Originally published October 2023; updated in September  and October 2024 to reflect new vaccine availability and recommendations for adults

What are you looking forward to this fall and winter?

Getting together with friends to cheer for your favorite teams? Halloween parties? Going to concerts or that new restaurant you want to try? Family holiday traditions? Maybe a trip somewhere warm?

But wait!

Unless you act now, you could instead be looking at a week or two lying on the couch, miserable. A potential trip to the emergency room. Using up your sick time at work, or going without pay because you don’t get sick time. Excruciating pain. Long-lasting fatigue. Or maybe weeks in the hospital.

No thanks.

But every fall and winter, millions of adults get sick and miss work and fun  because they didn’t get the vaccines that could have protected them from infectious diseases.

If you’re over 50, you’re especially vulnerable.

That’s why now is a perfect time to get the vaccines that could mean the difference between a great fall and winter, and a terrible one.

Even if you do get infected, vaccines will make your illness shorter and less awful.

Kahli Zietlow, M.D., is a University of Michigan Health geriatrician, or doctor who specializes in the care of older adults.

Every winter, she encounters patients who regret missing out on recommended vaccines, as they as they realize they could have stayed out of the hospital if they had gotten a simple shot.

“They say ‘I wish I’d known,’ or ‘I wish I’d gotten around to getting that vaccine,’” she said.

She also talks to patients who are on the fence about vaccination because they worry that getting a shot will make their arm sore or make them feel tired.

She said, "I tell them that one day of feeling under the weather after getting a vaccine is better than ending up in a stretcher in a windowless emergency room, being hospitalized, or feeling out of commission for weeks and realizing you could have avoided it." 

What vaccines should you get, when should you get vaccinated, and which ones should come first?

The newly updated COVID-19 vaccine and the updated flu vaccine are important to get right away, for everyone over the age of 6 months, says Preeti Malani, M.D., an infectious disease specialist at U-M Health. If you had COVID-19 during this summer's wave, you can wait a bit to get vaccinated.

Then, if you qualify for an RSV vaccine because you haven't had one yet and you qualify because of your age, health or pregnancy, get that one this fall too.

After that? Catch up on the other vaccines recommended for your age and health status, listed below in this article. 

If you're over the age of 65, or immunocompromised, you should plan to get a second dose of this year's COVID vaccine six months after you got the first one.

If you have kids, make sure they’re up to date too. Here's what Michigan Medicine pediatricians advise.

“The main thing is to start now, because each vaccine takes a couple of weeks to reach full effectiveness,” said Malani.

“Get ahead of the fall and winter respiratory virus waves and avoid missing the things you love most.”

Zietlow and Malani recommend older adults check out vaccination information prepared by the American Geriatrics Society, and take a quick vaccine-advice quiz for adults from the Centers for Disease Control and Prevention.

Where should you get vaccinated?

Go to the place where you can get your shots soonest.

That may mean the pharmacy down the street or in your grocery store, or the public health clinic downtown, rather than your usual doctor’s office.

And that’s OK – the important thing is to get vaccinated. You can search for COVID-19 and flu shot locations near you at vaccines.gov. 

The rise of pharmacy-based vaccination during the pandemic has made it much more convenient for many people.

Churches and temples, senior centers and other locations often offer vaccination clinics in the fall.

But it can still be hard for some older adults to get to a vaccination place or book an appointment online. Reach out to older neighbors, friends and relatives to see if you can help them.

Depending on what kind of health insurance you have, including Medicare Advantage plans and private insurance, you may need to check that the location you choose is part of your insurance plan's network. If you don't have health insurance, you may need to go to certain clinics that offer free vaccines - or you can get help finding out what kinds of insurance you qualify for, and enroll.

Key adult vaccines you should get

Updated COVID-19 vaccine

Designed to protect you against an ever-mutating coronavirus, this has become an annual fall vaccine just like the flu vaccine.

It's recommended for everyone over the age of 6 months, and was updated for fall 2024 to help your body fight off the strains of the virus that are now circulating. 

You can choose an mRNA vaccine made by Pfizer or Moderna, or if you're over the age of 12, you can get the protein-based vaccine made by Novavax.

Insurance covers the entire cost for almost everyone. If you don’t have insurance you may be able to find a dose at a safety-net clinic or local public health department -- and they may be able to help you enroll in an insurance program too.

SEE ALSO: An adjuvanted intranasal vaccine for COVID-19 protects both young and old mice

If you have Medicare Advantage or private insurance through your job or someone else's, make sure the pharmacy or clinic where you want to get vaccinated is in-network for your plan.

People over 50, and especially people over 65 or so, have a much higher chance of getting seriously sick if they get COVID-19. And while past vaccinations and cases of COVID-19 do offer some protection against future serious illness, it wanes over time.

Data presented at the formal meeting where this year’s COVID-19 vaccine was approved showed that people who got a dose of last year's updated vaccine had more protection against symptomatic infection, COVID-19-associated visits to emergency departments and urgent care centers, and hospitalizations compared to those who didn't get the updated vaccine.

Also, most older people who got sick enough to hospitalize for COVID-19 had multiple underlying health conditions – including obesity, heart disease, diabetes, and chronic lung diseases.

In late October 2024, the CDC's vaccine advisors recommended that people who are over age 65, or have a condition or take a medication that compromises their immune system, should get a second dose of the COVID-19 vaccine six months after the first. So, if you got a dose of vaccine in September or October, mark your 2025 calendar to remind you to seek a second dose in March or April.

You can also reduce your risk of long COVID if you get your updated vaccine.

Flu vaccine

Another vaccine to get immediately – on the same day as your COVID vaccine if you want to – is the tried-and-true flu shot.

It’s updated every year, and while it doesn’t give you a guarantee against catching the flu, you’ll get less sick if you do catch it.

If you’re over 65, you can get a high dose version that really ramps up your immune response. Both this version, and the regular flu vaccine, are available at no cost.

Zietlow says many people don’t realize that in older adults, the flu can lead to the lung infection called pneumonia, which is a top reason for ER visits and hospitalizations, and a top cause of death.

Other viruses and bacteria can cause pneumonia too – but we don’t yet have vaccines against all of those.

“These things that we think of as benign aren’t actually that benign, especially in older adults,” she said.

"The flu can send you to the emergency department with pneumonia. You could end up hospitalized. And, especially for our oldest adults, unanticipated hospitalizations all too often becomes the entry point to a nursing facility, and never coming home," she added. 

“Or you could get vaccinated," she said.

SEE ALSO:  Back to school viruses: what’s new with parvovirus B19, RSV, flu and COVID in kids

RSV vaccines

First approved last year, and with new recommendations for this fall, these vaccines can prevent another top cause of illness and pneumonia in older adults: the respiratory syncytial virus or RSV.

Three kinds of this vaccine are now on the market for adults, two based on proteins and one that uses the mRNA approach. You can get any of them if you meet qualifications.

If you got a dose of an RSV vaccine sometime in the last year, you don't need to get another one -- this is not an annual vaccine. 

Everyone over age 75 should get one dose if they haven't already. This is an across-the-board recommendation because of the serious danger this virus poses to everyone in thie age range.

Everyone between the ages of 60 and 74 who has a health condition that makes them more vulnerable to serious effects from an RSV infection should also get one dose if they haven't already. Here's a list of all the health conditions that make someone more vulnerable.

Babies, toddlers and anyone in their last months of pregnancy can also get protection against RSV now.

Both the youngest and the oldest Americans face the worst threat from RSV, which infects the lungs.

In fall 2022, RSV led to a massive surge in hospitalizations on top of a COVID wave. In fall and winter 2023-2024, data show that those who were vaccinated against RSV were much less likely to develop severe disease than those who weren't. But only about 24% of people over age 60 had gotten a dose of RSV vaccine by last spring.

That’s why the new vaccines are so exciting to doctors like Malani and Zietlow.

These things that we think of as benign aren’t actually that benign, especially in older adults.” 
Kahli Zietlow, M.D.

It’s not every day that they can offer their patients a new way to prevent a potentially serious illness.

A single dose of RSV vaccine is covered by Medicare Part D plans and other insurance at in-network locations for everyone in the recommended age or risk groups.

For now, it’s best to get it on a different day than your COVID-19 or flu shots. After you get it, you may have a sore arm or some fatigue for a short time.

Just think of that as the ounce of prevention that’s worth a pound of cure.

SEE ALSO: Many older adults want RSV vaccine, poll shows

Shingles vaccine

If chickenpox made you miserable when you were a kid or teen, shingles is even worse.

It’s what happens when the same virus rises like a zombie from its hiding places inside your body, and attacks your nerves.

It causes merciless, piercing pain that can last weeks or months.

Zietlow has seen some horrible cases in older adults, whose genitals, eyes, face or large patches of skin get taken over by shingles rash.

It can even affect vision or leave lasting nerve damage.

“I’ve heard so many people wishing they had gotten this vaccine, after it’s too late,” she said.

“We can treat the rash, but the medications we need to use can increase a person’s risk of a fall, or damage their kidneys.”

Everyone over age 50 can get the shingles vaccine, whether or not they know that they had chickenpox earlier in life. It’s a two-dose vaccine.

When you get your first dose, book an appointment to return two to six months later for the second.

Medicare now covers the full cost of the vaccine, unlike in past years when some older adults had to pay for it.

Pneumococcal vaccine

Viruses like COVID, flu and RSV aren’t the only things that can cause pneumonia – bacteria can too. That’s why people over 50, and adults of any age with certain health conditions, should also get the vaccine that can help fight off the most common bacterial forms of pneumonia. 

It’s called the pneumococcal vaccine.

These vaccines are covered by Medicare and other forms of insurance. A new form came on the market this year, and covers more types of pneumonia-causing bacteria than previously approved ones.

A new recommendation approved in October 2024 says that all people age 50 and older should get this vaccine -- previously, it had been recommended for people over age 65. 

Whichever form you can get, pneumococcal vaccine is especially important for people who live in nursing homes and assisted living facilities, and people with heart problems, diabetes, asthma or lung disease to get.

Zietlow says it’s best to talk with a doctor, pharmacist or nurse practitioner to figure out your personal schedule for getting the dose or doses of this vaccine needed for full protection, depending on your age and health status.

Tetanus and Tdap

What’s the last time you got a tetanus shot?

Can’t remember? It’s probably time for another one – you should get it every 10 years.

You can get it by itself or as part of a “combo platter” vaccine called Tdap.

That one also protects you against pertussis, commonly called whooping cough.

If you’re likely to be around babies or toddlers, who can get really sick from pertussis and can also give it to you, it’s important to get a Tdap vaccine if you haven’t had one in the last decade.  A bout of pertussis in an older adult can lead to a cough that lasts for months, Zietlow says.

Other adult vaccines

Depending on your age and circumstances, you can get vaccinated against Hepatitis B (especially if you’re under 59), measles, mumps and rubella (if you were born after 1957 and aren’t sure if you got vaccinated as a child, or you are planning an overseas trip).

Not sure you want to get all these vaccines?

Talk to a health care provider you trust, such as a primary care doctor or nurse practitioner, or the pharmacist at the place you go regularly.

“You won’t hurt anyone’s feelings by having questions,” said Zietlow.

“It makes us all better if we question with an open mind and discuss options."