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MSDMSD ManualProfessional Version
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Chemoprevention and Immunization for Older Patients

Disease to Be Prevented

Measure

Frequency

Comments*

Atherosclerotic cardiovascular disease (coronary artery disease, stroke)

Daily

COVID-19

COVID-19 vaccine

Boosters as they are available

For everyone over 6 months old: Recommendation by the CDC‡

For people ages 6 years and older if unvaccinated or previously received only monovalent vaccine doses: Recommended to receive 1 bivalent mRNA vaccine dose (for those with a monovalent dose, at least 8 weeks after)

Adults ≥ 65: May receive 1 additional bivalent mRNA vaccine dose at least 4 months after the first dose of a bivalent mRNA vaccine. 

People who are immunocompromised: Case by case basis after discussion of risk and benefit

Influenza

Influenza vaccine

Yearly

For everyone: Recommendation by the CDC†

Pneumococcal infection

Once or twice depending on specific vaccine

For adults > 65 who have never received a pneumococcal vaccination: PCV15 followed by PPSV23 at least 1 year later or PCV20 alone, recommended by the CDC

Centers for Disease Control and Prevention: Pneumococcal Vaccination).

Tetanus

Tetanus vaccine

Every 10 years

For adults > 19 who never received Tdap§: 1 dose of Tdap unless they have specific contraindications to the pertussis vaccine (dose is given at any time, regardless of the timing of the last dose of the Td vaccine) recommended by the CDC

For all people who have received Tdap: A Td or Tdap booster every 10 years recommended by the CDC

Zoster

2-dose series once at age 50

For people ≥

For immunocompromised patients: Possibly a shorter interval between the 2 doses of RZV

* Recommendations in the table rely mainly on the USPSTF and sometimes on the CDC and other organizations.

USPSTF recommendations are based on strength of evidence and net benefit (benefit minus harm):

  • A = Strong evidence in support

  • B = Good evidence in support

  • C = Balance of benefit and harm too close to justify recommendation

  • D = Evidence against

  • I = Insufficient evidence to recommend for or against

‡ For a summary of changes to the 2023 adult immunization schedule, including changes to COVID-19 vaccine information, see the Advisory Committee on Immunization Practices Recommended Adult Immunization Schedule, United States, 2023: Changes to the 2023 Adult Immunization Schedule.

§ Tdap—Diphtheria (D) vaccines contain toxoids prepared from Corynebacterium diphtheriae. Tetanus (T) vaccines contain toxoids prepared from Clostridium tetani. Acellular (a) pertussis (P) vaccines contain semipurified or purified components of Bordetella pertussis.

CDC = Centers for Disease Control and Prevention; Td = tetanus diphtheria; USPSTF = U.S. Preventive Services Task Force.

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