What are the recommended vaccines for a 65-year-old man?

Recommended Vaccines for a 65-Year-Old Man

A 65-year-old man should receive annual influenza vaccination (preferably high-dose or adjuvanted formulation), pneumococcal vaccination (PCV13 based on shared clinical decision-making followed by PPSV23 at least 1 year later), zoster vaccine (single dose), and Tdap vaccine (one-time dose if not previously received, then Td boosters every 10 years). 1, 2, 3

Core Vaccinations at Age 65

Influenza Vaccine (Annual)

• All adults aged ≥65 years should receive annual influenza vaccination. 1
• Preferentially use high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4) for adults ≥65 years due to increased immunogenicity in this age group. 1, 2
• If none of these enhanced vaccines are available, any age-appropriate influenza vaccine should be administered rather than delaying vaccination. 1
• The evidence shows vaccination may reduce influenza risk from 6% to 2.4% (number needed to vaccinate = 30) and ILI from 6% to 3.5% (number needed to vaccinate = 42). 4

Pneumococcal Vaccines

• For immunocompetent adults aged ≥65 years: Administer PCV13 based on shared clinical decision-making. 1, 3
• If both PCV13 and PPSV23 are given, PCV13 must be administered first, followed by PPSV23 at least 1 year later. 1
• Never administer PCV13 and PPSV23 during the same visit. 1
• Newer recommendations from CDC include single dose of PCV21, PCV20, or PCV15 as alternatives. 2
• If PCV15 is used, follow with PPSV23 ≥1 year later. 2
• Only one dose of PPSV23 is recommended at age ≥65 years unless previously vaccinated before age 65 (then one additional dose ≥5 years after the first). 1

Zoster (Shingles) Vaccine

• Single dose recommended for all adults aged ≥60 years, regardless of previous history of herpes zoster. 3, 5
• This vaccine prevents shingles and its debilitating complication, postherpetic neuralgia. 5

Tetanus, Diphtheria, and Pertussis (Td/Tdap)

• Administer one-time dose of Tdap if not previously received, regardless of interval since last Td-containing vaccine. 1, 3
• Adults aged ≥65 years may receive Tdap, though the primary recommendation targets those <65 years. 1
• After Tdap, continue Td boosters every 10 years. 3, 5

Additional Vaccines Based on Risk Factors

If Chronic Medical Conditions Present

Pneumococcal vaccination becomes even more critical if the patient has: 1, 3

• Chronic heart disease (excluding hypertension alone)
• Chronic lung disease (including asthma)
• Diabetes mellitus
• Chronic liver disease
• Alcoholism
• Cigarette smoking history

For these patients: Administer PPSV23 even before age 65, then additional dose at age ≥65 if ≥5 years have elapsed. 1

If Immunocompromising Conditions

For immunocompromised patients (HIV, chronic renal failure, immunosuppressive therapy, malignancy, asplenia): 1, 3

• Administer PCV13 followed by PPSV23 at least 8 weeks later
• Then another dose of PPSV23 at least 5 years after the previous PPSV23
• At age ≥65 years, administer one final dose of PPSV23 at least 5 years after most recent PPSV23
• Use inactivated influenza vaccine (not live attenuated) annually 2

Hepatitis B Vaccine

Administer if: 3

• End-stage renal disease or hemodialysis
• HIV infection
• Chronic liver disease
• Healthcare worker or public safety worker exposed to blood
• Sexually active with multiple partners
• Household contact of HBV-infected person

Hepatitis A Vaccine

Administer if: 3

• Chronic liver disease
• Men who have sex with men
• Injection drug use
• Travel to endemic areas
• Laboratory work with hepatitis A virus

Varicella Vaccine

Only if no evidence of immunity (born before 1980 generally considered immune unless healthcare personnel). 1

• If no immunity documented: 2-dose series 4-8 weeks apart 1

Meningococcal Vaccine

Only for specific high-risk conditions: 1, 3

• Anatomical or functional asplenia
• Persistent complement component deficiency
• Complement inhibitor use (eculizumab, ravulizumab)
• Microbiologists routinely exposed to Neisseria meningitidis

Common Pitfalls to Avoid

• Do not administer PCV13 and PPSV23 on the same day – this reduces immunogenicity. 1
• Do not use live attenuated influenza vaccine (LAIV/FluMist) in adults ≥65 years – only inactivated vaccines are appropriate. 1
• Do not skip Tdap assuming the patient is "too old" – pertussis protection wanes and Tdap is safe and recommended. 1, 3
• Do not forget to document previous vaccination history – unnecessary revaccination with PPSV23 should be avoided. 1
• Do not delay influenza vaccination waiting for enhanced formulations – if high-dose or adjuvanted vaccines are unavailable, standard-dose vaccine should be given. 1