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Prevention & screening

Which Vaccines Do Adults Actually Need?

Most adults need a yearly flu shot, an updated COVID-19 vaccine, and a Tdap or Td tetanus booster. The shingles vaccine (Shingrix, two doses) is recommended starting at age 50, and pneumococcal and RSV vaccines become standard in the mid-sixties — earlier for high-risk adults.

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Why adults need vaccines — immunity wanes and schedules have changed

Two facts make adult vaccination important even for people who had all their childhood shots.

Immunity can wane. Protection from the tetanus and pertussis series fades over roughly 10 years. Flu and COVID-19 viruses change regularly and require updated formulations each season 1.

Some vaccines were not routine when you were a child. Hepatitis B was added to the US childhood schedule in 1991 — adults born before then may never have received it. Varicella (chickenpox) vaccine was introduced in 1995; adults without documented immunity may need catch-up doses.

New vaccines address adult-onset risks. Shingles does not occur in children; the Shingrix vaccine is recommended for adults 50 and older 2.

Vaccines recommended for most adults

Flu vaccine (annual): Recommended every year for virtually all adults. The vaccine is reformulated each season to match circulating strains. For adults 65 and older, high-dose or adjuvanted flu vaccines are preferred because immune function declines with age 1.

COVID-19 vaccine (updated annually): The CDC recommends that all adults stay up to date with updated COVID-19 vaccines, revised periodically to target circulating variants. Older adults and immunocompromised people may need additional doses 1.

Tdap and Td: Tdap (tetanus, diphtheria, pertussis) is a one-time adult booster if not previously received as an adult, followed by a Td (tetanus and diphtheria) every 10 years. Pertussis protection wanes and has caused outbreaks — adults in close contact with infants especially need to be current. Tdap is also recommended during each pregnancy 1.

Age-based vaccines: when do they become relevant?

Shingrix (shingles vaccine) — starting at 50: Shingles is caused by reactivation of the varicella-zoster virus, often causing a painful rash and, in some cases, long-lasting nerve pain (postherpetic neuralgia). Shingrix is given as two doses and is recommended for all adults 50 and older, including those who have had shingles before or received the older Zostavax vaccine. Even prior shingles is not a reason to skip it 2.

RSV vaccine — starting at 60 (shared clinical decision): RSV can cause serious respiratory illness in older adults. The RSV vaccine is recommended for adults 60 and older as a shared clinical decision — not automatically for everyone 3. Adults 50–59 at high risk may discuss it with their clinician.

Pneumococcal vaccines — starting at 65 (or earlier for high-risk adults): Pneumococcal bacteria cause pneumonia, meningitis, and bloodstream infections that are especially dangerous in older adults and those with chronic conditions. PCV15 or PCV20 are the current options; adults with asthma, heart disease, diabetes, or chronic kidney disease may need pneumococcal vaccines before age 65 4.

Vaccines based on health status or risk factors

Hepatitis B: Recommended for all adults up to age 59 who are not previously vaccinated; adults 60 and older should discuss with their clinician. Anyone at elevated risk — healthcare workers, people who inject drugs, sexual partners of hepatitis B-positive people — should receive it regardless of age 1.

Hepatitis A: Two doses, recommended for adults traveling to certain countries, those with liver disease, men who have sex with men, and people who use drugs 5.

HPV vaccine: Recommended through age 26 for adults not vaccinated in childhood. For ages 27–45, it is a shared decision depending on prior HPV exposure. Not typically recommended after 45 6.

Meningococcal vaccine: Recommended for adults at increased risk — college freshmen in dormitories (if not already vaccinated), people without a spleen, and travelers to certain regions 1.

Varicella: Recommended for adults without evidence of immunity — no prior vaccination and no documented prior chickenpox. Two doses 1.

Travel vaccines and how to fill gaps in your record

Travel to certain regions adds considerations: typhoid, yellow fever (required for entry to some countries), cholera, Japanese encephalitis, and rabies pre-exposure prophylaxis. Some travel vaccine series take weeks to complete — plan at least four to six weeks before departure.

The most reliable way to know what you are missing is to bring vaccination records to a primary care visit and review them together. Your clinician can check state immunization registries or, for some vaccines, test for immunity with a blood titer rather than repeat vaccination. Many pharmacies also administer common adult vaccines.

Common questions

Do I need the shingles vaccine if I've already had shingles?

Yes. Shingrix is recommended even if you have had shingles before, because the vaccine reduces the risk of recurrence and its complications. Prior disease does not confer lifelong protection. Your clinician can advise on timing.

Is the flu vaccine necessary every year?

Yes. The influenza virus changes from season to season, so the vaccine is reformulated annually to match circulating strains. Prior-year vaccination does not reliably protect against the current season.

Can I get multiple vaccines on the same day?

Generally yes. Most adult vaccines can be given at the same visit. Your clinician or pharmacist will advise if there are any timing restrictions for your specific combination.

What if I am immunocompromised — are vaccines safe?

Many vaccines are safe for people who are immunocompromised, but live vaccines (such as MMR, varicella, and live attenuated flu) may be contraindicated depending on your condition and medications. Inactivated vaccines are generally safe but may be less effective. This requires individualized planning with a clinician.

How do I find out which vaccines I have already received?

Bring whatever vaccination records you have to a primary care visit. Your clinician can also check your state immunization registry — most states maintain one. For some vaccines, a blood test (titer) can confirm whether you are immune without repeat vaccination.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek care after a vaccine

  • —Difficulty breathing, swelling of the throat or face, rapid heartbeat, or dizziness after a vaccine — call 911 immediately (signs of anaphylaxis)
  • —High fever, severe pain, or rapidly spreading redness at an injection site — contact your clinician promptly
  • —New neurological symptoms (weakness, numbness, difficulty speaking or walking) after a vaccine — seek care and report

A severe allergic reaction to a vaccine is a medical emergency. Call 911. Vaccination sites are required to have you wait 15 minutes after injection to monitor for this reaction.

This article is a general educational overview of adult vaccine recommendations in the United States. It is not a personalized immunization plan. Your clinician will review your specific history and health conditions to determine exactly which vaccines are right for you and when. Recommendations are updated periodically — the CDC publishes an updated adult immunization schedule each year.

References

  1. 1.Wodi AP, Issa AN, Moser CA, Cineas S (2025). Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2025. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm7402a3 ✓Flu, COVID-19, Tdap/Td, hepatitis B, varicella, meningococcal vaccine recommendations for adults; preferred flu vaccines for adults 65+
  2. 2.Dooling KL, Guo A, Patel M, et al. (2018). Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm6703a5 ✓Shingrix recommended for all adults 50 and older, including those with prior shingles or prior Zostavax vaccination
  3. 3.Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP (2023). Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm7229a4 ✓RSV vaccine recommendation for adults 60 and older as a shared clinical decision
  4. 4.Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022). Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm7104a1 ✓Pneumococcal vaccine (PCV15, PCV20) recommendations for adults 65 and older and high-risk adults under 65
  5. 5.Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018). Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm6743a5 ✓Hepatitis A vaccine recommendations for high-risk adults and international travel
  6. 6.Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE (2019). Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm6832a3 ✓HPV vaccine recommended through age 26; shared clinical decision for ages 27–45; not routinely recommended after 45

6 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.