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Your Guide To Adult Vaccines

Vaccines You Need After 50

​Check out this list of what you need and when

Masked senior woman getting a vaccine while at the pharmacy by a masked female pharmacist.

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You already know it’s important to get your flu vaccine every year, ideally by the end of October. And when you go in for the shot, it’s a great time to make sure you’re up to date on all the other immunizations you should be receiving as an adult.

After all, it’s not just babies and youngsters who need a poke to protect against serious, and potentially lethal, diseases. Adults need them too, especially as our immune systems weaken with age.

So what shots should you get at 50 and beyond? “There are new vaccines that have come out in the past several years, specifically aimed at older adults,” says Morgan Katz, M.D., an assistant professor of medicine at Johns Hopkins University School of Medicine.

Checking In On Polio Vaccination Status

With newfound evidence that the poliovirus is circulating in the U.S., experts are recommending that anyone who is unvaccinated get immunized against the potentially debilitating disease. The CDC says most adults in the U.S. were vaccinated against polio as children (the vaccine first became available in 1955), and that continues to be the case. However, if you’re unsure of your status and are concerned, the CDC says it’s safe to repeat the vaccine.

One of them is Shingrix, the amazingly effective shingles vaccine. And there are a few new pneumococcal vaccines on the market that go hand-in-hand with updated recommendations for older adults.

Below you’ll find the vaccinations every adult needs, followed by two — for hepatitis A and B — that you need only if you have certain risk factors. What you won’t see on the list? Measles and chicken pox vaccines. Anyone born before 1957 wouldn’t need a measles vaccine because the disease was so prevalent when they grew up that immunity as an adult is assumed.

Chicken pox is similar in that most adults already have immunity from childhood exposure to the disease, Katz says. “Almost all adults over 40 have been exposed to chicken pox,” she adds, noting that it would be “an extremely rare case” for an adult not to have been. That said, if you think you could be in that tiny minority, ask your doctor about getting the chicken pox vaccine as an adult.

For the rest of the list, you can get your necessary shots at doctors’ offices, pharmacies, workplaces, community health clinics and other locations. And most health insurance plans will pick up the tab. So stop in and let ’em stick it to you. 

Influenza vaccine 

Who needs it: All adults, no matter the age.

How often: Once a year. “The virus itself changes every year,” Katz says. “Researchers try to predict what will be the most common strain that season, then reformulate the vaccine accordingly.” 

Flu season typically begins in October and ends in March, though experts predict it could hit earlier this year. And so the Centers for Disease Control and Prevention (CDC) recommends rolling up your sleeve by the end of October, since it takes about two weeks after a vaccination for flu-fighting antibodies to develop in the body. 

What you need: While experts say a standard flu shot is certainly better than no flu shot, the CDC is now recommending that adults 65 and older — a group at higher risk of complications from an influenza infection — opt for a high-dose version. Here’s a rundown of the options:

  • Fluzone High-Dose Quadrivalent is an injectable vaccine that contains four times the antigen (the flu proteins that our immune system recognizes and attacks) of a standard-dose inactivated flu vaccine, to help create a stronger immune response. A study published in The Lancet Respiratory Medicine reported that people 65 years and older who got Fluzone High-Dose (a previously available trivalent high-dose vaccine) had a lower risk of hospitalization compared with people in that age group who got the standard dose, especially those living in long-term care facilities. What’s more, research published in The New England Journal of Medicine found it to be more effective in preventing flu in adults 65 years and older relative to a standard-dose vaccine.

  • Fluad Quadrivalent is an adjuvanted flu vaccine, made with an MF59 adjuvant, an additive that creates a more robust immune response

  • Flublok Quadrivalent. This is a recombinant vaccine, which means it does not require an egg-grown virus and does not use chicken eggs in the manufacturing process. This may be a good option if you are allergic to eggs (the Fluzone and Fluad offerings are grown in eggs). Flublok Quadrivalent contains three times the antigen of other standard-dose inactivated flu vaccines.

Why you need it: The flu can lead to hospitalization and sometimes death — and seniors are the most vulnerable. In any year, 50 to 70 percent of flu-related hospitalizations occur among people 65 and older, according to the CDC. Still, research compiled by AARP found that only half of U.S. adults ages 50 to 64 had the influenza vaccine in 2020; 70 percent of adults 65 and older went in for the jab.

Talk to your doctor if: You’ve had a severe reaction to the flu shot in the past, are allergic to eggs, have (or have had) Guillain-Barré syndrome, or have a fever. (In that case, you’ll likely be asked to wait until your temp is back to normal before you get the vaccine.)

Parting shot: Even if you’re vaccinated, there’s a possibility you could get the flu. How well the inoculation protects depends on different factors, including your age and health status. That said, a flu vaccination may lessen the severity of illness if you do get sick. A 2017 study found that flu vaccination reduced ICU admissions and the length of hospital stays among flu patients, especially among older adults. It also reduced death.

COVID-19 vaccine  

Who needs it: All adults, no matter the age, and especially people ages 50 and older, who are considered to be at increased risk for complications from a coronavirus infection.

How often: It’s recommended that all adults receive their primary series (this is two shots, given a few weeks apart), followed by an updated (omicron) booster to protect against the coronavirus variants that are currently circulating. In the past, booster schedules varied — some older adults may have received two or more. However, the new recommendation is that all fully vaccinated adults — no matter how many boosters are under their belt — should get the newly authorized omicron booster at least two months after their last shot. Health officials are hopeful boosters from here on out will be on an annual schedule; stay tuned.

What you need: There are four different vaccines available, one from Novavax, one from Moderna, one from Pfizer-BioNTech and one from Johnson & Johnson, though the CDC recommends the J&J vaccine be considered only in some situations. The vast majority of Americans have been vaccinated with either Pfizer or Moderna.

The primary series for the Novavax, Moderna and Pfizer COVID-19 vaccines requires two shots, spaced a few weeks apart. Both Moderna and Pfizer have updated boosters; Novavax is expected to have a booster soon.

Why you need it: COVID-19 has killed more than 1 million Americans since it started circulating in the U.S. two years ago and has hospitalized countless others. It’s especially risky for adults 50 and older who are more likely to suffer complications from an infection.

CDC data from June 2022 shows that unvaccinated people are five times more likely to die from COVID-19 than their vaccinated peers. And among adults 50 and older, unvaccinated people are 14 times more likely to die from the illness than adults who are up to date on their COVID-19 vaccines and boosters.  

Talk to your doctor if: You’ve had a severe allergic reaction to a medication or vaccine in the past.

Parting shot: As the newly authorized omicron boosters ship out and supplies ramp up, health experts are encouraging people to schedule their COVID-19 booster at the same time as their flu shot for added convenience and enhanced protection against two illnesses that tend to spread more in the cold-weather months.

Pneumococcal vaccine

Who needs it: Healthy adults 65 years and older, or adults 19-64 with certain risk factors (smoking, or health problems, such as chronic lung or heart disease, leukemia, lymphoma or alcoholism).

How often: Adults who haven’t received a pneumococcal vaccine should opt for either the PCV15 or PCV20. If PCV15 is used, it should be followed by a dose of PPSV23 a year later. (If you're immunocompromised, you may get it sooner.) 

Why you need it: Before COVID-19 came along, pneumococcal disease, which can cause pneumonia, killed more people in the U.S. each year than all other vaccine-preventable diseases combined. Young children and those over 65 have the highest incidence of serious illness, and older adults are more likely to die from it. Experts estimate PCV13 (one of the pneumococcal vaccines available) prevented more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths in its first three years of use. About 65 percent of adults 65 and older received the pneumococcal vaccine in 2020, an AARP report shows.

Parting shot: If you work around chronically ill people — say, in a hospital or nursing home — you should get the vaccine, even if you’re healthy.

Tdap vaccine (tetanus, diphtheria, pertussis) and/or the Td booster (tetanus, diphtheria)

Who needs it: The Tdap vaccine came out in 2005, and along with protecting against tetanus and diphtheria, like the vaccine it replaced, it also includes new, additional protection against whooping cough, also known as pertussis. If you can’t remember ever getting this shot, you probably need it. And doing so, says Katz, can also count for one of the Td boosters you’re supposed to get every 10 years. (You know the one ... it’s the shot you wonder if you’re current on after you step on a rusty nail during your vacation.)

How often: Adults should receive a booster dose of either Tdap or Td (a different vaccine that protects against tetanus and diphtheria, but not pertussis) every 10 years, the CDC says, or after five years if you get a severe wound or burn.

Why you need it: Due to a rise in whooping cough cases in the U.S., you really do need to be vaccinated against it, even if you’re over 65. In the first year after getting vaccinated, Tdap prevents the illness in about 7 out of 10 people who received the vaccine. 

Talk to your doctor if: You have epilepsy or other nervous system problems, had severe swelling or pain after a previous dose of either vaccine, or have (or have had) Guillain-Barré syndrome.

Parting shot: This vaccine is especially crucial for people who have close contact with children younger than 12 months of age — including parents, grandparents and child care providers.

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Shingles (herpes zoster) vaccine

Who needs it: The CDC recommends that everyone 50 and older get the Shingrix shingles vaccine, even if they had the earlier recommended vaccine, Zostavax — which was much less effective — and even if they’ve already had shingles. 

How often: For now, the CDC is recommending only that you get this new vaccine, which is given in two doses spaced two to six months apart, to prevent both shingles and its complications. It remains to be seen if the agency will recommend getting it again after, say, five years, as its effectiveness starts to wane. 

Why you need it: One in 3 people will get shingles, usually after age 50. The risk rises with age. By 85, half of adults will have had at least one outbreak. Chicken pox and shingles are caused by the same virus, varicella zoster. After a person recovers from chicken pox, this virus stays dormant for decades in the body, ready to appear when the immune system is weakened by stress, medication or disease. This infection causes a red rash and painful blisters. About 15 percent of sufferers are left with extreme nerve pain — a condition called postherpetic neuralgia, which can last for months or years. Shingrix can protect 97 percent of people in their 50s and 60s, and 91 percent of those in their 70s and 80s. Data compiled by AARP shows that 16 percent of adults 50 to 64 received the shingles vaccine in 2020; that percentage jumps to 43 percent when looking at adults 65 and older.

Talk to your doctor if: You are not feeling well, or currently have shingles. There are few other reasons not to get the vaccine. 

Parting shot: Older adults should also get this vaccine whether or not they remember having had chicken pox as a child. Why? More than 99 percent of Americans over the age of 40 have been exposed to the varicella zoster virus, even if they don’t recall getting chicken pox. 

Hepatitis A vaccine 

Who needs it: People 50 and older who are at high risk for hepatitis A, a disease of the liver. Infections result primarily from travel to another country where hepatitis A virus transmission is common, through close contact with a hepatitis A–infected individual, or recreational drug use.

How often: Once, but given in two doses over six months.

Why you need it: Hepatitis A rates in the U.S. have declined by more than 95 percent since the hepatitis A vaccine first became available in 1995. In 2016, there were an estimated 4,000 hepatitis A cases in the U.S.

Parting shot: This is a sneaky disease. You may not have any telltale signs — and the likelihood of symptoms decreases as you age.

Hepatitis B vaccine

Who needs it: Adults 50 and older who are at risk for contracting hepatitis B, a liver infection. Hepatitis B is transmitted when a body fluid (blood, semen, saliva) from a person infected with the hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact, or things like contact with blood or open sores (say, from a job that exposes you to human blood or other bodily fluids), or sharing anything from a needle to a razor to a toothbrush with an infected person. Other risk factors for infection include being on kidney dialysis, traveling to countries where hepatitis B is common, or having HIV.

How often: Adults getting the vaccine need three doses — the second dose given four weeks after the first; the third dose five months after the second. There is also a combination vaccine for both hepatitis A and B called Twinrix, which is given in three doses over six months.

Why you need it: The CDC estimates that the number of new hepatitis B infections in 2016 was 20,900.

Talk to your doctor if: You have a life-threatening allergy to yeast, or to any other component of the vaccine, or are moderately or severely ill when a dose of vaccine is scheduled.

Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.

Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation’s top consumer publications. Her work has appeared in Reader’s Digest, Real Simple, Prevention, The Washington Post and The New York Times.

Editor’s note: This story, published March 15, 2021, has been updated to reflect new recommendations for COVID-19, flu and pneumococcal vaccinations.