Your guide to fall vaccines

Joaquin Villegas, MD, assistant professor at McGovern Medical School at UTHealth Houston. (Photo by UTHealth Houston)

Welcome to “Ask the Expert,” a UTHealth Houston news series where our leading experts examine pressing health challenges. In this edition, we address fall vaccines.  

The start of fall means talk of flu, COVID, and other respiratory virus prevention. But what vaccines do you need, and when should you get your annual shots? The answer depends on your age and current health conditions.  

Which vaccines should people consider updating or receiving this fall, and why is this season an important time for vaccination?  

This fall, people should consider three primary respiratory immunizations:  

• Influenza (flu): Recommended annually for everyone 6 months and older. Adults 65 and older should ask for higher-dose or adjuvanted formulations.   

• Updated COVID-19: Formulated for currently circulating strains and recommended for everyone 6 months and older to restore waning immunity.   

• RSV (Respiratory Syncytial Virus): Recommended for all adults age 75 and older, adults age 50 to 74 with specific chronic medical conditions (like cardiovascular or lung disease), and pregnant individuals in their third trimester to protect newborns. (Note: The RSV vaccine is currently a one-time lifetime dose; individuals who received one previously do not need another).   

Respiratory viruses thrive in colder temperatures when people spend more time indoors with closed ventilation. Transmission typically begins rising in October and peaks between December and February. Because the immune system takes approximately two weeks after vaccination to produce peak antibody levels, getting vaccinated in September or October ensures maximum protection before circulation surges.  

Can multiple vaccines be received during the same appointment, and what should patients know before doing so?  

It is clinically safe and routine to receive multiple vaccines. Receiving multiple vaccines at once does not compromise vaccine efficacy or cause negative immune interference.   

What to keep in mind:  

• Injection sites: Providers typically inject different vaccines into separate limbs (e.g., one in each arm) or space them at least one inch apart if given in the same arm to monitor local reactions.  

• Side effects: Common short-term side effects like arm soreness, mild fatigue, low-grade fever, or headache can feel slightly more noticeable when getting two or more shots at once, though they generally resolve within 24 to 48 hours.  

• Convenience: If scheduling separate appointments creates a barrier or risk of missing a dose, getting them together is strongly recommended by public health experts.  

How can parents ensure their children are up to date on recommended vaccines?  

Parents have different options to help keep track of vaccine recommendations:  

• Schedule an annual well-child visit: Your doctor routinely checks immunization records against the Centers for Disease Control and Prevention and state requirements during back-to-school checkups.  

• Access state immunization registries: Most state departments of health host an online immunization information system where parents can look up official records or download certified vaccination forms.  

• Verify school requirements: Check with your school district or daycare for mandated vaccines. The most commonly required vaccines are those for measles, mumps, and rubella; diphtheria, tetanus, and pertussis; chickenpox; polio; hepatitis B; and meningitis.   

• Include seasonal immunizations: In addition to required school shots, ensure children receive their seasonal flu shot and updated COVID-19 vaccine. Note that infants and young children receiving the flu vaccine for the first time require two doses spaced four weeks apart.  

What vaccines are recommended for older adults? 

As the immune system ages, older adults face a higher risk of complications and hospitalization from infectious diseases. Age-specific recommendations include:  

• High-dose/adjuvanted flu vaccines (age 65-plus): Older adults are advised to receive one of three enhanced formulations, which trigger a stronger immune response than standard flu shots. The annual shot has a second benefit: Research from UTHealth Houston found that an annual flu vaccine is associated with a 40% reduction in the four-year risk of developing Alzheimer’s dementia for those 65 and older, while the risk among older adults who receive the high-dose flu vaccine is reduced by nearly 55%. 

• RSV vaccines: Recommended as a single lifetime dose for all adults age 75 and older, and for those age 50 to 74 who have underlying conditions like COPD, asthma, congestive heart failure, or diabetes.   

• Pneumococcal vaccines (ages 65-plus): Protect against pneumococcal pneumonia, meningitis, and bloodstream infections. Anyone 65 or older who has not received a modern conjugate vaccine, a specialized type of vaccine that enhances immune response, should consult their doctor.  

• Shingles vaccine (ages 50-plus): A two-dose series administered 2 to 6 months apart to prevent shingles and postherpetic neuralgia, regardless of whether you previously had chickenpox or the older Zostavax shot.  

What should people know about the new COVID vaccine?  

• Updated formulation: The current seasonal vaccine is not a simple “booster.” It has been updated to closely match circulating variants.   

• Who should receive it: The shot is authorized for individuals 6 months and older. It is especially critical for adults age 65 and older, immunocompromised individuals, and those with chronic medical conditions.   

• Timing after infection or prior shots: If you recently had a COVID-19 infection, you can wait about 90 days before getting the updated shot, as infection provides temporary natural immunity. Ensure at least two months have elapsed since your last COVID-19 vaccine dose.  

• Primary goal: While it reduces the risk of symptomatic infection, the shot’s primary benefit is preventing severe illness, hospitalization, and long-term complications.  

Where can my child or I receive our annual vaccines?   

Vaccines are broadly accessible across multiple healthcare settings:  

• Retail pharmacies: Drug and grocery store chains offer walk-in or online scheduling for flu, COVID-19, and adult vaccines (and often for children age 3 and older).  

• Primary care and pediatric clinics: The best option for infants, toddlers, and individuals needing comprehensive wellness evaluations alongside their shots.  

• Local health departments and community clinics: Offer free or low-cost immunizations, often coordinating with the CDC’s Vaccines for Children program, which provides federally funded vaccines to uninsured, underinsured, or Medicaid-eligible children.  

• Workplace and school clinics: Many employers and public school districts sponsor mobile or pop-up vaccine clinics in September and October.  

• Online locators: Search Vaccines.gov by ZIP code to locate specific vaccines and schedule appointments near you.  

By Joaquin Villegas, MD, assistant professor at McGovern Medical School at UTHealth Houston. All quotes should be attributed to him.  

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