Influenza (“Flu”)

You should get one every fall!

1. If you are age 65 and over (or between 18 and 64 and you are an organ transplant recipient), there are only three brands: High dose Fluzone, Fluad, and Flublok. These vaccines trigger a stronger immune response than other flu shots. They also tend to cause more side effects that the “regular” flu vaccines.
2. If you are under age 65: There are many brands. We generally give Flucelvax.
3. Some flu vaccines are not made with the use of eggs (Flublok and Flucelvax). However, even severe allergy to eggs is no longer considered an increased risk of allergic reaction to any of the flu shots.

Pneumonia

The “pneumonia shot” protects against Streptococcus pneumoniae (“pneumococcus”). These bacteria can cause a variety of illnesses including sinusitis, ear infections, meningitis (life-threatening infection of the lining outside the brain), and pneumonia. Pneumococcal pneumonia is the most common bacterial pneumonia in the US.

In the fall of 2024, Capvaxive (Pneumococcal 21-valent Conjugate Vaccine, PCV-21) became the newest pneumonia vaccine. Studies indicate it is significantly more effective than previous shots (including Prevnar-20, which has a much different mix of pneumococcal strains from PCV-21, even though it would seem by the numbers it is only different by one!). This is the vaccine we now administer at our office.

Also in the fall of 2024, the age minimum for pneumonia vaccination was lowered from 65 to 50.

The following is a simplified version of the recommendations regarding who should receive Capvaxive (Prevnar-20 can be used if Capvaxive is not available). Because there have been many new pneumonia shots and recommendation changes and exceptions, we recommend looking at the CDC website for more specific information.

1. Everyone age over 50 who has never received a pneumonia vaccination.
2. Everyone age 50 and over who has received Prevnar 13 and/or Pneumovax 23 in the past.
3. Everyone ages 18 to 49 with diabetes, congestive heart failure, kidney disease, liver disease, or lung disease.

SARS-CoV-2 (“COVID-19”)

As per the CDC, you should get each new COVID vaccination when it becomes available.

There is increasing debate, however, as to whether COVID vaccine efforts should be concentrated amongst older people and those with chronic medical conditions OR recommended for the entire public.

We recommend anyone over age 65 or for any age individual with a significant chronic medical condition that increases the likelihood of severe disease/death from COVID (people with Diabetes, Heart Disease, Lung Disease, Cancer, or on immunosuppressive medication).

Note: This does not mean it is incorrect to receive the shot if you are a healthy 18-year-old.

A couple of more points regarding the COVID vaccine:

1. You should wait a minimum of two months after your last dose of COVID vaccine (or three months since your last COVID illness) to consider a booster. The CDC recommends one shot of the new 2025/2026 vaccine under age 65 if you have chronic medical issues and one shot for everyone age 65 and older.
2. COVID vaccines DO NOT prevent COVID. They DO significantly decrease the risk of severe disease, hospitalization, and death from the virus. The younger and healthier you are, the lower your risk of having severe or life-threatening COVID.

Respiratory Syncytial Virus (“RSV”)

RSV can cause severe lung infections. It has led to many hospitalizations and deaths among young children and older people. In 2023, a vaccine was finally developed to combat the virus. There are now two vaccines in use (Abrysvo and Arexvy). Both may provide immunity for several years or more. We will not know how long they are effective for several years.

The vaccination is recommended to be given once:

1. If you are over 75 or 
2. If you are age 60 to 74 and are immunocompromised or have severe kidney disease.
3. If you are between weeks 32 to 36 of pregnancy.

Should I spread out the vaccinations or can I get them all at once?

We generally recommend spreading them out, one or two vaccines every week or so. This is for a few reasons:

1. You will more easily be able to identify which shot caused which side effect if you do not get them all at once.
2. Each shot can cause flu-like symptoms, arm soreness, etc., so three or four at a time is more likely to make you feel lousy for the subsequent day or more.
3. The effectiveness of the vaccinations may be reduced if they are all administered together, though this has not been definitively proven.

We would much rather you receive most or all shots at the same time if, for some reason, you will not be able to receive the remainder of the vaccines for a long time (months or longer).

The Centers for Diseases Control’s website contains additional information about these and other vaccinations. Please visit CDC Vaccination Recommendations.

We hope this summary was useful!

– Julian Klapowitz, MD and the Avenue Medical Associates Team.