What are the recommended vaccinations for adults over 50 years?

Recommended Adult Vaccination Schedule for Adults Over 50 Years

Adults over 50 years should receive annual influenza vaccination, pneumococcal vaccination, herpes zoster vaccination (at age 60+), and other vaccines based on risk factors to reduce morbidity and mortality from vaccine-preventable diseases. 1, 2

Core Vaccinations for All Adults Over 50

Influenza Vaccination

• Annual vaccination against influenza is recommended for all persons 50 years and older 1
• Adults aged 65 years and older can receive either standard dose trivalent inactivated vaccine (TIV) or high-dose TIV (Fluzone High-Dose) 1
• Healthy, nonpregnant adults aged 50-64 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (LAIV) or inactivated vaccine 1
• Those with chronic medical conditions should receive the inactivated vaccine only 1

Pneumococcal Vaccination

• Pneumococcal polysaccharide vaccine (PPSV23) is recommended for all adults 65 years and older 1
• For adults 50-64 years, PPSV23 is recommended for those with:
  • Chronic lung disease (including asthma) 1
  • Chronic cardiovascular diseases 1
  • Diabetes mellitus 1
  • Chronic liver diseases or cirrhosis 1
  • Chronic alcoholism 1
  • Chronic renal failure or nephrotic syndrome 1
  • Functional or anatomic asplenia 1
  • Immunocompromising conditions 1
  • Cochlear implants and cerebrospinal fluid leaks 1
  • Smoking history 1
• One-time revaccination after 5 years is recommended for those with chronic renal failure, functional or anatomic asplenia, or immunocompromising conditions 1
• For persons 65 years or older, one-time revaccination is recommended if they were vaccinated 5 or more years previously and were younger than 65 years at the time of primary vaccination 1

Herpes Zoster (Shingles) Vaccination

• A single dose of zoster vaccine is recommended for adults aged 60 years and older regardless of prior history of herpes zoster 1
• SHINGRIX (recombinant zoster vaccine) is administered as a two-dose series with the second dose given 2-6 months after the first dose 2
• SHINGRIX demonstrates high efficacy (97.2%) in preventing herpes zoster in adults 50 years and older 2
• Protection persists for at least 8 years with minimal waning 2

Vaccinations Based on Risk Factors

Tetanus, Diphtheria, and Pertussis (Td/Tdap)

• Adults should receive Td booster every 10 years 1
• A one-time dose of Tdap is recommended for adults who have not previously received Tdap 1
• Tdap is specifically recommended for:
  • Adults who are close contacts of infants younger than 12 months 1
  • Healthcare personnel 1
  • Adults aged 65 years and older may receive Tdap 1

Hepatitis A Vaccination

• Recommended for adults with:
  • Chronic liver disease 1
  • Clotting factor disorders 1
  • Men who have sex with men 1
  • Illegal drug use 1
  • Occupational exposure to hepatitis A virus 1
  • Travel to countries with high or intermediate endemicity of hepatitis A 1
• Administered in a 2-dose schedule at either 0 and 6-12 months (Havrix) or 0 and 6-18 months (Vaqta) 1

Hepatitis B Vaccination

• Recommended for adults with:
  • End-stage renal disease, including those receiving hemodialysis 1
  • HIV infection 1
  • Chronic liver disease 1
  • Diabetes mellitus 1
  • Healthcare personnel and public safety workers exposed to blood 1
  • Multiple sexual partners or STD treatment 1
  • Injection drug use 1
  • Men who have sex with men 1
  • Household contacts and sexual partners of persons with chronic HBV infection 1

Measles, Mumps, Rubella (MMR) Vaccination

• Adults born before 1957 are generally considered immune to measles and mumps 1
• Adults born in 1957 or later should have documentation of at least one dose of MMR vaccine 1
• A second dose of MMR is recommended for adults who:
  • Are students in postsecondary educational institutions 1
  • Work in healthcare facilities 1
  • Plan to travel internationally 1

Human Papillomavirus (HPV) Vaccination

• For adults aged 50-64 who have not been previously vaccinated:
  • HPV4 is recommended for males through age 26 years if they are immunocompromised, have HIV, or are men who have sex with men 1
  • Either HPV4 or HPV2 is recommended for females through age 26 years 1

Common Pitfalls and Caveats

• Vaccination should be deferred in persons with moderate or severe acute illness 3
• Live vaccines (LAIV, MMR, zoster live vaccine) should be avoided in severely immunocompromised individuals 1
• For patients with autoimmune inflammatory conditions, SHINGRIX is preferred over live-attenuated zoster vaccine due to safety considerations 2
• Despite recommendations, vaccination rates remain suboptimal in adults aged 50-64 years with high-risk conditions (only 41.3% for influenza) 4
• Influenza vaccine effectiveness varies by season and strain match but can significantly reduce the risk of severe outcomes, especially in high-risk populations 5
• The high-dose influenza vaccine (Fluzone High-Dose) has been shown to induce greater antibody responses and better protection against influenza in older adults compared to standard-dose vaccines 6

Practical Implementation

• Healthcare provider recommendations significantly increase vaccination rates 4
• Public awareness campaigns about disease severity and vaccine importance can improve uptake 4
• For patients transitioning from older zoster vaccine (Zostavax) to SHINGRIX, there is no minimum interval required between the two different vaccines 2