COVID-19 · Influenza · RSV · Pneumonia
COVID-19 vaccines train your immune system to recognize the SARS-CoV-2 virus. They do not contain live virus and cannot give you COVID-19. The 2025–2026 formula is a monovalent JN.1-lineage-based vaccine updated to match currently circulating variants.
| Age Group | Doses Recommended | Key Notes |
|---|---|---|
| 6 months – 64 years | 1 dose | Based on shared clinical decision-making; prioritize if at increased risk |
| 65 years and older | 2 doses | Spaced 6 months apart (minimum 2 months) |
| Immunocompromised (any age) | 2–3 doses | Discuss exact schedule with provider |
| Brand | Technology | Ages |
|---|---|---|
| Moderna Spikevax | mRNA | 6 months+ |
| Moderna mNexspike | mRNA (new formulation) | 12 years+ |
| Pfizer-BioNTech | mRNA | 5 years+ |
| Novavax | Protein subunit (non-mRNA option) | 12 years+ — 1 dose for initial vaccination |
Obesity · Diabetes · Heart disease · Lung disease · Kidney disease · Weakened immune system · Age 65+ · Pregnancy · Healthcare workers · Long-term care residents
Sore arm, redness at injection site · Fatigue, headache, muscle aches · Low-grade fever, chills · Rare: allergic reaction — wait 15 min after vaccination
The flu vaccine protects against the influenza strains most likely to circulate each season. Because flu viruses mutate yearly, a new, reformulated vaccine is released each fall. Flu causes 9–41 million illnesses and up to 52,000 deaths annually in the U.S.
Everyone 6 months and older should get a flu vaccine every year — best timing is by end of October.
| Age Group | Recommended Vaccine(s) | Why |
|---|---|---|
| 6 months – 64 years | Any standard-dose inactivated vaccine | Broad protection |
| 65 years and older | High-dose or adjuvanted preferred | Enhanced immune response needed in older adults |
| Egg allergy | Flublok® Quadrivalent (egg-free) | Safe alternative |
| Pregnant women | Inactivated vaccine only | Safe for mom and baby |
People 65+ have naturally weaker immune responses to standard vaccines. Three specially formulated options provide significantly better protection:
| Vaccine | Brand | What Makes It Special | Efficacy Advantage |
|---|---|---|---|
| High-Dose Trivalent | Fluzone® High-Dose | Contains 4× more antigen than standard shots | ~24% more effective in adults 65+ |
| Adjuvanted Quadrivalent | Fluad® Quadrivalent | Contains MF59 adjuvant to boost immune response | Enhanced immunogenicity in seniors |
| Recombinant Quadrivalent | Flublok® Quadrivalent | Egg-free, contains 3× more antigen | Excellent for egg allergy |
✅ You can get the flu shot at the same visit as your COVID or RSV vaccine · ✅ People with egg allergies can still get most flu vaccines · ⚠️ The live nasal spray (FluMist) is NOT recommended for adults 50+, pregnant women, or immunocompromised individuals
RSV is a common respiratory virus. In most healthy adults, it causes mild cold-like symptoms — but in older adults and those with chronic illnesses, it can trigger severe pneumonia and respiratory failure, sending 160,000+ adults to the hospital and causing up to 10,000 deaths in adults 65+ each year.
| Who | Recommendation |
|---|---|
| All adults age 75+ | ✅ Strongly recommended — 1 lifetime dose |
| Adults age 50–74 with increased risk | ✅ Recommended — 1 lifetime dose |
| Adults 50–74 without risk factors | 💬 Discuss with your doctor |
| Already received an RSV vaccine | ❌ Do NOT get another dose yet — protection lasts 2+ years |
| Vaccine | Maker | Technology | Ages | Notes |
|---|---|---|---|---|
| Arexvy | GSK | Protein + AS01E adjuvant | 50+ | First FDA-approved RSV vaccine (May 2023) |
| Abrysvo | Pfizer | Bivalent protein subunit | 60+ | Also approved in pregnancy to protect newborns |
| mResvia | Moderna | mRNA technology | 60+ | FDA-licensed June 2024 |
Late summer to early fall (August–October) — before RSV season begins. You may receive it any time of year. Risk factors for severe RSV: Age 75+ · Chronic heart or lung disease · Weakened immune system · Diabetes · Chronic kidney disease · Living in a nursing home.
Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae. It can cause pneumonia (most common), meningitis, bacteremia (blood infection — most dangerous), and sinusitis. It causes approximately 150,000 hospitalizations and 3,000–6,000 deaths in adults annually in the U.S.
The polysaccharide is chemically linked to a carrier protein, triggering a stronger, longer-lasting immune response with immune memory. Your body "remembers" the pathogen and responds faster upon exposure. Three options available: PCV15, PCV20, PCV21.
Contains purified capsular polysaccharides from 23 strains but without a carrier protein, resulting in less durable immune memory. Now used mainly as a follow-up after PCV15 only.
| Patient Situation | PPSV23 Needed? |
|---|---|
| Received PCV20 as their vaccine | ❌ No — series is complete |
| Received PCV21 as their vaccine | ❌ No — series is complete |
| Received PCV15 as their vaccine | ✅ YES — give PPSV23 ≥1 year later (or ≥8 weeks if immunocompromised) |
| Previously received PCV13 only | Give PCV20 or PCV21 to complete; PPSV23 no longer recommended |
| Previously received PCV13 + PPSV23 (age 65+) | Optional upgrade: may receive PCV20 or PCV21 via shared clinical decision-making |
For adults 50+ who have never received a pneumococcal conjugate vaccine:
Choose PCV20 (Prevnar 20) — single dose, complete, includes Serotype 4 coverage.
OR: PCV15 + PPSV23 (two-step approach).
Choose PCV21 (CAPVAXIVE) — single dose, broadest adult IPD coverage (~84–86%).
OR: PCV20 if preferred by your provider.
| Feature | PCV15 (Vaxneuvance) | PCV20 (Prevnar 20) | PCV21 (CAPVAXIVE) | PPSV23 (Pneumovax 23) |
|---|---|---|---|---|
| Manufacturer | Merck | Pfizer | Merck | Merck |
| Vaccine Type | Conjugate | Conjugate | Conjugate | Polysaccharide |
| Serotypes | 15 | 20 | 21 | 23 |
| Immune Memory | ✅ Yes | ✅ Yes | ✅ Yes | ❌ Limited |
| Serotype 4 | ✅ Yes | ✅ Yes | ❌ No | ✅ Yes |
| 8 New Serotypes | ❌ No | ❌ No | ✅ Yes | ❌ No |
| Adult IPD Coverage | ~60% | ~59–75% | ~84–86.5% | ~60–70% |
| Follow-up Needed | ✅ PPSV23 required | ❌ Complete | ❌ Complete | N/A (after PCV15) |
| Designed for Adults | Pediatric origin | Pediatric origin | ✅ Adult-specific | Adults & children |
HIV infection · Cancer (leukemia, lymphoma, Hodgkin disease) · Sickle cell disease · Congenital or acquired immunodeficiency · Solid organ transplant recipients · Patients on immunosuppressive drugs or radiation · Congenital or acquired asplenia
Chronic heart disease (heart failure, cardiomyopathy) · Chronic lung disease (COPD, emphysema, severe asthma) · Chronic liver disease · Chronic kidney disease / nephrotic syndrome / dialysis · Diabetes mellitus · Cochlear implant · CSF leak · Alcoholism or smoking
| Vaccine | Frequency | Best Time | Notes |
|---|---|---|---|
| 🦠 COVID-19 | Annually (updated formula) | Fall | 2 doses if 65+; discuss with provider if 6 mo–64 yrs |
| 🤧 Influenza (Flu) | Every year | By end of October | High-dose/adjuvanted preferred if 65+ |
| 🫁 RSV | Once (not annual) | Late summer – early fall | Ages 75+ routine; 50–74 if at-risk |
| 🧬 Pneumococcal (PCV) | Once (1 dose) | Any time | PCV20 or PCV21 = done; PCV15 = follow with PPSV23 |
| 💊 PPSV23 (Pneumovax 23) | Once (after PCV15) | ≥1 year after PCV15 | Only needed if PCV15 was chosen |
| Your Situation | What to Do |
|---|---|
| Age 50+, never received any PCV | Get PCV20 or PCV21 (1 dose — done!) OR PCV15 then PPSV23 in ≥1 year |
| Age 19–49 with a risk condition, never vaccinated | Get PCV20 or PCV21 (1 dose — done!) OR PCV15 then PPSV23 in ≥1 year |
| Received PCV15, no PPSV23 yet | Get PPSV23 ≥1 year later (≥8 weeks if immunocompromised) |
| Received PCV20 alone | ✅ Complete — nothing more needed |
| Received PCV21 alone | ✅ Complete — nothing more needed |
| Received PCV13 only (no PPSV23) | Get PCV20 or PCV21 ≥1 year after PCV13 |
| Received both PCV13 + PPSV23, now age 65+ | Optional: Consider PCV20 or PCV21 via shared decision-making |
| Received PPSV23 only (no PCV) | Get PCV20 or PCV21 ≥1 year after PPSV23 |
Always tell your provider if you have:
No. None of these four vaccines contain live, active virus or bacteria that can cause infection. The flu shot, COVID vaccines, RSV vaccines, and pneumococcal vaccines all use killed, inactivated, protein, or mRNA components.
Influenza viruses mutate rapidly each season, so the vaccine formula is updated annually. RSV and pneumococcal vaccines use stable antigens that provide multi-year protection.
Yes — natural immunity from infection is less predictable and may wane. Vaccination provides more consistent, reliable protection even after prior infection.
Per the new 2025 CDC guidelines, routine vaccination starts at age 50. If you're 50 or older and unvaccinated, speak with your doctor. Nearly 90% of pneumococcal disease in adults aged 50–64 occurs in those with at least one underlying condition.
PCV21 (CAPVAXIVE) covers 21 serotypes including 8 entirely new serotypes not found in any previous vaccine, and was specifically designed for adults — offering approximately 84–86% coverage of adult invasive pneumococcal disease. PCV20 covers 20 serotypes including serotype 4, making it preferable in western U.S. regions where serotype 4 is prevalent. Both require only a single dose.