Which vaccines are best for people over 65?

If it’s pumpkin spice season, it's time to think about vaccines.  

This year’s flu vaccine is now available, as is the latest COVID-19 booster, which targets new strains, including EG.5 and BA.2.86. And there’s a new kid on the block for babies and older adults: the RSV vaccine, designed to protect against a disease that’s dangerous for both ends of the age spectrum. 

These all come on top of other recommended vaccines for older adults, such as shingles and pneumonia.  

It might feel overwhelming to sort out, so we asked Ana Oppenheimer, MD, MPH, an infectious disease specialist with Cape Cod Healthcare, to explain what’s important for people over 65 to understand about vaccines, particularly this year’s crop. Her answers are below; they have been edited for length. 

What are the vaccine recommendations for people over 65? 

I recommend, in line with the U.S. Centers for Disease Control, vaccinating against COVID-19, flu, tetanus, diphtheria, and whooping cough, measles, mumps and rubella, varicella, shingles, strep pneumonia, hepatitis A and B, meningitis, and haemophilus influenzae. RSV (respiratory syncytial virus) is a new vaccine that also targets this age group. 

Some vaccines may have been administered earlier in life, so discuss with your primary care physician which vaccines you need. When in doubt, or if you do not remember, get vaccinated! There are no major side effects to receiving extra doses.  

Does a vaccine mean I won’t get sick?  

You get vaccinated to prevent a disease or a severe form of the disease.  However, you can still become infected or slightly sick, depending on some factors, such as whether you have an immune-compromising condition, or multiple medical conditions of the heart, lungs, liver and kidneys, or have had an incomplete vaccination schedule, or the vaccine is less immunogenic (strong), or is administered incorrectly, or has not been properly stored.

Can a vaccine make me sick with the disease it's fighting?  

Since the first smallpox vaccine in 1796, we have accumulated a wealth of knowledge and continue to do so. There are many ways of manufacturing vaccines, ranging from dead or inactivated whole organisms to using parts of those organisms our body is trained to react to. The latest technology uses messenger RNA (Ribonucleic acid) or mRNA. These are only pieces of the virus, unable to cause disease but able to induce the production of viral proteins that our immune systems recognize as foreign. So when a person gets exposed to the real virus these proteins go immediately to work and neutralize the invading virus. When we get an mRNA vaccine we are never exposed to the virus and can never get sick from the vaccine.   

Do I really need another COVID shot? 

It looks like the COVID vaccine may become an annual vaccine, just like the flu vaccine. One gets immunity from getting the disease or getting the primary vaccination series. Over a few months, the immunity decreases and needs to be boosted, if the virus is still circulating in the community. If the virus changes, the immunity needs to match that variant, hence booster and new booster combinations.  

All current vaccine boosters are monovalent and target the XBB.1.5 Omicron variant that is currently the most prevalent in the US. This vaccine also neutralizes other circulating variants BA.2.86 and EG.5, while the CDC continues monitoring their behavior. 

So, yes, get the new available booster COVID vaccine.  

What about this year’s flu vaccine? When should I get it? 

It’s best to get it as early as possible during the flu season, which goes from October 1 through the third week of May in the United States. Even if you do not get immediately vaccinated, you can and should still be vaccinated anytime in the season. When a provider asks if you have received the flu vaccine, they usually mean the current flu season, not the last one. In general, the flu vaccine decreases the risk of being hospitalized with the disease by about 40 percent. When hospitalized, it decreases the risk of being admitted to the ICU with serious complications by up to 80 percent, and decreases the risk of death from respiratory failure by up to 30 percent when compared with non-vaccinated people. 

Remember, none of the flu vaccines can give you flu, nor can they make you susceptible to other respiratory viruses like COVID. 

People over 65 should be vaccinated with the adjuvanted vaccines; they have a stronger stimulus for an aging immune system. If adjuvanted vaccines are not available, it’s still good to get the non-adjuvanted vaccines. 

Should I get the RSV vaccine? 

RSV is highly contagious. It begins like a cold but can lead to severe pneumonia. Two vaccines have been approved for people 60 and older. They protect against RSV pneumonia, which can land people in the intensive care unit and/or intubated with artificial ventilation. RSV pneumonia has a high mortality in children and older adults. Your physician will advise which vaccine is appropriate for you. 

The RSV vaccine technology (mRNA) served as a model to manufacture the COVID vaccines made by Pfizer and Moderna. However, its release was delayed by the urgency of COVID. Overall, the efficacy of the RSV vaccine is about 82 percent. It can go as high as 94 percent for people with one or more comorbidities. 

How long does it take for most vaccines to be effective? 

Our immune system is wondrous biologic machinery, just like the overall human body. Vaccination is the act of receiving the shot that contains antigens – any materials that are new to the body. This will stimulate the immune system to react and create antibodies that will be circulating in your bloodstream and will react immediately if you do get exposed to that virus.  

It’s like the immune system going to school to learn new things and how to deal with them. That process takes about two to four weeks. 

Can I double up on some vaccines, e.g. get flu and COVID at the same time?  

Yes, most vaccines can be given at the same time. We are constantly exposed to germs (antigens), so our immune systems are used to being stimulated by hundreds of antigens naturally in our everyday living and working. A cold exposes us to about 10 or more antigens, a strep throat exposes us to up to 50 antigens. So it is OK to give several vaccines at the same time, it’s like mimicking our natural way of living.  

The immune system can multitask with a high degree of specificity. It can deal with each antigen separately and at the same time and make specific antibodies to those antigens. Such a wonder isn’t it? 

So, yes, you can take the flu, COVID and RSV vaccines and others at once. But one reason not to get several vaccines at the same time is to prevent sore arms!