🛡️ Adult Vaccination Programme

Mediklinik Mikhail — Evidence-Based 2025 | Based on MSGM VPD Recommendations for Older Adults 2025

💉 Personalised Vaccine Profiler

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Evidence-Based Vaccination Recommendations for This Patient
Enter patient details and medical history → get a personalised vaccination plan with schedules, brands, and doses.
Based on: MSGM National VPD Recommendations for Older Adults 2025 · MSIDC Adult Immunisation Guidelines 3rd Ed
👤 Patient Details
💉 Vaccination History

Select the patient's current vaccination status for each vaccine.

🏥 Medical Conditions & Risk Factors
Immune & Haematologic
Cardiovascular, Respiratory & Metabolic
Neurological / Anatomical
✈️ Travel, Exposure & Social Factors

📅 Quick Reference Schedule

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MSGM 2025 — Recommended Older Adults Immunisation Schedule

Based on the National VPD Recommendations for Older Adults, Malaysian Society of Geriatric Medicine, 2025.

Vaccine 50–59 years 60–64 years 65–69 years 70–74 years ≥75 years Doses / Schedule
Influenza A&B ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended 1 dose annually (updated formulation)
Shingles (RZV) ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended 2 doses, 2–6 months apart
Pneumococcal ⚡ If comorbidity ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended Preferred: PCV-20 single dose. See notes.
Tdap / Td ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended Tdap once, then Td every 10 years
COVID-19 ✅ 1 dose/year ✅ 1 dose/year ✅ 2 doses/year ✅ 2 doses/year ✅ 2 doses/year ≥65: 2 doses (6 months apart). 50–64: 1 dose (+1 if immunocompromised)
RSV ⚡ If high-risk ✅ Recommended ✅ Recommended ✅ Recommended ✅ Recommended 1 dose — single LIFETIME dose only
Hepatitis B ✅ If unvaccinated ✅ If unvaccinated ⚡ If risk factors ⚡ If risk factors ⚡ If risk factors 3 doses: 0, 1, 6 months
Hepatitis A ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based 2 doses: 6–12 months apart
Meningococcal ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based ⚡ Risk-based 1 dose; booster every 5 years if risk persists
Dengue (Qdenga) ✅ Recommended — Not recommended — Not recommended — Not recommended — Not recommended 2 doses, 3 months apart (age 4–60 only)
Legend: ✅ Recommended (all adults in this age group) · ⚡ Risk-Based (see risk factor criteria) · — Not currently indicated
Source: MSGM National VPD Recommendations for Older Adults 2025

Pneumococcal — Important Notes

  • Preferred: PCV-20 (Prevenar 20) — 1 single dose (no follow-up needed)
  • Alternative: PCV-13 or PCV-15 → PPSV-23 after ≥1 year (or 8 weeks if immunocompromised/asplenia/cochlear implant/CSF leak)
  • Prior PPSV-23 only: Give PCV-13, PCV-15, or PCV-20 ≥1 year after last PPSV-23
  • Maximum 3 doses PPSV-23 lifetime. Minimum 5 years between any 2 PPSV-23 doses.
  • Asplenia / complement deficiency / HIV: 2-dose PCV primary series (2 months apart), then PPSV-23 after 8 weeks

🔬 Vaccine Information

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Influenza A & B
Fluarix Tetra · Influvac · Vaxigrip Tetra · SKYCellFlu
Annual

Inactivated quadrivalent influenza vaccine. Recommended annually for all adults ≥50. Protects against 4 influenza strains. Updated formulation released each year.

💉 1 dose annually 🌡️ 2–8°C · Do not freeze ⚠️ Contains egg protein — caution in severe egg allergy
Herpes Zoster / Shingles (RZV)
Shingrix (recombinant zoster vaccine)
2 doses

Recombinant, adjuvanted vaccine. Highly effective (>90%) against shingles and post-herpetic neuralgia. Recommended for all adults ≥50 regardless of prior chickenpox or shingles history. Safe in immunocompromised (non-live).

💉 2 doses, 2–6 months apart 🌡️ 2–8°C · Do not freeze ✓ Safe in immunocompromised
Pneumococcal
Prevenar 20 (PCV-20) · Prevenar 13 (PCV-13) · Vaxneuvance (PCV-15) · Pneumovax (PPSV-23)
Sequential

Protects against invasive pneumococcal disease (IPD), pneumonia, meningitis. Preferred single-dose option is PCV-20. Sequential therapy with PCV-13/15 + PPSV-23 is the alternative. Max 3 doses PPSV-23 lifetime.

💉 PCV-20: 1 dose (preferred) 🌡️ 2–8°C · Do not freeze ⚠️ Complex scheduling — use profiler
COVID-19
Comirnaty (Pfizer-BioNTech mRNA) — LATEST updated formulation
Annual

mRNA vaccine. Annual updated formulation matching circulating variants. Age ≥65: 2 doses per year (6 months apart, minimum 2 months). Age 50–64: 1 dose per year (2 doses if immunocompromised).

💉 1–2 doses/year (age-dependent) ❄️ Store at -90°C to -60°C (freezer)
RSV (Respiratory Syncytial Virus)
Arexvy (RSVPreF3) — ≥50 · Abrysvo (RSVPreF) — ≥60 only
Single lifetime dose

Recommended for ALL adults ≥60. For age 50–59: only if high-risk conditions present. Only Arexvy is licensed for age 50–59. Single lifetime dose — do NOT repeat.

⚠️ Single lifetime dose — do NOT repeat 🌡️ 2–8°C · Do not freeze
Tdap / Td — Tetanus, Diphtheria, Pertussis
Boostrix (Tdap) · Adacel (Tdap) — ADULT formulation only
Every 10 years

Adult reduced-antigen formulation. Tdap once (for pertussis coverage), then Td booster every 10 years. Full 3-dose primary series if unvaccinated. Important: use Tdap/Td (adult) — NEVER DTaP (paediatric formulation) in adults.

💉 Tdap once, Td every 10 years ❌ Do NOT use DTaP in adults 🌡️ 2–8°C · Do not freeze
Hepatitis B
Engerix-B · Euvax-B · SII Hepatitis-B · Twinrix (HepA+HepB)
Risk-based ≥60

Recombinant vaccine (20 mcg per dose). 3-dose series at 0, 1, 6 months. For age 50–59: all unvaccinated. For age ≥60: if risk factors or on patient request. Consider Twinrix if HepA also indicated.

💉 3 doses: 0, 1, 6 months 🌡️ 2–8°C · Do not freeze
Hepatitis A
Avaxim · Havrix · Twinrix (HepA+HepB combined)
Risk-based

Inactivated HAV vaccine. Risk-based for adults. Indicated for chronic liver disease, HIV, MSM, travel to endemic areas. Any unvaccinated adult who requests it should receive it.

💉 2 doses, 6–12 months apart 🌡️ 2–8°C · Do not freeze
Meningococcal (ACWY)
Menactra · Menveo · Nimenrix · MenQuadfi
Risk-based

Polysaccharide conjugate vaccine against serogroups A, C, W, Y. Risk-based: asplenia, HIV, complement deficiency, HSCT, Hajj/Umrah travel. Hajj/Umrah: required by Saudi Arabia within 2–3 years of travel.

💉 1 dose; booster every 5 years if risk persists 🌡️ 2–8°C · Do not freeze Hajj: required within 2–3 years
Dengue (Qdenga / TAK-003)
Qdenga — tetravalent live-attenuated (DENV-2 backbone)
Age 4–60 only

Tetravalent live-attenuated dengue vaccine (DENV-1,2,3,4). Licensed for age 4–60 years. NOT recommended for adults >60 (insufficient evidence; studies ongoing). Contraindicated in immunocompromised.

💉 2 doses, 3 months apart ❌ CI: immunocompromised · HIV · age >60 🌡️ 2–8°C · Do not freeze · Protect from light

⚠️ Risk Groups & Special Considerations

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🦠 Immunocompromised
  • COVID-19: 2 doses (same as ≥65)
  • Pneumococcal: 8-week PCV→PPSV interval
  • Shingles: Shingrix safe (non-live)
  • Dengue: Contraindicated (live vaccine)
  • RSV: Indicated (age 50–59 risk group)
🫘 Asplenia / Complement Deficiency
  • Pneumococcal: 2-dose PCV primary series + PPSV-23
  • Meningococcal: Strongly recommended
  • Influenza: Annual (high risk of severe disease)
  • Hib: Consider in functional asplenia
🩸 HIV Infection
  • All recommended vaccines should be given
  • Pneumococcal: 2-dose PCV if advanced immunosuppression
  • Dengue: Contraindicated if impaired immune function
  • HepA and HepB: Both indicated
  • Meningococcal: Recommended
❤️ Chronic Cardiovascular Disease
  • Influenza: Annual (prevents cardiac events)
  • Pneumococcal: Recommended (if ≥50)
  • RSV: Indicated even at age 50–59
  • COVID-19: High priority — reduces hospitalization
🫁 Chronic Lung Disease (COPD/Asthma)
  • Influenza: Annual
  • Pneumococcal: Recommended (if ≥50)
  • RSV: Indicated even at age 50–59
  • COVID-19: Priority
🩺 Chronic Liver Disease
  • Hepatitis A: Indicated
  • Hepatitis B: Indicated
  • Consider Twinrix (combined HepA+HepB)
  • Influenza: Annual
  • Pneumococcal: Recommended
🕋 Hajj / Umrah Pilgrims
  • Meningococcal ACWY: Required by Saudi Arabia
  • Must be given within 2–3 years of travel
  • Influenza: Recommended before travel
  • COVID-19: Up to date
🏥 Dialysis / CKD
  • Hepatitis B: Indicated (40 mcg dose on dialysis)
  • RSV: Indicated even at age 50–59
  • Influenza: Annual
  • Pneumococcal: Recommended

⚠️ Live Vaccines — Contraindicated in Immunocompromised

Dengue (Qdenga) is a live attenuated vaccine and must NOT be given to immunocompromised patients including those on chemotherapy, high-dose corticosteroids, biologics, or with HIV (impaired immune function). All other vaccines on this page are inactivated or recombinant and are safe in immunocompromised patients.

🌡️ Storage, Handling & Co-administration

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Vaccine Storage Route Key Handling Note
Influenza 2–8°C IM (deltoid) Do not freeze. Protect from light.
Shingrix (RZV) 2–8°C IM (deltoid) Do not freeze. Reconstitute immediately before use — inject within 6 hours.
Pneumococcal (PCV/PPSV) 2–8°C IM or SC Do not freeze. PPSV-23 can be given SC or IM.
COVID-19 (Comirnaty) -90°C to -60°C (freezer) IM (deltoid) Thaw before use. Once thawed, use within timeframe per product insert. Do NOT refreeze.
RSV (Arexvy/Abrysvo) 2–8°C IM (deltoid) Do not freeze. Reconstitute Arexvy before use.
Tdap / Td 2–8°C IM (deltoid) Do not freeze. Shake well before use.
Hepatitis B 2–8°C IM (deltoid) Do not freeze. Shake well before use.
Hepatitis A 2–8°C IM (deltoid) Do not freeze.
Meningococcal 2–8°C IM (deltoid) Do not freeze.
Dengue (Qdenga) 2–8°C SC Do not freeze. Protect from light.

Co-administration

  • Multiple inactivated vaccines can generally be given simultaneously at different sites.
  • COVID-19 mRNA vaccines can be co-administered with influenza, RSV, pneumococcal, and other inactivated vaccines.
  • Give live vaccines (Dengue) simultaneously with other live vaccines, or separated by ≥4 weeks.
  • If multiple injections needed, use different limbs or separate sites ≥2.5 cm apart.
  • Document batch number, site, and date for each vaccine given.

📋 Overview & Key Principles

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Guideline Source

Based on the National Vaccine-Preventable Diseases Recommendations for Older Persons in Malaysia 2025, published by the Malaysian Society of Geriatric Medicine (MSGM), and the MSIDC Guidelines for Adult Immunisation, 3rd Edition. Endorsed by the Academy of Family Physicians of Malaysia (AFPM), Malaysian Medical Association (MMA), and 25+ professional bodies.

Why Vaccinate Older Adults?

  • Older adults are up to 13 times more likely to suffer complications from infectious diseases
  • Immunity from childhood vaccination wanes with age — boosters are needed
  • Malaysia is transitioning to an ageing society — vaccination is critical for healthy ageing
  • Vaccine-preventable diseases cause avoidable morbidity, hospitalisation, and loss of independence
  • Vaccination in older adults with CVD: 75% reduction in hospitalisations, >80% reduction in mortality (COVID-19)
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Vaccine-Preventable Diseases
Covered in this guideline
4
Universal Vaccines
Influenza · Shingles · Tdap · COVID-19
6
Risk-Based / Age-Conditional
RSV · Pneumo · HepA · HepB · Mening · Dengue

Key Contraindication Reminder

Live attenuated vaccines (Dengue — Qdenga) are contraindicated in immunocompromised patients. All other vaccines on this page (inactivated, recombinant) are generally safe in immunocompromised patients, though immune response may be reduced.