Vaccine Checklist
Know what vaccinations you need and when to get them.
By Linda Rath | Updated Sept. 26, 2024
If you take drugs that suppress your immune system, you may worry about taking vaccines. Here’s the latest information and guidance, including updates on the 2024-2025 COVID-19 vaccines.
2024-'25 COVID-19 VACCINE
Protects against: Newer COVID-19 omicrom subvariants
Who needs it: The Food and Drug Administration (FDA) approved new mRNA COVID-19 vaccines from Pfizer and Moderna for fall/winter 2024-2025. They are approved for ages 12 years and older and authorized for emergency use in children aged 6 months through 11. The Novavax vaccine was approved for emergency use in those aged 12 years and older. Novavax contains an ingredient that boosts the immune response (adjuvant). If you had a strong reaction to an mRNA vaccine, you may want to consider the Novavax vaccine, which has fewer side effects for many people.
How it’s different from last year's: COVID vaccines updated in 2023 targeted an omicron subvariant that was widely circulating at the time. The 2024-2025 vaccines target newer omicron subvariants. Although more recent variants are now more prevalent and more likely to evade immunity, experts say the updated vaccines can still prevent severe disease.
How effective are the new vaccines? These shots won’t necessarily prevent infection, but they can help keep you out of the hospital. A study of nearly two million people who received the 2023 vaccine found that protection after about four weeks was a little more than 50% effective at preventing infection. After 10 weeks, it prevented 32% of infections and 57% of hospitalizations. For now, the FDA has decided to treat COVID with a yearly shot, just like the flu. If you have been vaccinated and do get COVID-19, you might not be as sick for as long. (Even a mild bout, though, can lead to long COVID. If you’re at higher risk or live with someone who is, masking and social distancing can provide protection when hospitalizations spike in your area.)
When to get the shot: The Centers for Disease Control and Prevention (CDC) recommends that everyone get the updated vaccine as soon as it’s available. Other experts say healthy people can wait till fall, so they’re better protected when respiratory infections spike in winter months. High-risk people – older adults, those who are pregnant or have weakened immune systems – should get the shot as soon as possible. Immunocompromised adults should decide with their doctor if they need or want additional doses. The CDC recommends one or two additional doses for high-risk people, depending on their age and vaccination history.
If you have been sick with COVID or have already had a shot, wait about three months before getting the vaccine. You may do fine waiting as long as six months but talk to your doctor first.
Getting flu shots at the same time: If you have a weakened immune system or had a bad reaction to a previous vaccine, it’s best not to combine the COVID and flu shots. But many experts recommend healthy people get them at the same time, ideally from mid-September to October. Studies show this is safe but may increase the risk of side effects like muscle aches, headache and fatigue.
Where to get it: The 2024-2025 vaccine rolled out in September and is available in most major retail pharmacies and health systems. Find a pharmacy near you at vaccines.gov.
What it costs: The federal government no longer supplies free COVID-19 shots to everyone who wants one, but they still should be free for people with private insurance, Medicare or Medicaid, unless there are insurance-related delays and glitches. If you don’t have insurance, you can get a no-cost shot at your local or state health department. Children under 18 may be able to get free shots through the CDC’s Vaccines for Children Program (VCP). Ask your child’s doctor if they are enrolled in the program.
Who needs it: The Food and Drug Administration (FDA) approved new mRNA COVID-19 vaccines from Pfizer and Moderna for fall/winter 2024-2025. They are approved for ages 12 years and older and authorized for emergency use in children aged 6 months through 11. The Novavax vaccine was approved for emergency use in those aged 12 years and older. Novavax contains an ingredient that boosts the immune response (adjuvant). If you had a strong reaction to an mRNA vaccine, you may want to consider the Novavax vaccine, which has fewer side effects for many people.
How it’s different from last year's: COVID vaccines updated in 2023 targeted an omicron subvariant that was widely circulating at the time. The 2024-2025 vaccines target newer omicron subvariants. Although more recent variants are now more prevalent and more likely to evade immunity, experts say the updated vaccines can still prevent severe disease.
How effective are the new vaccines? These shots won’t necessarily prevent infection, but they can help keep you out of the hospital. A study of nearly two million people who received the 2023 vaccine found that protection after about four weeks was a little more than 50% effective at preventing infection. After 10 weeks, it prevented 32% of infections and 57% of hospitalizations. For now, the FDA has decided to treat COVID with a yearly shot, just like the flu. If you have been vaccinated and do get COVID-19, you might not be as sick for as long. (Even a mild bout, though, can lead to long COVID. If you’re at higher risk or live with someone who is, masking and social distancing can provide protection when hospitalizations spike in your area.)
When to get the shot: The Centers for Disease Control and Prevention (CDC) recommends that everyone get the updated vaccine as soon as it’s available. Other experts say healthy people can wait till fall, so they’re better protected when respiratory infections spike in winter months. High-risk people – older adults, those who are pregnant or have weakened immune systems – should get the shot as soon as possible. Immunocompromised adults should decide with their doctor if they need or want additional doses. The CDC recommends one or two additional doses for high-risk people, depending on their age and vaccination history.
If you have been sick with COVID or have already had a shot, wait about three months before getting the vaccine. You may do fine waiting as long as six months but talk to your doctor first.
Getting flu shots at the same time: If you have a weakened immune system or had a bad reaction to a previous vaccine, it’s best not to combine the COVID and flu shots. But many experts recommend healthy people get them at the same time, ideally from mid-September to October. Studies show this is safe but may increase the risk of side effects like muscle aches, headache and fatigue.
Where to get it: The 2024-2025 vaccine rolled out in September and is available in most major retail pharmacies and health systems. Find a pharmacy near you at vaccines.gov.
What it costs: The federal government no longer supplies free COVID-19 shots to everyone who wants one, but they still should be free for people with private insurance, Medicare or Medicaid, unless there are insurance-related delays and glitches. If you don’t have insurance, you can get a no-cost shot at your local or state health department. Children under 18 may be able to get free shots through the CDC’s Vaccines for Children Program (VCP). Ask your child’s doctor if they are enrolled in the program.
INFLUENZA (FLU) VACCINES
Protects against: Seasonal flu and flu complications. Flu vaccines are updated every year in the U.S. based on past seasons and forecasts of how the virus might change. Overall, flu vaccine effectiveness ranges from 40% to 60%, according to the CDC. It was about 50% effective in the 2023-2024 flu season, meaning it protected about half the people who got it.
Who needs it: The CDC recommends seasonal flu shots for almost everyone six months and older. Several different types are available, including high-dose and egg-free shots plus a nasal spray. The best type for you depends on your age and health status.
Because adults aged 65 and older are at greater risk of serious flu complications and tend to have weaker immune systems, they generally receive one of the following:
The FDA recently approved the nasal spray flu vaccine (FluMist) for home use. Because it contains live virus, it should not be used by:
Who needs it: The CDC recommends seasonal flu shots for almost everyone six months and older. Several different types are available, including high-dose and egg-free shots plus a nasal spray. The best type for you depends on your age and health status.
Because adults aged 65 and older are at greater risk of serious flu complications and tend to have weaker immune systems, they generally receive one of the following:
- A high-dose shot such as Fluzone, which is four times stronger than standard flu vaccine
- An adjuvanted shot such as Fluad, which contains a booster that makes the immune system react more strongly
- A recombinant shot such as Flublok Quadrivalent, which is not made in eggs and uses the virus’s genetic material instead of a killed form of the virus
The FDA recently approved the nasal spray flu vaccine (FluMist) for home use. Because it contains live virus, it should not be used by:
- People who are immunocompromised or take immune-suppressing drugs
- Adults aged 50 and older
- Pregnant people
HERPES ZOSTER (SHINGLES) VACCINE
Protects against: A viral infection marked by a painful rash. It’s caused by the reactivation of the varicella zoster virus – the same virus that causes chicken pox.
Who needs it: The CDC recommends the Shingrix vaccine for adults aged 50 and older, including those who are immunocompromised. It’s the first shingles vaccine approved for immunocompromised adults. It’s also suggested for those aged 19 and older who have weakened immune systems or take immune-suppressing drugs. In addition, the Shingrix vaccine is recommended
Who needs it: The CDC recommends the Shingrix vaccine for adults aged 50 and older, including those who are immunocompromised. It’s the first shingles vaccine approved for immunocompromised adults. It’s also suggested for those aged 19 and older who have weakened immune systems or take immune-suppressing drugs. In addition, the Shingrix vaccine is recommended
- If you ever received the Zostavax vaccine – a live vaccine no longer used in the U.S.
- Have already had shingles
- Aren’t sure if you’ve had chickenpox. After a bout of chicken pox, the varicella zoster virus hibernates in your body and may re-emerge years later as shingles. COVID-19 vaccines can reactivate this virus in some people, especially those with inflammatory forms of arthritis.
PNEUMOCOCCAL VACCINES
Protects against: Bacteria that can cause pneumonia, sinus and ear infections, meningitis and bloodstream infections. There are two main types of pneumonia vaccines: pneumococcal conjugate vaccines (PCVs), which provide longer-term immunity, and polysaccharide vaccines (PPSVs).
Who needs it: The CDC recommends the pneumonia vaccine for children under age 5 and unvaccinated adults over age 65. Adults who receive certain longer-term vaccinations will not need another one.
The American College of Rheumatology (ACR) recommends the pneumonia vaccine for people under 65 who are on medications that suppress the immune system, though it may not be as effective as in other people. If you have inflammatory arthritis, discuss the timing of the vaccine with your doctor. Ideally, you should get it before you start immunosuppressant drugs or when your arthritis isn’t active.
Decisions about whether and when to be vaccinated should be made with your doctor. Be sure you understand your options and the risks and benefits of vaccination.
Who needs it: The CDC recommends the pneumonia vaccine for children under age 5 and unvaccinated adults over age 65. Adults who receive certain longer-term vaccinations will not need another one.
The American College of Rheumatology (ACR) recommends the pneumonia vaccine for people under 65 who are on medications that suppress the immune system, though it may not be as effective as in other people. If you have inflammatory arthritis, discuss the timing of the vaccine with your doctor. Ideally, you should get it before you start immunosuppressant drugs or when your arthritis isn’t active.
Decisions about whether and when to be vaccinated should be made with your doctor. Be sure you understand your options and the risks and benefits of vaccination.
RESPIRATORY SYNCYTIAL VIRUS (RSV) VACCINE
Protects against: The virus that causes RSV, an upper respiratory infection that leads to relatively mild, cold-like symptoms in healthy people, but can seriously sicken some infants and older adults
Who needs it: There are three FDA-approved RSV vaccines for adults: mResvia, Abrysvo and Arexvy. They are intended for:
- Adults aged 75 and older
- People aged 60 to 74 at risk of severe infection, including those who have chronic heart or lung disease, a weakened immune system or live in a nursing home. People in this age group should not get the RSV vaccine if they’re not at high risk. People in their 50s should not be vaccinated with Arexvy, even if at high risk.
- Women during weeks 32 to 36 of pregnancy to protect newborns from RSV. Pregnant people who were vaccinated in a previous pregnancy shouldn’t get it again.
Older adults should have only one shot of the RSV vaccine, preferably in late summer or early fall. It’s usually OK to get it with other vaccines but check with your doctor first.
Precautions: RSV vaccines are associated with certain health risks, including Guillain-Barré syndrome, which can cause paralysis. Most people eventually recover, but some have permanent nerve damage. Guillain-Barré can occur after a vaccine or an infection like COVID-19 and sometimes resembles a rheumatic disease. Discuss with your doctor the risks and benefits of the RSV vaccine.
HEPATITIS B VACCINE
Protects against: A liver infection caused by the hepatitis B virus (HBV). For most people, hepatitis B is short-term, lasting less than six months. Chronic hepatitis B – lasting longer than six months – can damage the liver, increasing the risk of cirrhosis and liver cancer. Taking immunosuppressant drugs like methotrexate and corticosteroids can reactivate latent hepatitis B. Your doctor should test you for hepatitis B before starting any drugs that weaken your immune system. Because most people don’t know their hepatitis B vaccine status, the CDC recommends screening for most adults and shots for most who are unvaccinated.
Who needs it: The FDA has approved seven hepatitis B vaccines, some just for infants and children. All contain yeast and an adjuvant made from aluminum. You should not have the vaccine if you have an allergy to either of these ingredients or had a bad reaction to the hepatitis B vaccine in the past.
Immunization is recommended for:
Who needs it: The FDA has approved seven hepatitis B vaccines, some just for infants and children. All contain yeast and an adjuvant made from aluminum. You should not have the vaccine if you have an allergy to either of these ingredients or had a bad reaction to the hepatitis B vaccine in the past.
Immunization is recommended for:
- All infants – mothers can pass it to infants at birth
- Unvaccinated kids and teens under age 19
- Adults 19-59
- Adults aged 60 and older, especially those at risk of contracting hepatitis B, such as unprotected sex with someone with the virus, exposure to blood, or travel to areas with high rates of hepatitis B
All decisions about whether and when to be vaccinated should be made in equal partnership with your doctor. Be sure you understand your options and the risks and benefits of vaccination in your particular case.
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