Vaccine Checklist

By Linda Rath | Updated Oct. 20, 2025

If you take drugs that suppress your immune system, you need to know what vaccines to take and when. All decisions about whether and when to be vaccinated should be made in partnership with your doctor. Be sure you understand your options and the risks and benefits of vaccination in your particular case. Here’s the latest information and guidance.

Protects against: The Food and Drug Administration (FDA) approved mRNA vaccines by Moderna and Pfizer against a newer COVID-19 strain. Although it’s no longer the main strain circulating in the U.S., the vaccines still help protect against severe illness, hospitalization and death. The FDA also approved a non-mRNA Novavax vaccine that targets an older Omicron strain, but the vaccine is still effective. 

Who needs it: The Moderna vaccine is approved for those 6 months and older with a medical condition that raises their risk of COVID, and anyone over age 65. The Pfizer vaccine is approved for the same groups ages 5 to 64 and anyone over 65. The Centers for Disease Control and Prevention (CDC) advises vaccines based on recommendations by its Advisory Committee on Immunization Practices (ACIP). This year, ACIP decided not to recommend the COVID vaccine for most people, but you can get it if you consult with a health care provider, which can be a doctor, nurse or pharmacist. The committee emphasizes that people 65 and older and those under 65 who have health conditions that put them at risk from COVID are most likely to benefit from the vaccination. Some states are making their own policies.

Do I qualify for the vaccination? Health conditions that raise the risk of COVID include type 1 and type 2 diabetes, obesity and many others. People with immune systems that don’t work properly or who take medications that weaken their immune systems — like long-term corticosteroids — are also at higher risk of COVID. That includes people with autoimmune forms of arthritis. If you have one of these, talk to your health care provider about vaccine pros and cons. The panel did not vote on whether pregnant women should get the vaccine. However, the American College of Obstetrics and Gynecology recommends that women receive an updated COVID-19 vaccine “at any point during pregnancy, when planning to become pregnant, in the postpartum period, or when lactating.” Be sure to talk to your own rheumatologist and OB-GYN about it.

How effective are COVID vaccines? Almost all scientific evidence suggests they are effective, but some people are skeptical. The shots won’t necessarily prevent infection, but they can help keep you out of the hospital and keep COVID from becoming serious. Vaccines are most effective in the first two months, but then they start to weaken. If you do get COVID-19, keeping up with vaccinations may keep you from getting as sick for as long. (Even a mild case of COVID, though, can lead to long COVID. If you’re at higher risk or if you live with someone who is at higher risk, wearing a mask and keeping your distance from others may protect you and them when COVID hospitalizations spike in your area.)

When to get the shot: People at high risk — including adults 65 and older and younger people who have a serious medical condition or take immune-suppressing drugs — should get the shot from mid-September to mid-October to maximize protection before winter, when COVID and flu cases tend to spike. If you take immune-suppressing drugs, ask your doctor when is the best time to get the vaccine; some drugs lower the vaccine’s effectiveness. Ask whether you need additional doses, too. The American College of Rheumatology offers guidance on vaccine timing with other medications. If you have been sick with COVID or already had a shot, wait about three months before getting the vaccine.

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. Otherwise, combining them is safe but may increase the risk of side effects like muscle aches, headache and fatigue.

Where to get it: For the most part, people will still be able to get vaccines through physicians and pharmacies. The Affordable Care Act requires pharmacies to provide ACIP-recommended vaccines free to consumers, and most pharmacies have said they will continue to provide them without a prescription. For the most up-to-date information, check with pharmacies in your area or your state health department. 

What it costs: Private insurers generally won’t cover a vaccine not approved by the ACIP, but insurance officials say the shots will be covered at least through 2026. Medicare Part B has its own guidelines that aren’t tied to ACIP recommendations. The Bridge Access program, which provided free shots for uninsured adults, ended in 2024. Children and teens under 18 who qualify may be able to get free shots through the federally funded Vaccines for Children Program (VCP). (ACIP also is no longer recommending the combined MMRV [measles, mumps, rubella and varicella] vaccine for children, but children will still be able to receive separate MMR and varicella shots.)

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 is effective for about 40% to 60% of those who get it, according to the CDC. 

Like the COVID vaccine, a flu shot won’t necessarily prevent you from getting sick, but it may make you less sick and for a shorter time than without the shot.

Who needs it: The CDC continues to recommend seasonal flu shots for almost everyone 6 months and older, with one key change: The new ACIP recommended against flu vaccines that contain the preservative thimerosal. There is no scientific evidence to support this change, but since the great majority of flu vaccines in the U.S. don’t contain thimerosal, experts say it shouldn’t cause any disruption. 

For the 2025-2026 flu season, several different types of flu vaccine are available, including high-dose and egg-free shots plus a nasal spray. All protect against the three flu strains expected to be the most common. The best type for you this season 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, experts recommend they receive one of the following:
•    A high-dose shot such as Fluzone 
•    An shot like Fluad, which contains a booster that makes the immune system react more strongly
•    A shot like Flublok, which is not made in eggs and uses the virus’s genetic material instead of a killed form of the virus. Previously approved for those 18 and older, it’s now also approved for children and teens ages 9 to 18.

These shots provide better protection for older adults, but they also cause more side effects, such as injection site pain and swelling, headache and fatigue. It’s fine to get a standard flu shot if one of the others isn’t available. But if you’re 65 or older, experts strongly recommend asking for a vaccine for older adults, especially if you are of a minority racial or ethnic population. 

The nasal spray flu vaccine (FluMist), was recently approved by the FDA for use at home, where you can take it on your own. However, it contains live virus and should not be used by:
•    People who are immunocompromised or take immune-suppressing drugs
•    Adults aged 50 and older
•    Pregnant people
•    Kids and adults who have asthma.

When to get it: It is possible to get the flu vaccine too early. Flu season doesn’t ramp up until the end of October, so waiting until late fall to get the shot can help your protection last through peak flu season in January or February. According to the American College of Rheumatology, people with inflammatory arthritis or taking immune-suppressing drugs should get the seasonal flu vaccine even when their disease is active.

Where to get it: Most pharmacies, medical offices, clinics and health departments offer the flu vaccine. The shots are free for most people with health insurance. If you don’t have insurance, many cities offer no- or low-cost flu vaccines at public clinics and through the Vaccines for Children Program.

Protects against: A viral infection marked by a painful rash. It’s caused by the reactivation of the same virus that causes chicken pox, called varicella zoster virus.

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 virus hibernates in the 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. If you were born before 1980, it’s almost certain you had chickenpox, even if you don’t remember. 

The Shingrix vaccine is given in two doses, two to six months apart. People with weakened immune systems may get the second dose sooner but must allow at least four weeks between shots.

If you have an inflammatory autoimmune disease like rheumatoid arthritis (RA), or if you take immune-suppressing drugs or have a weakened immune system for other reasons, talk to your doctor about when to get the Shingrix vaccine. The best time is before you start medication that suppresses the immune response or when disease activity is lowest. You should not be vaccinated during a flare.

Protects against: Bacteria that can cause pneumonia, sinus and ear infections, meningitis and bloodstream infections. 
 
Who needs it: The CDC recommends the pneumonia vaccine for children under age 5 and unvaccinated adults over age 50. Adults who receive a longer-acting type of this vaccine will not need another one.

The American College of Rheumatology recommends the pneumonia vaccine for everyone who has arthritis and is taking medications that suppress the immune system, though it may not be as effective for them. Decisions about getting vaccinated should be made with your doctor. Be sure you understand your options and the risks and benefits of vaccination.

What it costs: The pneumonia vaccine should be free to eligible people who have insurance through the Health Marketplace, Medicare or Medicaid.

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 who are at risk of severe infection, including those with chronic heart or lung disease, a weakened immune system or who live in a nursing home. People in this age group should not get the RSV vaccine if they’re not at high risk. For those who qualify, only a single dose is needed. As of February 2025, the CDC’s vaccine advisory panel decided there wasn’t enough evidence to recommend the vaccine to people ages 18 to 49, even if they are at higher 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 be vaccinated again.
•    It’s usually OK to get the RSV vaccine with other vaccines but check with your doctor first.

In June 2025, the ACIP recommended newly approved clesrovimab for infants under 8 months of age. It is the second RSV vaccine for infants. Newborns should not receive the vaccine if their mother was vaccinated during pregnancy.   

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 it sometimes resembles a rheumatic disease. Ask your doctor about the risks and benefits of the RSV 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 the hepatitis B virus, which may already be in your system. Your doctor should test you for hepatitis B before starting any drugs that weaken your immune system.
 
Who needs it: The FDA has approved seven hepatitis B vaccines, some just for infants and children. All contain yeast and an ingredient meant to increase its effectiveness that’s 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 babies at birth because it can be passed to an infant during the birth process. This practice remains the standard of care for now in spite of some controversy. The American Academy of Pediatrics supports it because infants can also pick up and spread the disease at day care or from infected family members.
•    Unvaccinated kids and teens under age 19
•    Adults 19 to 59
•    Adults aged 60 and older who want the vaccine or are at risk of contracting hepatitis B, such as unprotected sex with someone with the virus, injection drug use, exposure to blood or travel to areas with high rates of hepatitis B

For most people, three doses are nearly 100% effective at preventing infection. Two- and four-dose regimens are also available. The shot is known to be safe and can be given along with other vaccines.