What vaccines do adults need every year?

One: the flu vaccine, each fall, ideally in September or October. The COVID-19 vaccine is also updated each fall, and as of 2026 that dose is a person-by-person decision made with a clinician, with the strongest case for adults 65 and older and people at higher risk of severe illness. Everything else on the adult schedule is a one-time series or a 10-year booster.

At what age do you get the shingles vaccine?

Age 50, for most adults: 2 doses of the recombinant zoster vaccine, spaced 2-6 months apart. Adults 19 and older with weakened immune systems from disease or treatment qualify earlier. CDC recommends the doses regardless of whether you have already had shingles or received the older shingles vaccine.

At what age do you need the pneumonia vaccine?

Age 50, as of the CDC update in October 2024, which lowered the threshold from 65. Most adults who have never had a pneumococcal vaccine need a single dose of a conjugate vaccine, PCV20 or PCV21. Adults under 50 with certain chronic conditions qualify earlier.

How often do adults need a tetanus booster?

Every 10 years, as either Td or Tdap. Any adult who has never received Tdap, the version that adds whooping cough protection, should make the next booster a Tdap. A separate Tdap dose is recommended in every pregnancy, ideally early in weeks 27-36.

Do adults need the hepatitis B vaccine?

Yes. Since 2022, CDC recommends hepatitis B vaccination for all adults ages 19-59, with no risk assessment required. At 60 and older the recommendation is risk-based, and any adult who wants protection can still choose the series. It runs 2-3 doses depending on the product.

Can adults still get the HPV vaccine?

Yes, through age 26 as routine catch-up. From 27 through 45 it is a shared decision with a clinician: the vaccine still works, and the average benefit is smaller because most HPV exposure happens earlier in life. Fishtown Medicine treats that range as a conversation about your situation, and either answer is fine.

Who needs the RSV vaccine?

All adults 75 and older, adults 50-74 with conditions that raise the risk of severe RSV, and pregnant patients at weeks 32-36 during September through January, which passes protection to the newborn. It is a single dose under current guidance, and people who already received one are not due another.

Do I need the MMR vaccine as an adult?

Only if you were born in 1957 or later and have no record of vaccination or immunity; then at least 1 dose is recommended, and 2 doses for healthcare workers, college students, and international travelers. Adults born before 1957 are presumed immune, because measles infected nearly everyone before the vaccine era.

What if I have no vaccine records?

Treat undocumented doses as not given and rebuild from there, which is CDC's approach as well. For most vaccines an extra dose is safe, and for measles, mumps, rubella, chickenpox, and hepatitis B a blood test called a titer can confirm immunity instead. Fishtown Medicine can also request old records on your behalf once you connect, which recovers more history than most people expect.

Where do Fishtown Medicine patients get their vaccines?

At the pharmacy or lab most convenient to them. The plan is made with Dr. Ash at the yearly review, the doses happen near home or work, usually walk-in, and each one goes into the chart so the record stays current for the next review.

Why did the pneumococcal vaccine age drop from 65 to 50?

Because a large share of serious pneumococcal disease arrives between 50 and 64, and the old risk-based rules for that group were complicated enough that many eligible adults were never vaccinated. In October 2024 the CDC advisory committee replaced them with a simple age trigger at 50, a change that also narrows longstanding racial gaps in who ends up protected.

Why is the shingles vaccine 2 doses?

The recombinant zoster vaccine pairs a viral protein with an adjuvant, an ingredient that amplifies the immune response, and the 2nd dose 2-6 months after the 1st is what pushes protection above 90% in adults 50 and older. People with weakened immune systems can take the 2nd dose as early as 1-2 months after the 1st to finish the series before treatment intensifies.

Can several vaccines be given at the same visit?

Yes. CDC's general best practice guidance supports giving all vaccines you are due for at one visit, at different injection sites, and combinations like flu plus COVID-19 or flu plus shingles are routine at pharmacies. Spacing rules still apply inside a series, like the 2-6 months between shingles doses, and a yearly review keeps those straight.

What extra vaccines come with a missing or damaged spleen?

4 lines of protection: pneumococcal vaccination regardless of age, a dose of Hib (Haemophilus influenzae type b), and both meningococcal series, MenACWY with boosters every 5 years and the MenB series. The spleen filters encapsulated bacteria, bacteria wrapped in a sugar coat, and without that filter those infections turn dangerous fast, so this list is among the least optional in adult medicine.

Who should get the hepatitis A vaccine as an adult?

Adults with chronic liver disease of any cause, travelers to countries where hepatitis A is common, men who have sex with men, people who use drugs, people experiencing homelessness, and anyone who wants the protection. The series is 2 doses, 6 months apart, and a late 2nd dose picks up where the 1st left off; the series never restarts.

Is it safe to repeat a vaccine dose if my records are lost?

For most vaccines, yes. CDC guidance treats undocumented doses as not given, and an extra dose of the common adult vaccines poses no medical problem. Titers can confirm immunity for measles, mumps, rubella, chickenpox, and hepatitis B, which turns the question into a blood draw instead of a guess.

Do tetanus boosters have to be Tdap, or is Td enough?

Either one maintains tetanus and diphtheria protection, and CDC accepts both for the 10-year booster. Tdap adds pertussis protection, which fades after a few years; the schedule asks for at least 1 adult Tdap dose plus a dose in each pregnancy, and choosing Tdap again is a reasonable move for anyone about to spend time around a newborn.

What vaccines do adults need every year?

One: the flu vaccine, each fall, ideally in September or October. The COVID-19 vaccine is also updated each fall, and as of 2026 that dose is a person-by-person decision made with a clinician, with the strongest case for adults 65 and older and people at higher risk of severe illness. Everything else on the adult schedule is a one-time series or a 10-year booster.

At what age do you get the shingles vaccine?

Age 50, for most adults: 2 doses of the recombinant zoster vaccine, spaced 2-6 months apart. Adults 19 and older with weakened immune systems from disease or treatment qualify earlier. CDC recommends the doses regardless of whether you have already had shingles or received the older shingles vaccine.

At what age do you need the pneumonia vaccine?

Age 50, as of the CDC update in October 2024, which lowered the threshold from 65. Most adults who have never had a pneumococcal vaccine need a single dose of a conjugate vaccine, PCV20 or PCV21. Adults under 50 with certain chronic conditions qualify earlier.

How often do adults need a tetanus booster?

Every 10 years, as either Td or Tdap. Any adult who has never received Tdap, the version that adds whooping cough protection, should make the next booster a Tdap. A separate Tdap dose is recommended in every pregnancy, ideally early in weeks 27-36.

Do adults need the hepatitis B vaccine?

Yes. Since 2022, CDC recommends hepatitis B vaccination for all adults ages 19-59, with no risk assessment required. At 60 and older the recommendation is risk-based, and any adult who wants protection can still choose the series. It runs 2-3 doses depending on the product.

Can adults still get the HPV vaccine?

Yes, through age 26 as routine catch-up. From 27 through 45 it is a shared decision with a clinician: the vaccine still works, and the average benefit is smaller because most HPV exposure happens earlier in life. Fishtown Medicine treats that range as a conversation about your situation, and either answer is fine.

Who needs the RSV vaccine?

All adults 75 and older, adults 50-74 with conditions that raise the risk of severe RSV, and pregnant patients at weeks 32-36 during September through January, which passes protection to the newborn. It is a single dose under current guidance, and people who already received one are not due another.

Do I need the MMR vaccine as an adult?

Only if you were born in 1957 or later and have no record of vaccination or immunity; then at least 1 dose is recommended, and 2 doses for healthcare workers, college students, and international travelers. Adults born before 1957 are presumed immune, because measles infected nearly everyone before the vaccine era.

What if I have no vaccine records?

Treat undocumented doses as not given and rebuild from there, which is CDC's approach as well. For most vaccines an extra dose is safe, and for measles, mumps, rubella, chickenpox, and hepatitis B a blood test called a titer can confirm immunity instead. Fishtown Medicine can also request old records on your behalf once you connect, which recovers more history than most people expect.

Where do Fishtown Medicine patients get their vaccines?

At the pharmacy or lab most convenient to them. The plan is made with Dr. Ash at the yearly review, the doses happen near home or work, usually walk-in, and each one goes into the chart so the record stays current for the next review.

Why did the pneumococcal vaccine age drop from 65 to 50?

Because a large share of serious pneumococcal disease arrives between 50 and 64, and the old risk-based rules for that group were complicated enough that many eligible adults were never vaccinated. In October 2024 the CDC advisory committee replaced them with a simple age trigger at 50, a change that also narrows longstanding racial gaps in who ends up protected.

Why is the shingles vaccine 2 doses?

The recombinant zoster vaccine pairs a viral protein with an adjuvant, an ingredient that amplifies the immune response, and the 2nd dose 2-6 months after the 1st is what pushes protection above 90% in adults 50 and older. People with weakened immune systems can take the 2nd dose as early as 1-2 months after the 1st to finish the series before treatment intensifies.

Can several vaccines be given at the same visit?

Yes. CDC's general best practice guidance supports giving all vaccines you are due for at one visit, at different injection sites, and combinations like flu plus COVID-19 or flu plus shingles are routine at pharmacies. Spacing rules still apply inside a series, like the 2-6 months between shingles doses, and a yearly review keeps those straight.

What extra vaccines come with a missing or damaged spleen?

4 lines of protection: pneumococcal vaccination regardless of age, a dose of Hib (Haemophilus influenzae type b), and both meningococcal series, MenACWY with boosters every 5 years and the MenB series. The spleen filters encapsulated bacteria, bacteria wrapped in a sugar coat, and without that filter those infections turn dangerous fast, so this list is among the least optional in adult medicine.

Who should get the hepatitis A vaccine as an adult?

Adults with chronic liver disease of any cause, travelers to countries where hepatitis A is common, men who have sex with men, people who use drugs, people experiencing homelessness, and anyone who wants the protection. The series is 2 doses, 6 months apart, and a late 2nd dose picks up where the 1st left off; the series never restarts.

Is it safe to repeat a vaccine dose if my records are lost?

For most vaccines, yes. CDC guidance treats undocumented doses as not given, and an extra dose of the common adult vaccines poses no medical problem. Titers can confirm immunity for measles, mumps, rubella, chickenpox, and hepatitis B, which turns the question into a blood draw instead of a guess.

Do tetanus boosters have to be Tdap, or is Td enough?

Either one maintains tetanus and diphtheria protection, and CDC accepts both for the 10-year booster. Tdap adds pertussis protection, which fades after a few years; the schedule asks for at least 1 adult Tdap dose plus a dose in each pregnancy, and choosing Tdap again is a reasonable move for anyone about to spend time around a newborn.

Adult Vaccine Schedule Philadelphia | What You Need by Age

TL;DR30-second take

Most adults need a flu shot every fall, a tetanus booster every 10 years, the 2-dose shingles vaccine starting at 50, and 1 pneumococcal vaccine dose at 50 or older. Hepatitis B is recommended through age 59, and RSV vaccination starts at 75, or at 50 with health risks. Fishtown Medicine reviews the full list at the yearly visit.

TL;DR: Adults need vaccines on a schedule, and most of us are missing a dose or 2. Everyone: a flu shot each fall, and a tetanus booster every 10 years. Under 60: finish the hepatitis B series if you never did. At 50: the shingles vaccine, 2 doses, and the pneumonia vaccine, 1 dose for most people. At 65: ask for the stronger flu shot made for older adults. At 75: the RSV shot. Pregnant: a whooping cough shot in every pregnancy. If your records are scattered, bring what you have to your yearly visit. We make the short list together, and you get the doses at a pharmacy near you.

Childhood vaccines come with a school form and somebody chasing them. Adult vaccines come with nobody in charge, which is why a 55-year-old with good insurance and a doctor they like is often missing 2 or 3 doses they would have gotten on request. The schedule itself is short and calm: a few shots for everyone, a few that begin at 50, a few tied to specific situations. This page lays it out by age, as of 2026, and the CDC adult immunization schedule is the living source when the details move again.

What does every adult need, at any age?

3 items apply to every adult: a flu vaccine each fall, a tetanus booster every 10 years, and a yearly COVID-19 decision made alongside the flu shot.

The flu vaccine is annual because the virus changes from year to year and the vaccine is rebuilt to match it. September and October are the window CDC points to, ideally done by the end of October, which in Philadelphia means having it behind you before holiday travel and indoor season begin. Getting it later still counts; flu circulates well into spring.

The tetanus booster runs on a 10-year clock, and the vaccine behind it comes in 2 versions: Td, which covers tetanus and diphtheria, and Tdap, which adds pertussis, the bacteria behind whooping cough. CDC accepts either for the 10-year booster, and every adult should have received Tdap at least once, so if you cannot find a Tdap in your history, make the next booster that one. Whooping cough in an adult is a miserable cough that can last 10 weeks or more; in a newborn it is dangerous, which is why the pregnancy dose described below exists.

COVID-19 also gets a fall update matched to circulating strains. As of 2026 the federal recommendation frames it as an individual decision made with your clinician in place of a blanket instruction, with the benefit clearest for adults 65 and older and for people with conditions that raise the risk of severe illness. The wording has changed more than once since 2025 and parts of it are under court review, which is a practical argument for settling your dose in the yearly conversation with someone who tracks the changes for a living.

What should adults under 50 catch up on?

4 series, for anyone who never finished them: hepatitis B, HPV, measles-mumps-rubella, and chickenpox.

Hepatitis B moved from a risk-based vaccine to a universal one in 2022: CDC now recommends the series for all adults ages 19-59, with no questions about risk factors required. The virus attacks the liver and spreads through blood and sex, and the series, 2 or 3 doses depending on the product, gives durable protection. At 60 the recommendation becomes risk-based again, though any adult 60 or older who wants protection can still choose it. If you were born before the mid-1990s, there is a fair chance you missed it as a child, and finishing it before 60 keeps the decision simple.

HPV, human papillomavirus, is the virus behind most cervical, anal, and throat cancers, and catch-up vaccination is recommended through age 26. From 27 through 45 it becomes a shared decision: the vaccine still works, and the average benefit is smaller because most exposure happens earlier in life. Some people in that range have good reasons to get it, a new partner or a narrow exposure history among them, and either answer is fine.

Measles-mumps-rubella depends on your birth year. Adults born before 1957 are presumed immune, because measles infected nearly everyone before the vaccine existed. Born in 1957 or later with no record of vaccination or immunity, you need at least 1 dose, and 2 doses if you work in healthcare, attend college, or travel internationally. Chickenpox follows a similar logic: adults born in the United States before 1980 are generally counted as immune, and anyone younger with no history of chickenpox or vaccination needs 2 doses. A blood test called a titer can confirm immunity for either when the history is murky.

What changes at 50?

2 vaccines start on this birthday: shingles and pneumococcal, and a 3rd, RSV, applies if your health carries extra risk.

Shingles is the chickenpox virus waking back up decades later, usually as a painful band of rash, sometimes with nerve pain that lasts months. The recombinant zoster vaccine (Shingrix) is recommended at 50 for everyone, as 2 doses spaced 2-6 months apart, and in adults 50 and older with healthy immune systems it is over 90% effective at preventing shingles. The recommendation holds whether or not you have already had shingles, and whether or not you received the older shingles vaccine years ago. Adults 19 and older with weakened immune systems, from disease or from treatment, qualify early. There is also an encouraging line of research connecting this vaccine to lower dementia rates, laid out in the shingles vaccine and dementia; the shingles protection alone justifies the doses, and the brain data ride along as a possible bonus.

The pneumococcal vaccine guards against pneumococcus, the bacteria behind most bacterial pneumonia and behind many bloodstream and brain infections in older adults. For years the starting age was 65; in October 2024 CDC lowered it to 50, because a large share of serious pneumococcal disease arrives before 65. For an adult who has never had one, a single dose of a modern conjugate vaccine, PCV20 or PCV21 in the shorthand, where the number counts the strains covered, is usually the whole job. If you received pneumococcal doses in earlier years, what comes next depends on which ones, and that is a records question a yearly review can settle.

RSV, respiratory syncytial virus, causes a cold in most adults and serious lung infections in some. From 50 through 74 the vaccine is recommended when a condition raises the risk of severe RSV, chronic heart or lung disease and a weakened immune system among the common ones. It is a single dose, once, under the current guidance.

What changes at 65 and beyond?

The vaccines you already get come in stronger versions from here, and RSV joins for everyone at 75.

The reason is immunosenescence, the gradual weakening of the immune response with age, which makes standard vaccine doses produce a smaller effect. So at 65 the flu shot upgrades: CDC preferentially recommends higher-dose or adjuvanted flu vaccines for adults 65 and older, and pharmacies usually shelve them as the senior flu shot. Ask for that version by name; if it is out of stock, the standard dose is the right fallback instead of a delay.

The COVID-19 case is also strongest in this decade, and current guidance allows adults 65 and older a 2nd dose of the season's vaccine 6 months after the 1st. At 75, RSV vaccination applies to everyone, no risk condition required. And if the shingles or pneumococcal doses never happened at 50, this is the decade to close them out, since both diseases get more dangerous with each year of age.

Which vaccines depend on your health or your plans?

3 come up most often: hepatitis A, the meningococcal vaccines, and Hib, plus the travel list when a trip is on the calendar.

Hepatitis A vaccination, 2 doses 6 months apart, is recommended for adults with chronic liver disease of any cause, travelers to countries where the virus is common, men who have sex with men, people who use drugs, and anyone who simply wants the protection. The meningococcal vaccines and Hib, Haemophilus influenzae type b, protect against encapsulated bacteria, bacteria wrapped in a sugar coat that a healthy spleen filters out, so they matter most for people with a missing or damaged spleen and a few other specific conditions; that cluster is covered in the Deep Questions below.

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Travel adds its own column: typhoid, yellow fever, and destination-specific doses, and some of them need a head start of weeks to months before departure. Travel medicine preparation walks through that timeline, so the vaccines are done working by the time you land.

What if you are pregnant, immunocompromised, or missing your records?

Pregnancy adds 2 scheduled doses, a weakened immune system moves some vaccines earlier and puts live ones on hold, and missing records are a solvable problem.

In pregnancy, a Tdap dose is recommended every time, ideally early in weeks 27-36, because the antibodies you build cross to the baby and protect them from whooping cough in the first months, before their own vaccines begin. A flu shot applies in any trimester during flu season. And for pregnancies that reach 32-36 weeks between September and January, an RSV dose in that window passes RSV protection to the newborn the same way. Live vaccines, MMR and chickenpox among them, wait until after delivery.

With a weakened immune system, from illness or from medications like chemotherapy, biologics, or long-term steroids, the pattern runs in both directions: the recombinant shingles vaccine applies from age 19 and pneumococcal vaccination from any adult age, while live vaccines generally wait until immunity recovers. The timing gets planned with whoever manages the underlying treatment.

Missing records put you in the majority, and the fix is calmer than people expect. CDC's approach is to treat undocumented doses as not given, because for most vaccines an extra dose is safe, and for measles, mumps, rubella, chickenpox, and hepatitis B a titer can confirm immunity from a single blood draw instead of guessing.

What does the whole schedule look like at a glance?

Condensed, as of 2026, with the CDC schedule as the living source:

Vaccine	Who, as of 2026	Doses
Influenza	Every adult, each fall	1 per year; 65+ ask for the higher-dose or adjuvanted version
COVID-19	Decided with your clinician; case strongest at 65+ or with risk conditions	Updated each fall; 65+ may add a 2nd dose after 6 months
Td or Tdap	Every adult	Booster every 10 years; Tdap at least once, and in each pregnancy
Shingles (recombinant zoster)	50+; 19+ with weakened immunity	2 doses, 2-6 months apart
Pneumococcal	50+ if never vaccinated; earlier with certain conditions	1 dose of PCV20 or PCV21 for most
RSV	75+; 50-74 with health risks; weeks 32-36 of pregnancy, September through January	1 dose, once
Hepatitis B	All adults 19-59; 60+ by risk or by request	2-3 doses by product
HPV	Through 26; a shared decision from 27-45	3 doses for most adults
MMR	Born 1957 or later without immunity	1-2 doses
Varicella (chickenpox)	No history of chickenpox, born after 1980	2 doses
Hepatitis A	Liver disease, travel, other risk groups	2 doses, 6 months apart
Meningococcal, Hib	Missing or damaged spleen, other specific risks	Series by condition

Guidance from the Clinic

"Vaccines are one of the few parts of medicine where the plan is already written, and my job is fitting it to your health and your year. Most adults are a dose or 2 away from current. We make the short list together at your yearly review, you get the doses wherever is convenient, and I keep the record straight so you never have to reconstruct it again."

How does Fishtown Medicine handle vaccines?

The plan gets made in the yearly conversation, and the doses happen wherever is convenient for you, usually the pharmacy near home or work. Most adult vaccines are a walk-in counter service now, so once the list is set, each dose is a 15-minute errand on your own schedule.

At the review, Dr. Ash checks your history against the current schedule and writes down which doses you need this year and which are coming in the next few, the same way labs and screenings get planned. If your records are scattered across old practices and pharmacy printouts, you do not have to reconstruct them from memory: upload whatever you hold during the intake, and once you connect, the practice can request old records on your behalf, immunization history included. Each dose you get afterward goes into your chart, so the running list stays current and the next review starts from what is documented instead of what anyone remembers.

When should you catch up now?

Start with the doses that carry the most protection per shot: shingles and pneumococcal if you are 50 or older, hepatitis B if you are under 60, and a Tdap if you cannot remember your last tetanus booster.

Flu and COVID-19 have a season, so those wait for fall and then happen early in it. Pregnancy runs on its own clock, with the Tdap and RSV windows above. A planned trip abroad moves travel doses to the front, since some need weeks to months of lead time. Everything else rides along with the yearly review, which is where the schedule stops being a list on a website and becomes 2 or 3 lines with your name on them.

If vaccines are a subject you have questions or doubts about, bring them. The yearly conversation has room for evidence, side-effect data, and sequencing one dose at a time, and the list above stays available whenever you want it.

Key Takeaways

Every adult needs a fall flu shot and a tetanus booster every 10 years; the

COVID-19 dose is a yearly decision made with your clinician. - 50 is the big birthday on the adult schedule: the 2-dose shingles vaccine and, since October 2024, the 1-dose pneumococcal vaccine both start there. - Hepatitis B vaccination is now recommended for all adults 19-59; RSV vaccination covers everyone 75 and older, adults 50-74 with health risks, and a window late in pregnancy. - Lost records are normal and fixable: most vaccines are safe to repeat, titers can confirm immunity, and Fishtown Medicine can request old records for you. - The schedule keeps changing; the CDC adult immunization schedule is the living source, and the yearly review is where it gets applied to you.

The shingles vaccine and dementia - the evidence behind the most interesting bonus on this list
Preventive care in Philadelphia - the fuller prevention visit these vaccines belong to
The Deep Dive annual visit - the yearly review where the vaccine plan gets made
Travel medicine preparation - the destination vaccines and their lead times

Scientific References

Centers for Disease Control and Prevention. "Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States." CDC / Schedule notes
Centers for Disease Control and Prevention. "Who Needs a Flu Vaccine." CDC
Centers for Disease Control and Prevention. "CDC Director Adopts Preference for Specific Flu Vaccines for Seniors." June 30, 2022. CDC archive
Centers for Disease Control and Prevention. "CDC Immunization Schedule Adopts Individual-Based Decision-Making for COVID-19." 2025. CDC newsroom / 2025-2026 COVID-19 vaccination guidance
Congressional Research Service. "Changes to CDC Vaccine Recommendations in 2025 and 2026." Congress.gov
Centers for Disease Control and Prevention. "Pertussis Vaccination Recommendations." CDC
Centers for Disease Control and Prevention. "Shingles Vaccine Recommendations." CDC
Centers for Disease Control and Prevention. "Pneumococcal Vaccine Recommendations." CDC
Centers for Disease Control and Prevention. "RSV Vaccines" and "Clinical Guidance for RSV Immunizations." CDC / Clinical guidance
Weng MK, et al. "Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19-59 Years, United States." MMWR. 2024;73(48). Full text
Centers for Disease Control and Prevention. "HPV Vaccination for Adults Aged 27-45 Years: Shared Clinical Decision-Making." CDC
Centers for Disease Control and Prevention. "Measles Vaccine Recommendations." CDC
Centers for Disease Control and Prevention. "Vaccine Administration." Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book). CDC

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Frequently Asked Questions

Common Questions

Deep-Dive Questions

PCV stands for pneumococcal conjugate vaccine, a design that produces stronger and longer-lasting immunity, and the number counts the bacterial strains covered. PCV20 and PCV21 each work as a single dose for most adults. PPSV23 is the older polysaccharide vaccine, now used mainly as a follow-on dose after PCV15. For a never-vaccinated adult at 50, one dose of PCV20 or PCV21 is the usual answer, and prior doses change the math in ways a records review sorts out.

Yes, with changed wording. As of the 2025-26 season, CDC frames COVID-19 vaccination for adults as individual-based decision-making: a yearly decision made with a clinician, with the benefit clearest for adults 65 and older and people at higher risk of severe disease, who can also receive a 2nd dose 6 months after the 1st. The recommendation language has changed more than once since 2025 and parts of it are under court review, so Fishtown Medicine anchors the decision in your risk and the current evidence at the yearly review.

The evidence is encouraging and short of proof. A natural experiment in Wales found about a 20% lower rate of new dementia diagnoses over 7 years among people eligible for the vaccine, and studies of the current recombinant vaccine point the same direction. None of this is a randomized trial yet. Get the vaccine for shingles prevention, which is proven, and read the shingles vaccine and dementia for the full story.

Live vaccines, MMR and chickenpox among them, generally wait until immunity recovers, because they contain weakened virus. The recombinant shingles vaccine contains no live virus and is recommended from age 19 for immunocompromised adults, pneumococcal vaccination applies at any adult age with qualifying conditions, and timing around chemotherapy, biologics, or transplant is planned with the treating specialist.

3 by default: Tdap in every pregnancy, ideally early in weeks 27-36, which passes whooping cough antibodies to the baby; a flu shot in any trimester during flu season; and an RSV dose at weeks 32-36 for pregnancies that reach that window between September and January. The COVID-19 decision in pregnancy is made with your obstetrician and Dr. Ash together. Live vaccines, MMR and chickenpox, wait until after delivery.

Ready when you are