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Immunization Guidelines for Older Adults

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Why Get Vaccinated? | Recommendations | Paying for Vaccines

Flu shot image A vaccine is a medication given to produce antibodies against a certain infection to prevent that infection from occurring. The vaccination program in the US has dramatically reduced the prevalence of once-common diseases, including measles, mumps, and polio. Today, many vaccines are administered during childhood and adolescence, but some are necessary in adulthood. Many adults are not aware that they could still benefit from new vaccinations and “booster” doses of previously administered vaccinations.

Why Get Vaccinated?

Older adults are particularly susceptible to some of the infections that can be prevented by vaccination. In fact, complications from influenza (the flu) and pneumonia —both diseases that can be vaccinated against—are a leading cause of death in older adults. Fortunately, getting the recommended vaccines can greatly reduce the risk of vaccine-preventable infections.

Another reason for getting recommended immunizations is to protect your family, friends, and others around you from becoming ill. Many vaccine-preventable infections can be spread from person to person, so getting vaccinated helps protect anyone who comes in contact with you from contracting these diseases.


If you are an older adult, you may need to get some or all of the following vaccines:

Like many diseases, the flu is usually mild in younger people, but can be life-threatening in older adults. Symptoms of the flu may include fever, chills, cough, sore throat, congestion, headache, muscle aches, and fatigue.

Since the flu virus can change from year to year, the US Centers for Disease Control and Prevention (CDC) recommends a yearly influenza vaccine for everyone 6 months and older. To get the most protection, be sure to get the vaccine before the flu season starts, which can be as early as October.

Most people associate pneumococcal disease with the lung disease pneumonia, but it can also cause meningitis, infections of the blood and middle ear, and sinus infections.

The CDC recommends that people aged 65 years and older get the pneumococcal vaccine. Most people need only a single dose. However, if you received the shot more than five years ago and were younger than 65 when you received it, you may need a second, or “booster” dose.

Tetanus (lockjaw) is caused by a bacterium that can enter the body through a scratch or wound. Symptoms of tetanus include jaw stiffness, neck stiffness, abdominal stiffness, difficulty swallowing, and muscle spasms. Tetanus is a serious disease that can result in death.

Diphtheria is also caused by a bacterium, and it can be spread from person to person. Signs of diphtheria include a severe sore throat and a fever. Diphtheria can lead to breathing problems, coma , and even death.

Most people have received a series of shots called DTaP when they were children. DTaP is a vaccine that protects against diphtheria, tetanus, and pertussis (whooping cough). A shot of another vaccine called Tdap, which also protects against these three infections, is given to adults if they did not receive the Tdap vaccine when they were older children. A booster dose of the tetanus and diphtheria vaccine (Td) should be given every 10 years, or after an exposure to tetanus under some circumstances.

Varicella (chickenpox) is a very contagious viral infection that can be spread through the air or by touching a chickenpox sore. Chickenpox is a relatively mild disease in children, but it can be serious—even life-threatening—in older adults. Symptoms of chickenpox include aching, tiredness, fever, and sore throat, followed by a widespread, itchy, blister-like rash.

People who have had chickenpox are protected from getting it again. However, for adults who never had chickenpox or have never been vaccinated, two doses of the varicella vaccine are recommended, at least 4 weeks apart.

The shingles vaccine is the new kid on the block for older adults. Shingles is a painful and sometimes severely debilitating flare-up of chickenpox.

Older people are susceptible to getting shingles, as well as certain high-risk groups (eg, those with compromised immune systems). Severe complications include vision problems or blindness, pneumonia, brain inflammation, and hearing problems. The CDC now recommends that adults aged 60 and older get the shingles vaccine. Research is still being done to determine whether booster vaccines are necessary.

While they were once very common diseases, measles, mumps, and rubella (MMR) are now very rare, thanks to widespread immunizations against them. Measles is a viral respiratory disease that may lead to diarrhea, ear infections, pneumonia, swelling of the brain, seizures, and death. Mumps is a viral disease of the lymph nodes that can cause meningitis, inflammation of the testicles, ovaries, or pancreas, and permanent deafness. Rubella is a viral respiratory disease that can cause birth defects, including deafness, cataracts, heart defects, intellectual disability, and liver and spleen damage.

Everyone born in the US before 1957 are generally considered immune to measles and mumps. People born before 1957 who work in healthcare and do not show immunity should consider being vaccinated against MMR. If you are exposed to an outbreak of measles or mumps, are a student in college, or plan to travel internationally, you might need another MMR vaccine dose.

In addition to the vaccines listed above, people who experience unexpected exposures to a virus, are traveling abroad, are employed in certain occupations, or who have certain medical conditions may need additional vaccines. Some people should not receive certain vaccines, either due to allergies or due to a medical condition. Talk with your doctor to see if you should be considered for any other vaccines.

Paying for Vaccines

Medicare, which is the health insurance program that covers almost all Americans age 65 and older, pays 100% of the cost of influenza and pneumococcal vaccines. If you are not covered by Medicare, check with your state health department to see if they offer free vaccines.


Centers for Disease Control and Prevention


National Institute on Aging



Baker CJ, Pickerling LK, Chilton L, et al; Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154(3):168-173.

McCoy K. Influenza vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated June 19, 2012. Accessed August 19, 2012.

Pneumococcal polysaccharide vaccine. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-ppv.pdf. Updated October 2009. Accessed August 19, 2012.

Recommended adult immunization schedule—United States, 2010. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a9.htm. Updated February 3, 2012. Accessed August 19, 2012.

Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles/index.html. Updated May 18, 2012. Accessed August 19, 2012.

Shots for safety. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/shots-safety. Updated August 10, 2012. Accessed August 19, 2012.

Tetanus (lockjaw) vaccination. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm. Updated January 19, 2012. Accessed August 19, 2012.

Vaccine-preventable childhood diseases. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/vpd-vac/child-vpd.htm. Updated February 25, 2012. Accessed August 19, 2012.

1/24/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (tdap) vaccine from the advisory committee on immunization practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-15.

Last reviewed August 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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