Yes, the shingles vaccine is recommended for adults 50 and older, including those who are immunocompromised. It is also specifically recommended for adults 19 and older who are immunodeficient or immunosuppressed due to disease or therapy. The live vaccine used for chickenpox, however, is not safe for immunocompromised individuals.
What if I have never had chickenpox?
Adults who have not had chickenpox or who were born after 1957 and lack documented immunity should get the two-dose varicella vaccine. This is important because the shingles vaccine is only effective for people who have been infected with the varicella virus.
Can I get the flu vaccine if I am currently sick?
If you have a moderate or severe illness, you should wait until you recover before getting vaccinated. If you have a minor illness, such as a mild cold, you can generally receive the vaccine.