Which Vaccines Do You Need in 2023-24? Here Are Experts’ Recommendations for All Ages

Remember the last time smallpox, polio or diphtheria swept through the US? No? That’s because most of the once-dangerous diseases we vaccinate against today are gone or well-controlled, popping up only in small clusters.

Yet these success stories make it easy to forget the damage these illnesses can cause—and the importance of the vaccines that curb them. In fact, in recent years the Centers for Disease Control and Prevention (CDC) has estimated that only 21.8% of US adults have received all age-appropriate vaccines. The CDC has also noted that the national childhood vaccination rate is in decline, too.

Researchers are already spotting worrying clues that these trends may continue in the post-pandemic world. A June 2022 study published in the New England Journal of Medicine found that a community’s low Covid-19 vaccination rate predicts a lower-than-normal rate of seasonal flu vaccination. Some infectious disease authorities are concerned this hesitancy will spill over into public beliefs about other vaccines, too.

Even before the Covid-19 pandemic, the World Health Organization (WHO) named vaccine hesitancy as one of the top 10 threats to global health. This intensified with the rollout of the Covid-19 vaccine, as we entered what the WHO called an “infodemic“: a flood of confusing, often conflicting information about the vaccine. A study published in the Journal of General Internal Medicine found that about 73% of Americans reported exposure to vaccine misinformation during the pandemic—and that this exposure is a direct predictor of vaccine hesitancy.

Because the reach of vaccine misinformation is so vast, experts want to set the record straight about infectious disease protection for all ages.

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Why are vaccines given at different ages?

The CDC’s standard vaccine schedule, outlined below, aims to protect individuals when they’re typically most vulnerable to a disease, explains William Schaffner, MD, the Medical Director of the National Foundation for Infectious Diseases and professor of infectious diseases at Vanderbilt University Medical Center. “It all has to do with how frequently the diseases you might encounter were historically associated with different age groups.”

Back in the day, Dr. Schaffner says, there were many infectious diseases that occurred primarily in infancy, childhood and adolescence. These rates of illness informed what we now consider “baby shots” and childhood vaccine schedules.

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Childhood Vaccine Schedule

• At birth: Hepatitis B

• One to two months: Hepatitis B, Tdap (Diphtheria, tetanus, pertussis), Hib (Haemophilus influenzae type b), Polio, Pneumococcal, Rotavirus

• Four months: Tdap, Hib, Polio, Pneumococcal, Rotavirus, HepB

• Six months: Tdap, Hib, Polio, Pneumococcal, Rotavirus, Influenza, Covid

• One to two years: Chickenpox, Tdap, Hib, MMR (Measles, mumps, rubella), Polio (before 18 months), Pneumococcal, Hepatitis A, Hepatitis B, Covid

• Two to three years: annual flu vaccination, Covid

• Four to six years: Tdap, Polio, MMR, Chickenpox, flu, Covid

• 11 to 12 years: Meningococcal conjugate vaccine, HPV, Tdap (Tdap booster), flu, Covid

If a child misses a shot, there’s no need to start over—a doctor can simply administer the right doses to get them back on schedule. There’s no upper limit to how many vaccines can be administered in one doctor’s visit, either (in most cases). “[Multiple vaccinations at once] is more a matter of individual tolerance than anything scientific,” Dr. Schaffner says.

In the United States, childhood vaccination rates are comparably high to the rest of the world, too. While vaccination coverage slipped during the pandemic, it’s bounced back.

Still, the CDC reports that for the 2021-22 school year, 93% of kindergarten-aged children had all required vaccines, which was one percentage point lower than the previous year. An additional 4.4% were not up-to-date with the MMR vaccine. While this might not sound like a lot, just one percentage point amounts to about 35,000 kids without vaccine protection—enough to jeopardize herd immunity against preventable diseases, like measles.

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Current rates for childhood vaccinations by age two:

• Tdap: 80.4%

• Polio: 92.5%

• Measles, mumps, rubella (MMR): 90.8%

• Haemophilus influenzae type b (Hib): 80.0%

• Hepatitis B: 91.4%

• Chickenpox: 90.3%

• Pneumococcal conjugate vaccine (PCV): 81.4%

Do childhood vaccines last for life?

Many of the vaccines you receive in childhood will protect you for life—but not all of them. “This has everything to do with the nature of a virus and how that particular virus interacts with the immune system,” Dr. Schaffner says. He points to measles as an example. “It’s a very stable virus, it doesn’t change—basically, the virus today is the same as it was in 1935.” So, once you get vaccinated against measles, your protection extends for life.

In contrast, illnesses like the flu and Covid-19 are not at all stable. Because these viruses mutate, infectious disease experts have to keep up with the changes and constantly rework vaccine compositions. (Be sure you know Who Needs a Flu Shot This Year, from Infectious Disease Specialists.)

Still, the protection we get from certain longer-term vaccines simply declines over time. As examples: Tetanus starts to wane after about 10 years, meningococcal nets you about eight years of protection, and the pertussis vaccine declines after four.

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Do I need vaccines as an adult?

The CDC updates its adult immunization schedule on an annual basis—though, Dr. Schaffner says compliance with the vaccination schedule “really plummets” among adults.

Sampling of Adult Vaccination Rates

• Pneumococcal vaccination ages 19-64: 23.9%

• Pneumococcal vaccination ages 65+: 61.0%

• Shingles vaccination ages 50+: 29.4%

• Shingles vaccination ages 60+: 39.1%

• Tdap vaccination ages 13-17: 90.2%

• Tdap vaccination ages 19+: 43.6%

• Annual flu ages 18+: 49.4%

• HPV (at least one dose) ages 13-17+: 76.9%

• HepB ages 19+: 30.0%

Dr. Schaffner points to a few reasons for this trend. “First, people don’t recognize that vaccines are not just for kids,” explaining that these recommendations are rather recent to the last three decades or so. Additionally, “Doctors who care for adults spend a relatively brief period of time with the patient at each visit—and they’re almost always preoccupied with diagnosis and treatment issues”—instead of preventive care, like vaccines.

And while almost all childhood vaccinations are covered by either insurance or governmental programs, there’s often a financial hurdle for adults. “In the United States—shame on us—we have not yet created a comprehensive adult vaccination program,” Dr. Schaffner says.

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Which vaccines do I need as an adult?

Since not all vaccines offer life-long protection, adults need to top-up their protection against illnesses like tetanus, Diptheria, and pertussis (whooping cough) with a Tdap booster. Some studies do suggest that the Tdap booster is unnecessary if you were fully vaccinated as a child, but the CDC still urges people to get it every 10 years or with each pregnancy. The major reason for this is the risk these diseases pose to children. For example, whooping cough is no picnic for adults, but it can be fatal for kids…especially for infants too young to receive their first vaccine dose.

In 2022, the CDC also announced it recommends vaccination against hepatitis B for all adults under age 60. “We have been administering the hepatitis B vaccine universally to children,” Dr. Schaffner says. The infection—which can lead to liver cancer down the road—has been largely eliminated among kids. “But it is continuing to occur substantially in adults.” He says that because the HepB vaccine is so effective, widespread adult vaccination could eliminate the hepatitis B virus from the population as soon as 2030.

In May 2023, the US Food and Drug Administration (FDA) approved a respiratory syncytial virus (RSV) vaccine, which the CDC recommends for all adults over 60 and immunocompromised populations. The RSV vaccine is due to be available this fall, and has the potential to reduce hospitalizations due to the illness, says Ryan Maves, MD, professor of infectious diseases at Wake Forest School of Medicine and chair of the American College of Chest Physicians’ COVID-19 Task Force. “We don’t actually know what the impact of the vaccine is going to be,” he says. “If there’s a lot of vaccine uptake [within this high-risk group], then we may see a lot fewer hospital admissions.” 

This is vital because while RSV is fairly mild in healthy adults, it tends to be serious in people with pre-existing health conditions. People who need to be hospitalized due to RSV have a greater chance of dying than someone who is hospitalized with the flu, Dr. Maves says. If the vaccine can lower this rate of serious illness, it could mean a major impact for these high-risk groups. 

Then there’s the HPV (human papillomavirus) vaccine. While commonly associated with preventing cervical cancer in women, the HPV vaccine is strongly recommended for all adolescents ages 11 and 12, says Ashley Lipps, MD, an infectious diseases physician at Ohio State University’s Wexner Medical Center. As a sexually transmitted disease, unvaccinated males can spread the virus to females—but they’re at risk of other cancers HPV can cause, including but not limited to head/neck, penile, and anal cancers. If the HPV vaccine was not available when you were an adolescent, the vaccine is strongly recommended for anyone under age 26, Dr. Schaffner says. That said, it’s now approved in some cases up to age 45.

“I would also mention that everyone aged 65 and older is eligible for the pneumococcal vaccine,” Dr. Maves says. This vaccine protects against the most prominent bacterial cause of pneumonia (and it’s available to people under 65 with underlying health conditions).

All adults should also be vaccinated annually against influenza and up-to-date on the latest Covid vaccine, Dr. Schaffner adds. And the CDC updates its guidance on these shots—it’s totally safe to get them at the same time. As for those eligible for the RSV shot this fall: “We do have some data that co-administering [the flu, Covid, and RSV vaccines] all together is safe,” Dr. Maves says.

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Recommendations for Adult Vaccinations* (age 19+)

• Flu vaccine: One dose annually

• Covid-19 vaccine: Everyone six months and older should receive one updated Pfizer-BioNTech or Moderna Covid-19 vaccine when it becomes available this fall to be up to date (people aged 65 years and older, immunocompromised individuals, and children under age 5 may receive additional doses, per your doctor’s recommendation)

• Tdap: Booster every 10 years, with each pregnancy, or for wound management

• MMR: One to two doses if born in 1957 or later and has not been fully immunized

• Varicella (chickenpox): Two doses for those unvaccinated and have never had chickenpox

• Zoster (shingles): Two doses for adults 50 years and older

• HPV: Two to three doses before age 26 or before age 45 depending on your doctor’s recommendation

• Pneumococcal: For all adults over age 65, one dose PC15 followed by PPSV23 or one dose PCV20

• Hepatitis A: People with certain medical conditions or traveling overseas may require two to three doses depending on the vaccine

• Hepatitis B: Two to four doses for all adults, depending on the vaccine

• Meningococcal: Recommended for adults who haven’t been vaccinated and are a college student, in the military, or have a compromised immune system

• RSV: recommended for adults over 60 and immunocompromised individuals 

*Note: Some guidelines change for adults with additional risk factors or health conditions.

Can you get multiple vaccines at once?

In addition to a flu shot and Covid vaccine combo, most vaccines can be given at the same time. “There are a few exceptions to this,” Dr. Lipps says. The Prevnar-13 (PCV-13) should not be given with the meningitis vaccine or at the same time as the Pneumovax-21 (PPSV-23) shot. “This is because the immune response has been shown to be better when these vaccines are given at different times.” Read Can You Get Multiple Vaccines at Once? Doctors’ Advice for 2023-2024

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