Recommended Vaccines for Adults Over 65 Years
All adults aged 65 years and older should receive the pneumococcal polysaccharide vaccine (PPSV23), annual influenza vaccination, recombinant zoster vaccine (RZV), and tetanus-diphtheria (Td) or tetanus-diphtheria-pertussis (Tdap) boosters, with pneumococcal conjugate vaccine (PCV13) recommended based on shared clinical decision-making. 1
Core Vaccines for Adults ≥65 Years
Pneumococcal Vaccination
- PPSV23 (Pneumovax 23): Single dose recommended for all adults aged ≥65 years 1
- If previously received PPSV23 before age 65, give another dose at least 5 years after the previous dose 1
- PCV13 (Prevnar 13): No longer routinely recommended for all adults ≥65 years as of 2019 1
- Now recommended based on shared clinical decision-making for immunocompetent adults ≥65 years 1
- Factors favoring PCV13 administration include:
- Residence in nursing homes or long-term care facilities
- Living in areas with low pediatric PCV13 uptake
- Travel to regions without pediatric PCV13 programs
- Presence of chronic heart, lung, liver disease, diabetes, alcoholism, or smoking 1
- If PCV13 is given, administer before PPSV23 with at least 1 year between doses 1
- PCV13 remains strongly recommended for adults ≥65 years with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants 1
Influenza Vaccination
- Annual vaccination: Recommended for all adults ≥65 years 1
- High-dose or adjuvanted formulation: Preferred over standard-dose for adults ≥65 years 1
- Vaccination reduces risk of influenza from 6% to 2.4% and influenza-like illness from 6% to 3.5% 2
Zoster (Shingles) Vaccination
- Recombinant zoster vaccine (RZV, Shingrix): 2-dose series recommended for all adults ≥50 years 1
Tetanus, Diphtheria, Pertussis Vaccination
- Td or Tdap: Booster every 10 years 1
- If never received Tdap as an adult, substitute one Tdap for Td to provide pertussis protection 1
Additional Vaccines Based on Risk Factors
Hepatitis A and B
- Recommended for adults with specific risk factors:
- Chronic liver disease
- Men who have sex with men
- Injection drug users
- Travelers to endemic countries 1
Meningococcal Vaccination
- Recommended for adults with:
- Anatomical or functional asplenia
- Persistent complement component deficiency
- Eculizumab use
- Microbiologists routinely exposed to Neisseria meningitidis 1
Measles, Mumps, Rubella (MMR)
- Consider for adults born in 1957 or later without evidence of immunity 1
- Contraindicated in severely immunocompromised individuals 1
Vaccination Timing and Administration
Pneumococcal Sequence (if both vaccines given)
- For adults ≥65 years who have not previously received either vaccine:
- Give PCV13 first, then PPSV23 at least 1 year later 1
- For adults ≥65 years who previously received PPSV23:
- Give PCV13 at least 1 year after PPSV23 1
Considerations for Immunocompromised Patients
- More aggressive pneumococcal vaccination schedule required 1
- Consider holding certain immunosuppressive medications around vaccination time to improve immune response 1
- Avoid live vaccines in severely immunocompromised individuals 1
Common Pitfalls and Caveats
- Failure to revaccinate with PPSV23 in patients who received it before age 65 (should receive another dose at ≥65 years, at least 5 years after previous dose) 1
- Co-administration errors: PCV13 and PPSV23 should not be administered simultaneously 1
- Missing high-risk indications for additional vaccines (e.g., smoking is an indication for pneumococcal vaccination) 3
- Not considering high-dose or adjuvanted influenza vaccines for older adults, which may provide better protection 1, 2
- Overlooking the need for shared decision-making regarding PCV13 in immunocompetent adults ≥65 years 1
By following these evidence-based recommendations, healthcare providers can help reduce the burden of vaccine-preventable diseases in adults over 65 years of age.