Adult vaccinations: the underrated protection after 60

Few preventive measures are as well studied, as inexpensive and as effective as vaccination. Yet many adults still think of the vaccination schedule as something for children. That is a costly misconception: shingles, pneumonia, influenza and RSV (respiratory syncytial virus) hit older people hardest – and it is exactly for this group that Germany's Standing Committee on Vaccination (STIKO) has issued several new recommendations in recent years. According to the latest data from the Robert Koch Institute (RKI), Germany's public health agency, only about a third of people aged 60 and over were vaccinated against flu in the 2024/25 season; for shingles the figure was 24%. This article summarises what STIKO recommends for adults as of autumn 2026, what the trials show in absolute numbers – and who pays.

Who decides, who pays

STIKO is an independent expert committee based at the RKI. Its recommendations appear in the Epidemiologisches Bulletin; the consolidated 2026 edition was published in January (issue 4/2026). The Federal Joint Committee (G-BA), which decides what statutory insurance covers, usually adopts them into its vaccination directive. From then on, statutory health insurance (GKV) pays in full, with no co-payment.

The recommendations at a glance

• All adults: tetanus and diphtheria booster every 10 years; once in adulthood, add whooping cough (pertussis) as a combination shot.
• Born after 1970, aged 18+: one measles dose (as MMR) if your status is unclear, or if you had none or only one dose as a child.
• From 60: annual flu shot (high-dose or MF59-adjuvanted vaccine); pneumococcal vaccine once (PCV20); shingles – two doses of the non-live vaccine, 2 to 6 months apart.
• From 75: RSV once; COVID-19 annually, preferably in late summer or early autumn.
• With chronic illness or other risk: flu at any age; shingles from 18; RSV from 60; COVID-19 annually at any age from 6 months; pneumococcal regardless of age.

What changed in 2025–26

COVID-19: In Epidemiologisches Bulletin 28/2026 (9 July 2026), STIKO raised the routine recommendation from age 60 to 75. The advice to build "basic immunity" from three antigen contacts no longer applies to adults. The G-BA adopted the change on 3 September 2026.

Shingles: Since Epidemiologisches Bulletin 45/2025, the risk-based recommendation starts at 18 instead of 50 – for example with immunodeficiency, transplantation, immunosuppressive therapy, cancer, rheumatoid arthritis, inflammatory bowel disease, severe COPD, chronic kidney disease or diabetes. Mild, well-controlled conditions in 18- to 59-year-olds explicitly do not qualify. Statutory insurance has covered this since 13 January 2026.

RSV and flu: Since 2026, an mRNA RSV vaccine is recommended alongside the two protein vaccines; none is preferred. The flu indication now also includes people with regular direct contact with pigs, poultry, wild birds or seals.

What the trials show – in absolute numbers

Shingles

In ZOE-50, with 15,411 adults aged 50 and over, there were 6 cases in the vaccine group and 210 in the placebo group over a mean of 3.2 years: 0.3 versus 9.1 per 1,000 person-years, an efficacy of 97.2%. Among 13,900 people aged 70 and over (ZOE-70), the figures were 0.9 versus 9.2 per 1,000 person-years (89.8%). Against the nerve pain that can persist for months after shingles (postherpetic neuralgia), protection in the pooled analysis of those aged 70+ was 88.8% – 4 versus 36 cases. The price: within a week, 74% had injection-site reactions such as pain or redness (placebo 10%) and 53% had general reactions such as fatigue or muscle aches (placebo 25%), mostly lasting a day or two.

Influenza

The high-dose vaccine was tested in a trial in the US and Canada of 31,989 people aged 65 and over against the standard vaccine – an active comparator, not placebo. Laboratory-confirmed flu occurred in 1.4% versus 1.9%: 24.2% fewer in relative terms, about 5 fewer cases per 1,000 vaccinated per season. Serious adverse events were slightly less frequent with the high dose (8.3% vs 9.0%).

Pneumococcal disease

The large Dutch CAPiTA trial of 84,496 people aged 65 and over tested PCV13, the predecessor of today's recommended PCV20. Over almost four years there were 49 versus 90 pneumonias caused by vaccine serotypes (efficacy 45.6%) and 7 versus 28 invasive pneumococcal infections such as sepsis or meningitis (75%). In absolute terms: roughly one fewer such pneumonia per 1,000 vaccinated over four years. The vaccine had no measurable effect on pneumonia from all causes. If you previously received the polysaccharide vaccine PPSV23, PCV20 is given at least six years later. The newer PCV21 is not currently recommended by STIKO.

RSV

In the pivotal trial of a protein vaccine with 24,966 people aged 60 and over, 7 vaccinated and 40 placebo recipients developed RSV lower respiratory tract disease in the first season – 82.6% efficacy, about 2 to 3 fewer cases per 1,000. Against severe disease, efficacy was 94.1%. Because the risk of severe illness rises steeply with age, STIKO sets the routine recommendation at 75. Typical side effects are injection-site pain, fatigue and aches; Guillain-Barré syndrome has rarely been observed after the protein vaccines; STIKO nonetheless judges the benefit to clearly outweigh the risk in the recommended groups.

And HPV?

STIKO recommends HPV vaccination as a routine vaccine for girls and boys aged 9 to 14, with catch-up up to the day before the 18th birthday. There is no STIKO recommendation for adults, though some statutory insurers pay voluntarily. Who may still benefit later – for example men who have sex with men, people with HIV or immunosuppression, and women after conisation – is covered in a separate article, HPV vaccination in adults.

Taking doubts seriously

Hesitancy is understandable and deserves answers rather than lectures. First, reactions are common but brief. A sore arm or a day of feeling flat after the shingles vaccine is the immune system at work, not a sign of harm. Second, in the large trials, serious events were no more frequent among the vaccinated than with placebo (ZOE-70: 16.6% vs 17.5%). Rare side effects are actively searched for after approval and openly reported – as with Guillain-Barré syndrome. Third, the benefit should be stated honestly. Some vaccines prevent only a few illnesses per 1,000 people per year. But these are precisely the illnesses that, in later life, lead to hospital stays, frailty or chronic pain. For how to read relative and absolute figures, see our piece on absolute versus relative risk.

What this means for you

• Find your vaccination record (Impfpass). When was your last tetanus booster? Have you had a pertussis dose as an adult? Were you born after 1970 with only one or no documented measles dose?
• Raise it at your next appointment – for example at the Check-up 35, a good opportunity to have your vaccination status checked.
• Use the autumn. Flu, COVID-19 (from 75 or with risk) and RSV can be bundled in September or October; flu and RSV, and COVID-19 mRNA and RSV, may be given on the same day.
• Chronic illness? Ask early. Before planned immunosuppressive therapy or a transplant, vaccinations should ideally be completed beforehand.
• Cost: all STIKO recommendations above are covered by statutory insurance. Non-recommended vaccines or use outside the indication may be self-pay "IGeL" (individual health services billed privately).

Note: recommendations in other countries, such as the US (CDC/ACIP), differ in places on age thresholds and vaccine choice. This article follows Germany's STIKO recommendations as of October 2026.

This article is general information and not individual medical advice. Decisions about tests and treatment belong in a conversation with your own physician.