What are the recommended vaccines for the elderly?

Recommended Vaccines for the Elderly

The core recommended vaccines for elderly individuals include annual influenza vaccination, pneumococcal vaccines (PCV13 followed by PPSV23), tetanus-diphtheria-pertussis (Tdap/Td), herpes zoster vaccine, and additional vaccines based on specific risk factors or conditions. 1

Core Vaccinations for Elderly Adults

Influenza Vaccine

• Annual influenza vaccination is universally recommended for all adults aged 65 years and older 1
• High-dose influenza vaccine (Fluzone) is specifically licensed for adults aged 65 years or older and may provide better protection 1
• Vaccination should ideally be administered before the start of flu season to maximize protection 2

Pneumococcal Vaccines

• For adults aged 65 years or older (immunocompetent): 1 dose of PCV13 (pneumococcal conjugate vaccine) if not previously received, followed by 1 dose of PPSV23 (pneumococcal polysaccharide vaccine) at least 1 year after PCV13 and at least 5 years after any previous PPSV23 dose 1
• For those who previously received PPSV23 before age 65: Administer PCV13 at least 1 year after the most recent PPSV23 dose 1
• For elderly with certain immunocompromising conditions: Additional doses may be required according to specific schedules 1

Tetanus, Diphtheria, and Pertussis Vaccines

• Adults aged 65 years or older should receive Tdap vaccine if they have not previously received it, regardless of the interval since the last tetanus-containing vaccine 1
• Td booster should be administered every 10 years after Tdap 1
• Tdap is especially important for elderly who have close contact with infants younger than 12 months 1

Herpes Zoster (Shingles) Vaccine

• Adults aged 50 years and older should receive the recombinant zoster vaccine (RZV) as a 2-dose series, administered 2-6 months apart 1
• RZV is preferred over the older live zoster vaccine due to higher efficacy in preventing shingles and post-herpetic neuralgia 3

Additional Vaccines Based on Risk Factors

Hepatitis B Vaccine

• Recommended for adults with diabetes, end-stage renal disease, chronic liver disease, or other specific risk factors 1, 3
• A complete series consists of either 2 or 3 doses depending on the specific vaccine used 1

Hepatitis A Vaccine

• Recommended for elderly with chronic liver disease, men who have sex with men, injection drug users, or those traveling to endemic areas 1
• Administered as a 2-dose series 1

Meningococcal Vaccines

• Recommended for elderly with anatomical or functional asplenia, persistent complement component deficiencies, or during outbreaks 1
• A 2-dose series of meningococcal conjugate vaccine (MenACWY) is recommended for those with high-risk conditions 1

MMR (Measles, Mumps, Rubella) Vaccine

• Generally, adults born before 1957 are considered immune to measles and mumps 1
• For healthcare personnel born before 1957 without evidence of immunity, vaccination should be considered, especially during outbreaks 1

Special Considerations for Elderly Vaccination

• Elderly individuals often have decreased immune responses to vaccines compared to younger adults, which may affect vaccine effectiveness 2, 4
• Higher antigen doses, alternative administration routes, or adjuvanted vaccines may help improve immune response in the elderly 2
• Vaccination coverage remains suboptimal in the elderly population, highlighting the need for increased awareness and implementation of vaccination recommendations 5, 3
• Medicare Part B covers influenza and pneumococcal vaccines, as well as tetanus boosters for post-exposure management, while zoster vaccine is covered under Medicare Part D 5

Common Pitfalls to Avoid

• Failing to administer Tdap to elderly individuals who have never received it, regardless of when they last received a Td-containing vaccine 1
• Missing the opportunity to administer pneumococcal vaccines according to the recommended sequence (PCV13 followed by PPSV23) 1
• Not considering the elderly's specific risk factors that might warrant additional vaccines beyond the core recommendations 1
• Assuming that vaccines are less important for the elderly when in fact they are at higher risk for complications from vaccine-preventable diseases 2, 6