When Should High-Risk Patients Get Vaccinated?

Millions of people get vaccinated every year for conditions ranging from the flu, measles and chickenpox to HPV and meningococcal disease, a potentially deadly bacterial infection.

If you’re a high-risk patient, including pregnant women, the elderly and those with certain conditions, it’s even more important to get vaccinated. However, guidelines for these groups vary from the general population, so here’s what you should know:

Vaccinations for Pregnant Women

Pregnant women should receive the inactivated flu vaccine and tetanus, diphtheria, pertussis vaccine (Tdap). The pertussis vaccine, which is used to protect against whooping cough, should be administered during the 27th to 36th weeks of pregnancy.

If a woman has a history within six weeks of vaccination getting Guillain-Barre Syndrome — a disorder in which the immune system attacks a part of the body’s nervous system — she should talk to her doctor before getting immunized.

Pregnant women also should not receive live vaccines, including the shingles, chickenpox, MMR or live flu vaccines in the form of a nasal spray.

Vaccinations for the Elderly

Patients 65 and older have the option of receiving the high dose or standard dose of the inactivated flu vaccine. They also should receive both pneumococcal vaccines, ideally PCV13 first followed one year later by PPSV23, Tdap if not already administered and shingles vaccine at 60 or older.

Vaccinations for People with Specific Conditions

Patients with a weakened immune system (excluding HIV): Should receive the inactivated flu vaccine, Tdap or Td vaccine as indicated and the pneumococcal vaccines (for pneumonia). Meningococcal vaccines, hepatitis A and B vaccines may be recommended, but these patients should not receive shingles, chickenpox or MMR (measles, mumps, Rubella) vaccines.

Patients with HIV with a T-cell count less than 200: Should receive the inactivated flu vaccine, Tdap or Td vaccine and both pneumococcal vaccines. Depending on the patient, we may recommend meningococcal vaccines, the Hib and the hepatitis A vaccine. The HPV vaccine (through age 26) and hepatitis B vaccine should be given if the patient hasn’t received them during childhood. However, these patients should not receive the shingles, chickenpox or MMR vaccines.

Patients with HIV with a T-cell count 200 or greater: Should receive the inactivated flu vaccine, Tdap or Td vaccine and both pneumococcal vaccines. You should get the MMR, HPV (through age 26), chickenpox and hepatitis B vaccines if you weren’t vaccinated for these diseases as a child. The hepatitis A vaccine, meningococcal vaccines and Hib vaccine may be recommended, depending on your risk factors and condition.

Patients with severe chronic kidney disease: Should receive the flu vaccine, Tdap or Td as indicated, both pneumococcal vaccines, shingles vaccine (if you’re 60 and older) and the hepatitis B vaccine. You should get the MMR, HPV (through age 26), chickenpox vaccine and hepatitis B vaccines if you didn’t get them when you were younger, and the meningococcal vaccines and Hib vaccine may be recommended for certain patients.

Patients without a spleen or with a poorly functioning spleen: Should receive the flu vaccine, Tdap or Td as indicated, shingles vaccine (if you’re 60 and over), both pneumococcal vaccines, meningococcal vaccines and Hib vaccine. You should get the MMR, HPV (through age 26) and chickenpox vaccines if you didn’t get them as a child. The hepatitis A and B vaccines may be recommended.

Patients with heart disease, chronic lung disease, chronic alcoholism and those who smoke: Should receive the flu vaccine, Tdap or Td vaccine as indicated, the shingles vaccine (if you’re 60 and older) and the PPSV23 pneumococcal vaccine. You should get the MMR, HPV (through age 26) and chickenpox vaccines if you didn’t get them during childhood.

Patients with diabetes types 1 and 2: Should receive the flu vaccine, shingles vaccine (if you’re 60 and older), hepatitis B vaccine (if you’re under 60) and the PPSV23 pneumococcal vaccine. If you weren’t vaccinated as a child, you should get the MMR HPV vaccine (through age 26) and chickenpox vaccines.

Patients with chronic liver disease, including chronic hepatitis C: Should receive both the hepatitis A and B vaccines, the flu vaccine, Tdap/Td as indicated, the shingles vaccine (60 and older) and the PPSV23 pneumococcal vaccine. You should receive the MMR, HPV vaccine (through age 26) and chickenpox vaccine if you weren’t previously immunized. Patients with a severe allergy to eggs may receive the inactivated flu vaccine under direct medical supervision.

Patients with additional risk factors: Vaccinations for the meningococcal, Hepatitis A, Hepatitis B and Haemophilus Influenzae Type b (Hib) — a type of bacterial infection — also are recommended if someone has specific risk factors, such as HIV, intravenous drug use or traveling to countries that have high rates of these diseases.

Follow these guidelines to get properly vaccinated. This can help you stay healthy and reduce your risk of potentially serious or fatal conditions. If you are in a high-risk group, also check with your doctor before you get vaccinated. Your doctor can give you specific advice for your specific condition and medical history. For more information about immunizations for adults by age and by health condition, please visit the CDC’s website.