A patient sat across from me last winter, a little embarrassed, and said, "I honestly have no idea what shots I've had since college." She's not unusual. Most adults can't tell me, and that's not a personal failing. Vaccine records get lost, recommendations change, and nobody hands you a tidy checklist when you turn 40.
That's exactly the gap an adult immunization review is meant to fill. In my Direct Primary Care practice here in Los Angeles, I sit down with each patient, reconstruct their vaccine history as best we can, and figure out what's actually due. It's less about checking a box and more about making sure you're protected against illnesses we genuinely can prevent.
What is an adult immunization review?
An adult immunization review is a focused look at which vaccines you've had, which you're missing, and which ones make sense for you right now. I pull together whatever records exist, ask about your past illnesses and travel, and cross-check against your age and health history.
Vaccines aren't just a childhood thing. Some wear off. Some are newer than your last pediatrician visit. And some only become relevant as you get older or develop a chronic condition.
Which vaccines do adults actually need?
It depends on your age, health, and history, which is the honest answer most people don't love. There's no single list that fits everyone. That said, here are the ones I find myself talking about most:
- Tetanus, diphtheria, and pertussis (the Tdap booster, then a Td every ten years)
- Influenza, which I recommend yearly for nearly everyone
- Shingles, generally for adults 50 and up
- Pneumococcal vaccines, often around 65 or earlier with certain conditions
- Hepatitis A and B, depending on risk and prior coverage
- HPV, for younger adults who didn't complete the series
If you live with diabetes, heart disease, or a lung condition, some of these move up the priority list. People managing type 2 diabetes, for instance, are more vulnerable to complications from the flu and pneumonia, so I tend to be more proactive with them.
How do I know which shots I've already had?
Honestly, we piece it together. I start with any paperwork you have, then check old clinic and pharmacy records, and in California I can often look up your history through the state immunization registry. When a record truly can't be found, we make a reasonable judgment together rather than guessing in the dark.
Sometimes the safest move is simply to revaccinate, which is generally well tolerated. Other times we can confirm immunity with a blood test. I'll walk you through the trade-offs so the decision feels like yours, not something handed down.
Why does coordination matter so much?
Because knowing you need a vaccine and actually getting it are two different things. Plenty of good intentions die in the gap between the exam room and the pharmacy.
The coordination piece is where I think a small practice earns its keep. I'll administer some vaccines in the office, send others to a pharmacy with the right paperwork, and make sure nothing slips through. If you're planning a trip abroad, I fold that into the plan too, since preventive care and travel readiness often overlap. A patient heading to a region with hepatitis A risk needs a different conversation than someone just due for a tetanus booster.
And I keep track over time. Vaccines have schedules, boosters come due, and a one-and-done visit doesn't keep you current for life. Folding this into your regular checkups means it stays on the radar without you having to remember every interval.
What about the flu and seasonal respiratory viruses?
The flu vaccine is the one I bring up every fall, and yes, I still recommend it even for healthy adults. It won't always stop you from catching anything, but it reliably lowers the odds of a serious illness, which is the whole point. I coordinate flu vaccine timing for my patients each season, ideally before LA's cases start climbing.
Respiratory viruses tend to circulate together once the weather cools, so I often discuss flu, COVID, and where appropriate other seasonal vaccines in the same visit. One conversation, one plan.
A quick word on safety and side effects
Most adults feel fine, maybe a sore arm or a day of feeling run-down. That's your immune system doing its job, not a sign something's wrong. If you have a history of a serious reaction or a condition that affects your immune system, tell me, and we'll tailor things accordingly. There's almost always a safe path forward.
If you're not sure where you stand, that's a perfectly good reason to come in. Bring whatever records you have, even the scraps, and we'll build the rest together. I'd genuinely rather you ask than assume. Reach out anytime and we'll get you sorted, one shot at a time.