Most parents know that newborn babies, toddlers, and young children go through a litany of vaccines. Very specific schedules are set, and parents are frequently back-and-forth to doctors’ offices just to keep up. But, what shots do adults need? The schedules can be difficult to read or understand. To stay on top of adult vaccines, read on to help determine what may be best for you.
If you’ve felt overwhelmed by the number of vaccines you’re hearing about this fall, you are not alone. Christian Miller, 34, who says he’s always kept up to date on his vaccines found himself “facing a bit of uncertainty,” this year.
“There were a lot more options and considerations to take into account. It felt overwhelming to decide which ones were necessary and which ones I could potentially do without,” he added.
There’s the usual flu shot, a new COVID booster, and a brand new vaccine approved to prevent respiratory syncytial virus (RSV) for some adults. That’s in addition to existing recommendations for occasional vaccinations to protect against tetanus, pneumonia, shingles, and more.
With guidance from his family doctor, as well as some internet sleuthing, he ultimately decided to get the flu, COVID, and pneumonia vaccinations this year. On the other hand, 43-year-old Joanna Sieczkowska, always gets her flu shot, but is wondering if she can get the RSV vaccine this year. She is a photographer who works with infants and small children.
“I want to make sure my little clients are safe when coming to me for their photo session,” she says.
If you’re wondering which shots you need this season, here’s what you should know about the benefits and side effects of vaccines recommended for adults.
How U.S. Vaccine Recommendations are Made
A group of experts, known as the Advisory Committee on Immunization Practices (ACIP), a committee under the Centers for Disease Control (CDC), reviews the available evidence regarding new vaccines, and new evidence regarding older vaccines, too. The ACIP convenes at three meetings per year and develops the recommendations for both adult and childhood vaccine schedules. During COVID, the group met more often, virtually.
The meetings are open to the public, who can comment during designated times in addition to the opportunity for written public comment. However, only the 15 voting members of the committee get to vote on the recommendations. The ACIP members include experts in immunology, virology, pediatrics, and public health, alongside one consumer representative.
Here are the vaccines that ACIP recommends for adults of different ages.
Vaccines for Adults 19 to 49 Years Old
Shots You May Need Annually
Shots that Last 10 Years or More
- Tdap for tetanus, diphtheria and pertussis (whooping cough)
- Varicella for chicken pox, if you have not previously been vaccinated or infected. Two doses should be enough for life.
Shots Your Provider May Recommend if You Have Certain Conditions
- Shingrix for shingles: two doses should be enough for life.
- Pneumococcal: the number of shots will depend on which versions you receive and when.
- Meningococcal: If you haven’t already received the meningococcal vaccine after the age of 16, experts recommend getting the shot before moving into a college dorm setting.
If You’re Pregnant
- Tdap for tetanus, diphtheria and pertussis (whooping cough)
- RSV (it’s not yet known how often you may need this)
Vaccines for Adults 50-64 Years Old
Shots You May Need Every Year
Shots You May Need That Will Last 10 Years or More
- Tdap for tetanus, diphtheria and pertussis (whooping cough)
- Shingrix for shingles: two doses should be enough for life.
If You Have Preexisting Conditions
- Varicella for chicken pox (two doses should be enough for life)
- RSV (it’s not yet known how often you may need this)
Vaccines for Adults 65 or Older
Shots You May Need Every Year
- COVID Shot
- Flu Shot
- RSV (it’s not yet known how often you may need this)
Shots You May Need That Will Last 10 Years or More
- Pneumococcal: the number of shots will depend on which versions you receive and when.
If You Have Preexisting Conditions
- Varicella for chicken pox (two doses should be enough for life)
Flu shot
The main ingredients in influenza vaccines are either dead or weakened flu viruses. These viruses cannot replicate and wreak havoc on your body like a normal flu virus, but their purpose is to prompt your immune system to mount an immune response. This response prepares your body to recognize and respond faster if it does encounter the actual influenza virus later in the season.
To come up with a new flu vaccine each year, researchers make educated guesses as to which strains of flu are most likely to cause the illness based on what circulated the previous year.
“They can never know exactly which strains are going to happen. Each flu shot that we get has at least three or four strains of flu from the preceding season,” says Daren Wu, MD, chief medical officer at Open Door Family Medical Center in New York City.
Side Effects of Flu Vaccines
The flu vaccine can cause side effects, which, while generally not dangerous, can mimic the types of symptoms you might get from a mild influenza infection.
“Once in a while, people have very uncomfortable reactions. Your body aches, [you can experience] chills, headaches. I’ve had those [myself] at least twice in the last 20 years of getting flu shots since I became a doctor. And I felt terrible,” says Wu.
“In the process of mounting that immune response, making the antibodies to be able to battle the real flu, people can feel terrible because it feels like you ARE fighting off the flu,” Wu says.
He adds, “It’s a one-, two-day reaction that’s completely different from actually getting the flu, which is a seven-day or more process. One is an immune reaction that is temporary, and the other is you are infected.”
Aside from brief, flu-like symptoms lasting a day or two, patients also report pain or soreness at the injection site. This is common with many vaccines. Wu recommends keeping the arm moving to alleviate the pain. A nurse once told Melissa Finley, Editorial Content Manager at MedShadow, that “instead of clenching the arm, I should try to go loose, like it is jello,” when receiving the injection to help prevent soreness after. “And it really did,” she says.
Lastly, there are some other possible side effects, depending on the type of vaccine you get. Most vaccines do not contain thimerosal, a preservative that was once considered controversial, but has since been shown to be safe in vaccines. It does, however, contain egg, which can be a problem for patients with severe egg allergies.
If you or your child has an egg allergy, know that most doctors and pharmacists stock a few eggless vaccines, says Wu. These vaccines, known as cell culture vaccines, are made using animal cells and recombinant vaccines that are synthetic and don’t have egg products.
COVID Vaccine
COVID hasn’t settled into one particular season just yet, but much like the flu vaccine, researchers are tracking the dominant strains and updating the original vaccine to target newer strains that might otherwise be able to escape the immune defense you built up from a previous vaccine. Leading up to the Fall of 2023, Omicron subvariant XBB.1.5 was the dominant strain, and that’s the variant that the new vaccines target. Newer strains have since become more prevalent than XBB.1.5 since, but researchers say they are related, and the vaccine remains effective against them, too.
Because the current strain can evade the immunity from previous vaccines, the CDC recommends that everyone over the age of 6 months get at least one shot of the updated vaccines this season, no matter when your last shot was. Scientists will continue tracking the virus as it mutates and issue new recommendations for another booster, when and if they are needed. If you are unable to get one of the two mRNA vaccines made by Pfizer or Moderna, the Food and Drug Administration (FDA) also approved an updated vaccine from Novavax made with an protein from the virus, as opposed to mRNA that instructs your body to make the spike protein.
Side Effects of the COVID Vaccine
The most common side effects of the COVID shots to date are similar—but sometimes more intense—to side effects of flu vaccines. For about two days after the getting the shot, many people experience:
- Fatigue
- Muscle pain
- Low-grade fevers
- Headaches
Because so many people have received the shots, researchers have been able to track a variety of less common side effects such as menstrual cycles lasting 24 hours longer than usual.
There are some other rare side effects such as myocarditis and hives lasting several weeks.
Check out MedShadow’s vaccine side-effects tracker for more details and frequent updates on side effects. You can also check out MedShadow’s COVID-19 topic page to find more in-depth reporting on specific findings, like what doctors say about the risk of myocarditis for kids.
Tdap for Tetanus, Diphtheria, and Pertussis (Whooping Cough)
You should get a Tdap vaccine when you’re about 10 or 11 years old. However, the immunity you build from this shot doesn’t last forever, so experts recommend getting it every 10 years.
Additionally, since infants are at high risk for whooping cough, the CDC suggests that women get the vaccine during pregnancy—ideally during the third trimester—so that they form antibodies which get passed on to their infant and protect the baby during the first few months of its life when it is most vulnerable to the infection. At two months, babies can get their first DTap shot, but they still need several boosters to build up protection from these illnesses.
It is important to know that this type of immunity is not long-lasting for the child. Since mom makes the antibodies and passes them along to the baby, the baby’s immune system doesn’t know how to make these antibodies. When they start to leave the bloodstream over time, the child’s immunity is gone until they get the shot themselves and their immune systems learn to make their own antibodies.
Side Effects of Tdap
Like many vaccines, pain, swelling, and redness at the injection site is common. You may also have a mild fever, fatigue, headaches, nausea, diarrhea, or stomach pain.
In rare cases, people have also had severe allergic reactions, swelling, hives, and neurological complications such as Guillain-Barre, in which your immune system attacks your nerves and can cause temporary or long-term paralysis.
A study of over 100,000 pregnant women found that the vaccine did not raise the risk of preterm birth or other adverse infant outcomes.
RSV Vaccine
The FDA approved two vaccines for RSV in 2023: GlaxoSmith Kline’s Arexvy for adults over the age of 60, and Pfizer’s Abrysvo, for adults over the age of 60, as well as pregnant mothers to provide immunity for their newborns.
In older adults, one dose of GSK’s Arexvy was 82.6% effective at preventing symptomatic RSV during the first season after they were given the vaccine. After a year, during the second RSV season, protection dropped to 56.1%.
For Prizer’s Abrysvo, efficacy during the first season was 88.9%. After a year, it fell to 78.6%. Only a few patients in either group ended up hospitalized with severe illness, so the vaccine’s efficacy against severe disease was not quantified, but the experts suggested that since it prevents symptomatic disease, it will likely also reduce hospitalization.
Given between the 32nd and 36th week of pregnancy, the shots lowered the risk of lower respiratory tract disease by 34.7% in newborns and the risk of severe lower respiratory tract disease by 91.1% for 90 days after the babies were born. As the babies got older, protection started to wane. By the time they were six months old, the risk of any lower respiratory tract disease was 57.3% lower than it was for babies who received a placebo and the risk of severe disease 76.5% lower. It’s not yet clear if breastfeeding extends protection.
RSV is a seasonal illness. It doesn’t mutate as much as respiratory viruses like COVID or influenza, but since most of us are infected multiple times throughout our lives, it’s reasonable to guess that vaccine-induced immunity will not last forever. Of course, at this point, we simply don’t know. The research is ongoing.
Side Effects of the RSV Vaccines
“The main side effects that we know are what we expected: people feel sore on the arm, people feel achy, some malaise, a little bit of a headache,” says Ed Ward, MD, a Mayo Clinic Hospital Physician
However, there were a few rare, but worrisome, side effects that ACIP pointed out it will be keeping an eye on in the future. The group said that between both vaccines for older adults, six individuals (out of tens of thousands of people in the trials) had inflammatory neurologic events such as Guillain-Barre syndrome, and acute disseminated myeloencephalitis which is temporary multiple-sclerosis-like inflammation that can cause long-term damage.
“Whether these events occurred due to chance, or whether RSV vaccination increases the risk for inflammatory neurologic events is currently unknown. Until additional evidence becomes available from post marketing surveillance, clarifying the existence of any potential risk, RSV vaccination in older adults should be targeted to those who are at highest risk for severe RSV disease and therefore most likely to benefit from vaccination,” the committee wrote.
Additionally, some experts hesitate to recommend the vaccine for pregnant women, as there was a signal in the trials the shot could raise the risk of preterm birth, though it wasn’t statistically significant.
Shingrix for Shingles
Shingles is a unique disease in that it’s not caused by a new infection. It’s a reactivation of the herpes zoster virus that causes chickenpox in children. After you recover from chickenpox, the virus lays dormant in your body for decades. It can be reignited to cause shingles at any age, but this becomes more likely as you get older, or if you are immunocompromised. The CDC recommends the vaccine for people 50 years and older, even if you’ve already had shingles, and those 19 and older who are immunosuppressed.
The Shingrix vaccine contains two shots. You should get these shots two to six months apart. Clinical trials demonstrated that it was 91% to 97% effective in preventing shingles, and that protection seems to stay strong, at least for the first four years in the patients who were tracked. Since the vaccine was approved in 2018, there’s a chance that adults will need additional booster shots if immunity wanes in the future, but scientists don’t yet know if that will be the case or what timeframe that booster may be needed.
Side Effects of Shingrix
As with other shots, pain at the injection site is common. Keep your arm moving to help lower the pain.
Other typical vaccine side effects were also common, with 10% of people reporting that the symptoms were intense enough to limit their activity. Others reported the following:
- 45% muscle pain
- 45% fatigue
- 38% headaches
- 27% chills
- 21% fevers
- 17% gastrointestinal symptoms like nausea or diarrhea
If you are experiencing systemic symptoms after taking the vaccination, says Natalie Baker, DNP, president of the gerontological advanced practice nursing association (GAPNA), basic medications can help.
“It’s certainly fine to take [over-the-counter (OTC) painkillers] through the first two to three days when having symptoms,” says Baker. If the symptoms last longer than that, she says it’s time to call your healthcare provider.
Like many vaccines, Shingrix may raise your risk of Guillain-Barre syndrome, a rare complication that can cause temporary paralysis.
Pneumococcal Vaccine
There are four different pneumococcal vaccines to prevent pneumococcal diseases which include pneumonia, meningitis, certain types of sinus infections, blood infections and ear infections. You’ll want to speak with your healthcare provider about which one to get, based on your risk factors and whether you’ve received the pneumococcal vaccine in the past. Depending on which shots you get, you may need one, two, or three shots in a series.
Typically, you won’t need these shots until you’re 65 or older, however if you have certain preexisting conditions such as chronic obstructive pulmonary disease (COPD), asthma, or heart disease, all of which put you at higher risk, your healthcare provider may recommend getting the shots earlier.
Side Effects of the Pneumococcal Vaccine
More than half of those who get the pneumococcal vaccine have pain and tenderness at the injection site. Twenty percent have swelling and 15 percent have redness. These typically go away within three to four days.
Fever, chills, fatigue, headaches, and muscle and joint pain are also common during the three to four days after the injection.
Can I Get All the Seasonal Vaccines at The Same Time?
Several vaccines can be taken at once, though not all combinations have been thoroughly evaluated yet by researchers. Here’s what we know so far.
Getting your flu shot and COVID booster at the same time does not change their efficacy or the likelihood of experiencing side effects, according to a September 2023 study.
You can also safely get the pneumococcal vaccine alongside the shingles vaccine, flu shot, or COVID booster if needed. However, getting the Tdap vaccine with the pneumococcal vaccine may lower the effectiveness of your pneumococcal shot.
Despite this, the CDC says it’s ok to get Tdap at the same time as any other vaccines if needed.
You can get the shingles vaccine at the same time as the pneumococcal vaccine, flu shot, or Tdap. Scientists are still testing whether it’s safe and effective to get it at the same time as the COVID shots.
It’s not yet clear whether you should get the RSV vaccine at the same time as other shots. Limited data suggests that it may be more effective, and reduce your risk of side effects, to get your RSV and flu shots separately, but more research is needed.
When it comes to vaccination, particularly in adulthood, it’s important to discuss your options with your healthcare provider. Depending on any preexisting conditions and your medical and vaccination history, your individual recommendations should be unique to you.
What Are Vaccines Made Of?
While you often hear about the active ingredients of vaccines, such as the mRNA, the attenuated virus, or viral particles designed to wake up our immune systems and prime them to respond to future, more potentially virulent, attacks, there are several other ingredients that go into creating vaccines, such as chemicals that keep the vaccine stable (extend shelf-life) or help it to work better. Read what Paul Offit, MD, director of the Vaccine Education Center and a professor of pediatrics at the Children’s Hospital of Philadelphia told MedShadow about these additives.
While the recommended vaccine schedule for adults can be a helpful guide, each individual is different, and you should speak to your doctor about what you may individually need or not need at any given time in your life.
