HomeTIP - 2024 CDC Vaccine Recommendations for Older Adults

TIP - 2024 CDC Vaccine Recommendations for Older Adults

Updated by Ina Goldberg, 4-Year Member

Ina is an Adult Primary Care Nurse Practitioner. She summarizes the most current information on recommendations by the CDC (Centers for Disease Control; www.cdc.gov). Please consult your healthcare provider for questions and concerns related to your specific medical history. Also, please see the CDC.gov website for a complete schedule of vaccinations.

Vaccines you need

As we get older, our immune systems tend to weaken over time, putting us at higher risk for certain diseases. All adults ages 65 and older should make sure they’re up to date on these vaccines:

COVID-19 vaccine
Flu vaccine (influenza)
Pneumococcal vaccine
Shingles vaccination(zoster)
Tdap (tetanus, diphtheria, and whooping cough) or Td (tetanus and diphtheria)

You may need other vaccines, too

You may need other vaccines based on your age or other factors, too. Talk with your doctor to learn which vaccines are recommended for you. This may include:

RSV (respiratory syncytial virus) – adults aged 60 years or older should talk to their healthcare provider about getting a single dose of RSV vaccine

According to most CDC Guidelines (June 27, 2024), healthcare providers should use the following information to make recommendations for you:

Determine recommended vaccine by age (Table 1- By Age)
Assess need for additional recommended vaccinations by medical condition or other indication (Table 2 – By Medical Condition)
Review vaccine types, dosing frequencies and intervals, and considerations
for special situations (Notes)
Review contraindications and precautions for vaccine types (Appendix)
Review new or updated ACIP (Advisory Committee on Immunization Practices) guidance (Addendum)

COVID-19 Vaccine:

Updated 2024-2025 COVID-19 Vaccine Recommendations

CDC recommends everyone ages 6 months and older receive an updated 2024-2025 COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 this fall and winter even if they have ever previously been vaccinated with a COVID-19 vaccine. Updated COVID-19 vaccines will be available from Moderna, Novavax, and Pfizer this year. This recommendation will take effect as soon as the new vaccines are available.

Routine COVID-19 vaccine recommendations (please see CDC.gov website for “Special Situations,” “Contraindications and Precautions”:

Age 19 years or older

Unvaccinated:

1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech vaccine
2-dose series of updated (2023–2024 Formula) Novavax at 0, 3–8 weeks

Previously vaccinated* with 1 or more doses of any COVID-19 vaccine: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine administered at least 8 weeks after the most recent COVID-19 vaccine dose.

*Note: Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023-2024 formulation There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

The new updated fall monovalent Covid-19 booster is a better match to the currently circulating variants and will therefore provide better protection against infection in the next few months than the older vaccine. If you are eligible for a booster now, for most people it makes sense to wait for the new updated booster rather than get the bivalent booster.

Some people are wondering if it is safe to wait for the new booster to be available. If you are immunocompromised or 65 years of age or older, you should only consider getting the bivalent booster if you are at high risk for exposure due to travel or other circumstances in the coming weeks. Otherwise, wait for the updated fall booster. It is important to know that if you get the bivalent booster, you will need to wait 2-3 months before being able to get the new monovalent booster. People in this situation should speak to their clinician about what is best for them based on their health condition and/or age.

If you had Covid-19 recently, it makes sense to wait since having the infection gives you high levels of protective immunity for several months. The CDC recommends waiting at least 3 months from infection before getting any Covid-19 vaccine.

Immunological data suggests that waiting up to 3-6 months may maximize the benefit you will get from the booster. Between now and when the updated booster is available, it is important to ramp up other prevention strategies such as wearing a good quality mask (N-95 or KN-95) when in crowded spaces, opting for outdoor gatherings (such as parties or dining out) and at-home testing if you feel ill, believe you were exposed to someone with Covid-19, or are planning to visit someone who would possibly get very sick if they get Covid-19 (such as those with chronic illness, frail elderly, pregnant people, newborns). Adhering to these prevention behaviors will lower your risk of getting infected with Covid-19 and spreading it to others.

If you get Covid-19, despite having had the vaccines, you should take Paxlovid (see ** below). This will significantly reduce your chance of being hospitalized and dying from Covid-19. It is critical that you start Paxlovid within 5 days of symptom onset, or if you have no symptoms, then start it within 5 days from the date of your positive test. If your clinician says wait to start it until you get sick or sicker, speak to a different clinician. Waiting to start it or not taking it at all is the biggest reason people are being hospitalized now and dying from Covid. This is preventable with Paxlovid. People worry about “Paxlovid rebound.” There is no such thing as Paxlovid rebound. Rebound comes with any viral infection and typically happens during the second week of infection. It happened just as often in people with Covid-19 before Paxlovid was available to us. So be sure to take Paxlovid if you become infected.

**You may not be able to take Paxlovid if you are taking certain medications. Your clinician will determine if this is the case for you. If you cannot take Paxlovid, then Remdesivir is an excellent alternative medication. It is given by IV for 3 doses. You should take one or the other.

Seasonal influenza (flu)

Updated 2024-2025 Flu Vaccine Recommendation CDC recommends everyone 6 months of age and older, with rare exceptions, receive an updated 2024-2025 flu vaccine to reduce the risk of influenza and its potentially serious complications this fall and winter. CDC encourages providers to begin their influenza vaccination planning efforts now and to vaccinate patients as indicated once 2024-2025 influenza vaccines become available.

Most people need only one dose of the flu vaccine each season. While CDC recommends flu vaccination if influenza viruses are circulating, September and October remain the best times for most people to get vaccinated. Flu vaccination in July and August is not recommended for most people, but there are several considerations regarding vaccination during those months for specific groups:

For adults (especially those 65 years old and older) and pregnant people in the first and second trimester, vaccination in July and August should be avoided unless it won’t be possible to vaccinate in September or October.
Pregnant people who are in their third trimester can get a flu vaccine in July or August to protect their babies from flu after birth, when they are too young to get vaccinated.
Children who need two doses of the flu vaccine should get their first dose of vaccine as soon as it becomes available. The second dose should be given at least four weeks after the first.
Vaccination in July or August can be considered for children who have health care visits during those months if there might not be another opportunity to vaccinate them.

Updated 2024-2025 flu vaccines will all be trivalent and will protect against an H1N1, H3N2 and a B/Victoria lineage virus. The composition of this season’s vaccine compared to last has been updated with a new influenza A(H3N2) virus. Approximately 12,000 older adults died from seasonal influenza (flu) during the 2019-2020 season. Seasonal influenza, or “the flu”, presents with sudden onset of fever, muscle pain, dry cough, sore throat and runny nose. We can see illness from influenza viruses at any time during the year. But like many respiratory viruses, we tend to see the most flu infections in the fall and winter months.

In the US and Canada, we tend to see flu ramping up in October with the peak number of infections occurring between December and February, and then tapering off in May.

Getting a flu vaccine can reduce the risk of needing to go to the doctor by 40% to 60%. Because protection wanes throughout a season, you should wait until October to get the flu vaccine. This is the best time to get vaccinated so that you are fully protected before a flu wave. If you are 65 or older, get the vaccine that is intended for this age group.

Even if you get the vaccine, you may still get the flu. If this happens to you, be sure to speak with your clinician about getting Tamiflu. This can help reduce your chances of more severe illness. Tamiflu must be started within 48 hours of the onset of flu symptoms. After this time, it will not be effective and you should not take it.

Pneumococcal pneumonia vaccine

Pneumococcal pneumonia is caused by bacteria called Streptococcus pneumoniae and can range from ear and sinus infections to pneumonia and bloodstream infections. According to the American Lung Association, even healthy adults aged 65 and older are over 10 times more likely to be hospitalized with pneumococcal pneumonia than younger adults. Also, if you also live with a chronic lung disease like COPD, asthma, diabetes, or chronic heart disease, you face a greater risk if you develop this infection.

There are several vaccines available that protect you from pneumococcal pneumonia. Prevnar 20 is effective for adults aged 65 and older. You only need to take it once. There are several other Prevnar vaccines. Speak with your clinician about which of these vaccines is best for you. This will depend on whether you have had a pneumococcal vaccine in the past and which one you had.

Zoster recombinant (RZD) (Shingles)

Age 50 years or older: 2-dose series recombinant zoster vaccine (RZV, Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon), regardless of previous herpes zoster or history of zoster vaccine live (ZVL, Zostavax) vaccination.

RSV vaccine for older adults

Each year, it is estimated that between 60,000-160,000 older adults in the United States are hospitalized and 6,000-10,000 die due to Respiratory Syncytial Virus (RSV) infection. Older adults are at highest risk for severe RSV infection. The RSV vaccine is a new vaccine and is available from two manufacturers - GSK and Pfizer.

Both effectively protect against severe illness, with 82-86% efficacy. The two vaccines are slightly different in design, but only at a microscopic level. And side effects like fever and body aches are uncommon.

The RSV vaccine is recommended for people ages 60 and older. People with underlying health conditions (like heart or lung disease or diabetes) and those living in long-term care facilities should strongly consider the vaccine. RSV vaccine effectiveness does not wane as quickly as flu and Covid-19 vaccines, so getting one now should protect you throughout the entire season (and maybe even next season).

Severe side effects were rare and similar between vaccine and placebo groups. However, there were two potentially concerning side effects:

Acute disseminated encephalomyelitis (ADEM) — a neurological condition in which the brain or spinal cord rapidly swells due to inflammation.
- GSK: 2 cases for a total incidence of 1 per 15,000. In the general population, there are 1-2 cases of ADEM per 250,000 people per year.

Guillain-Barré syndrome (GBS) — also a nerve condition caused by inflammation that causes weakness and paralysis that typically begins in the legs and rises.
- GSK: 1 case for a total incidence of about 1 per 15,000.
- Pfizer: 2 cases for an incidence of about 1 per 9000. In the general population there are 1.5 to 3 per 100,000 people per year.

Both vaccines produced similar adverse events and at similar rates that are above their background rates. However, because the number of events was so small, it’s difficult to know whether these are coincidental events or reflect a real safety issue. Future research data will clarify this, but it will take time for this information to accumulate. It’s always best to discuss your health situation with your clinician. Is your risk from getting RSV greater than the very small risk of the complications mentioned above? Remember, 6,000-10,000 older adults die each year in the US due to RSV infections.

Can I get the vaccines (flu, RSV, Prevnar and/or Covid-19) at once?

There is no combined shot (some companies are working on it, but such a vaccine will not be available for years). This means that you will need to get separate shots to protect against these diseases.

Vaccines that can be given at same visit:

Flu and Covid-19
Flu and Prevnar
Flu and RSV
Covid-19 and Prevnar

But it may not be ideal to get them together only because you might have more annoying side effects if you get them all at once. If you experienced uncomfortable symptoms like body aches or fatigue after your last Covid-19 or flu vaccine, you may decide doubling up in the same visit is not for you.

There is no recommended length of time to wait between vaccine visits, but if you do not take them on the same day, then waiting 2 weeks between vaccine visits is probably the best plan.

Upcoming travel, scheduled indoor activities, and the start of school are all very good reasons to plan to receive your flu and Covid-19 vaccine as soon as possible.

With cooler weather and increased time in shared indoor space on the horizon, the incidence of Covid-19 and flu are expected to increase. Protect yourself by getting two safe and effective vaccines as a pair or one at a time.

Tetanus, diphtheria, pertussis (Tdap or Td)

The CDC recommends that adults receive a Tdap or Td booster shot every 10 years after receiving the initial Tdap dose. The Tdap vaccine protects against tetanus, diphtheria, and pertussis (whooping cough).