Shingles. Two doses of Shingrix prevent about 97% of cases, still above 80% ten years out 1; 2. The rash is bad for weeks; the burning nerve pain after it lingers months to years in one case in five 3.
RSV. About 83% protection against the serious lower-respiratory kind in older adults 4. It kills roughly as many older adults each year as flu, just less visibly 5.
Pneumococcal. A single conjugate shot cuts invasive disease by about 76% 6. The invasive form kills one in five or six older adults it hospitalises.
Tdap in pregnancy. A dose at 27โ36 weeks prevents about 78% of whooping cough in babies too young for their own shots 7.
The U.S. schedule, for an adult without unusual risk, in the order to think about it 8:
The heaviest year is the one you turn 50 โ two Shingrix doses, a pneumococcal shot, and the flu shot cluster together. Spread them over a few months and pick days you don't need to be sharp the next morning.
The payoff only shows up in the rear-view mirror.
- Forties and fifties: mostly flu seasons that pass without wiping you out for ten days. Nothing dramatic, just absences.
- Past 60: friends get shingles, or pneumonia bad enough for the hospital, and you don't. RSV puts someone you know on oxygen for a month; you're not that someone.
- Across the population, the schedule averts on the order of twenty thousand deaths a year, most of them past 65 9.
The fine print โ when to skip it, and what people get wrong
Where it goes wrong: the ten-year Tdap gets forgotten because nothing prompts it โ put the date on a calendar. The second Shingrix dose gets skipped after the first sore arm; book both at once. Records at your pharmacy and your doctor don't talk, so use one pharmacy or carry a list.
"The flu shot gave me the flu." It contains no live virus; the 24โ48 hours of ache and mild fever is the immune response, not an infection. "I had the shingles shot years ago." If it was Zostavax, it was about 51% effective and has worn off โ get Shingrix, a different vaccine. "I'm healthy, I don't need it." Flu and RSV hospitalise healthy adults too, and pertussis travels from you to babies who can't defend themselves.
- 1Lal H, Cunningham AL, Godeaux O, et al. (2015). Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults (ZOE-50). New England Journal of Medicine. link
- 2Strezova A, Diez-Domingo J, Al Shawafi K, et al. (2022). Long-term Protection Against Herpes Zoster by the Adjuvanted Recombinant Zoster Vaccine: Interim Efficacy, Immunogenicity, and Safety Results up to 10 Years After Initial Vaccination (ZOE-LTFU). Open Forum Infectious Diseases. link
- 3Yawn BP, Saddier P, Wollan PC, et al. (2007). A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction. Mayo Clinic Proceedings. link
- 4Papi A, Ison MG, Langley JM, et al. (2023). Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults (AReSVi-006). New England Journal of Medicine. link
- 5Falsey AR, Hennessey PA, Formica MA, et al. (2005). Respiratory Syncytial Virus Infection in Elderly and High-Risk Adults. New England Journal of Medicine. link
- 6Bonten MJM, Huijts SM, Bolkenbaas M, et al. (2015). Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults (CAPiTA). New England Journal of Medicine. link
- 7Skoff TH, Blain AE, Watt J, et al. (2017). Impact of the US Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program on Preventing Pertussis in Infants <2 Months of Age: A Case-Control Evaluation. Clinical Infectious Diseases. link
- 8Murthy N, Wodi AP, McNally V, et al. (2025). Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older โ United States, 2025. MMWR Morbidity and Mortality Weekly Report. link
- 9CDC (2025). 2024โ2025 Influenza Season Summary: Severity, Disease Burden, and Burden Prevented by Vaccination. link
Related in the handbook (9)
- โ People with COPD are a priority for the vaccine schedule; an infection can be a serious setback.
- โ Pair the shot schedule with the cancer-screening schedule; together they cover most preventable late-life exits.
- โ Most of these shots get given at the visits your yearly cadence already books.
- โ This is the adult catch-up version of a shot most people miss โ it slots into the broader vaccine schedule.
- โ Biologics dial down your immune system, so it's best to get vaccines sorted before you start โ live ones especially.
- โ An adjacent topic in the handbook.
- โ Your immunization list is a core part of the one page you carry โ nobody else reliably keeps it for you.
- โ The RSV shot stacks neatly onto the rest of your fall vaccine visit โ easiest to do them in one appointment.
- โ These two are the highest-payoff shots on the adult schedule โ see the full lineup for everything else you're due.
Adult Vaccine Schedule
Among the largest preventable causes of death in older adults are flu, pneumonia, shingles complications, and RSV. The schedule blocks most of them.
In the US, insurance and Medicare cover the adult schedule without copay. Out of pocket, it's roughly $200โ$300 in the heaviest single year, near zero in the others.
A few minutes at a pharmacy, mostly walk-in. Some shots (shingles, RSV, high-dose flu) leave you sore and tired for a day; plan them for a slow afternoon.
Multiple large randomised trials per vaccine, replicated in real-world data, with aligned guidelines from independent national bodies in the US, UK, Germany, Canada, and the WHO.
Two to three fewer sick weeks across a typical year โ fewer flu beds, fewer pneumonia hospital stays, no shingles to interrupt life for a month.
Shingles can leave permanent facial scars and, when it hits the eye nerve, take some of your sight. The vaccine prevents about nine in ten cases.
A bad flu can knock you flat for two weeks and leave you tired for a month. Several of those weeks, across the years, are what the schedule buys back.
Postherpetic nerve pain after shingles can last years and reliably wrecks mood; the vaccine prevents about nine in ten cases of it.