What are the recommended vaccinations for elderly individuals?

Recommended Vaccinations for Elderly Individuals

All elderly individuals aged 65 years and older should receive annual influenza vaccination, pneumococcal vaccination (PCV13 based on shared clinical decision-making followed by PPSV23), Tdap/Td vaccination, and zoster vaccination as core preventive measures to reduce morbidity and mortality from vaccine-preventable diseases. 1, 2

Core Vaccinations for All Elderly (≥65 years)

Influenza Vaccination

• Annual influenza vaccination is universally recommended for all adults regardless of age 1
• High-dose influenza vaccine (Fluzone High-Dose) is specifically licensed for adults aged 65 years and older and may provide better protection in this population 1, 3
• Influenza vaccination significantly reduces the risk of hospitalization and death in older adults 2
• Vaccination should be administered annually before the start of influenza season 1

Pneumococcal Vaccination

• For adults aged 65 years or older (immunocompetent): PCV13 (based on shared clinical decision-making) followed by PPSV23 at least 1 year later 1, 2
• If both PCV13 and PPSV23 are to be administered, PCV13 should be administered first 1
• The two vaccines should not be administered during the same visit and should be given at least 1 year apart 1
• Only one dose of PPSV23 is recommended at age 65 years or older 1

Tetanus, Diphtheria, and Pertussis (Td/Tdap) Vaccination

• Tdap is recommended for all adults, including those aged 65 years and older 1
• Tdap can be administered regardless of interval since the last Td-containing vaccine 1
• After receiving one dose of Tdap, a Td booster should be administered every 10 years 1, 2
• Elderly individuals who have close contact with infants younger than 12 months should prioritize receiving Tdap vaccination 1

Zoster (Shingles) Vaccination

• One dose of zoster vaccine is recommended for adults aged 60 years and older, regardless of previous history of herpes zoster 1, 2
• Zoster vaccination significantly reduces the risk of shingles and post-herpetic neuralgia, improving quality of life 2

Vaccinations for Elderly with Special Conditions

For Immunocompromised Elderly

• Pneumococcal vaccination: PCV13 followed by PPSV23 at least 8 weeks later, then another dose of PPSV23 at least 5 years after previous PPSV23 1
• Meningococcal vaccination: 2-dose primary series for those with anatomical or functional asplenia or persistent complement component deficiencies 1
• Haemophilus influenzae type b (Hib): One dose for certain high-risk individuals 1
• Note: Live vaccines (such as LAIV for influenza) are contraindicated in severely immunocompromised individuals 1

For Elderly with Chronic Medical Conditions

• Pneumococcal vaccination is strongly recommended for those with:
  • Chronic lung disease (including asthma) 1, 2
  • Chronic cardiovascular diseases 1, 2
  • Diabetes mellitus 1, 2
  • Chronic liver diseases 1, 2
• Hepatitis B vaccination for those with:
  • End-stage renal disease, including patients receiving hemodialysis 2
  • HIV infection 2
  • Chronic liver disease 2

Risk Factor-Based Recommendations for Elderly

For Elderly Healthcare Workers

• Hepatitis B vaccination for those exposed to blood 2
• Annual influenza vaccination 1
• Meningococcal vaccination for microbiologists routinely exposed to Neisseria meningitidis 2

For Elderly Travelers

• Hepatitis A vaccination for those traveling to countries with high or intermediate endemicity of hepatitis A 2
• Additional travel vaccines based on destination-specific risks 2

Practical Considerations for Elderly Vaccination

Safety and Timing

• Multiple vaccines can be administered simultaneously at different anatomical sites 4
• Simultaneous administration of influenza and pneumococcal vaccines is safe and effective 4
• Vaccine series does not need to be restarted, regardless of the time that has elapsed between doses 1

Special Considerations

• Egg allergy: Those with severe egg allergy can still receive influenza vaccination under appropriate medical supervision 1
• History of Guillain-Barré syndrome: Those with a history of Guillain-Barré syndrome within 6 weeks of a previous dose of influenza vaccine generally should not receive influenza vaccine 1
• High-dose or adjuvanted influenza vaccines may provide better protection for elderly individuals compared to standard-dose vaccines 3

Common Pitfalls to Avoid

• Failing to administer Tdap at least once in adulthood, even for those over 65 years 1
• Administering PCV13 and PPSV23 simultaneously (they should be separated by at least 1 year in immunocompetent elderly) 1
• Overlooking the need for annual influenza vaccination, which remains crucial even in those who received vaccination in previous years 5
• Neglecting to assess the need for additional vaccines based on specific risk factors or chronic conditions 2