CDC’s 2026 Adult Vaccine Schedule: What People With Lupus Need to Know

Why vaccines matter in lupus

If you live with lupus, infections are more than an inconvenience. They are a leading cause of hospitalization and serious complications in people with systemic lupus erythematosus (SLE). The Centers for Disease Control and Prevention (CDC) notes that lupus affects the immune system itself — and many common treatments, including corticosteroids, mycophenolate, methotrexate, and biologics, can further reduce the body’s ability to fight infection.

That does not mean everyone with lupus is severely immunocompromised. Risk varies widely depending on disease activity and medication. But it does mean vaccination plays an important preventive role.

Each year, the CDC publishes an updated Adult Immunization Schedule in the Morbidity and Mortality Weekly Report (MMWR). The 2026 schedule includes detailed notes for adults who are moderately or severely immunocompromised — a category that includes many, but not all, people with lupus.

Here’s what the 2026 guidance means in practical terms.

What the 2026 CDC schedule says for immunocompromised adults

The CDC’s 2026 Adult Immunization Schedule continues to recommend that most immunocompromised adults stay up to date on:

Annual influenza vaccination
Updated COVID-19 vaccination
Pneumococcal vaccination (with current conjugate vaccine options)
Recombinant zoster vaccine (Shingrix) for shingles
RSV vaccination for eligible older adults

Importantly, the schedule clearly distinguishes between inactivated or recombinant vaccines — which are generally safe for people on immunosuppressive therapy — and live vaccines, which are usually avoided in people on moderate-to-high immunosuppression.

Most routine adult vaccines used today for influenza (shot form), COVID-19, pneumococcal disease, shingles (Shingrix), and RSV are not live vaccines.

Key vaccines explained for people with lupus

Influenza (flu)

The CDC recommends annual flu vaccination for all adults, including those who are immunocompromised. For people with lupus:

The inactivated flu shot is recommended.
The live nasal spray vaccine is generally avoided if you are significantly immunosuppressed.

Flu can trigger severe illness in people with autoimmune disease, particularly those on high-dose steroids or biologics.

COVID-19

Updated COVID-19 vaccines remain recommended for immunocompromised adults. The CDC schedule includes additional-dose options for certain immunocompromised individuals because vaccine response may be reduced.

Studies in patients with rheumatic diseases show that people receiving B-cell–depleting therapy, such as rituximab, may have a blunted antibody response. That does not mean the vaccine has no benefit — T-cell immunity may still develop — but protection may be less predictable.

Pneumococcal vaccines

The 2026 schedule continues to include modern conjugate options (such as PCV20 or PCV15 followed by PPSV23 in certain situations). Immunocompromised adults are at higher risk of invasive pneumococcal disease, including bloodstream infections and meningitis.

If you have lupus and have never received a pneumococcal conjugate vaccine, your clinician may recommend a single-dose option such as PCV20, depending on your history.

RSV (Respiratory Syncytial Virus)

RSV vaccination is recommended for adults 75 and older, and for adults ages 60–74 with certain risk factors, using shared decision-making with a clinician.

For older adults with lupus — especially those on immunosuppressive therapy — RSV vaccination may reduce the risk of lower respiratory tract disease. It is not an annual vaccine at this time.

Shingles (Recombinant Zoster Vaccine – Shingrix)

Shingrix is recommended for adults 50 and older, and for immunocompromised adults 19 and older.

This vaccine is recombinant, not live, and is considered safe for people on immunosuppressive therapy. The risk of shingles is significantly higher in people with lupus, particularly those on steroids or certain biologics.

Medication timing: Why it matters

The CDC schedule provides broad recommendations. The American College of Rheumatology (ACR) offers more specific guidance on medication timing around vaccination for patients with rheumatic diseases.

Steroids

High-dose corticosteroids (generally 20 mg or more of prednisone daily for two weeks or longer) may reduce vaccine response. If possible, vaccination before starting prolonged high-dose therapy is preferred.

Methotrexate

ACR guidance suggests that, for some vaccines, temporarily holding methotrexate for a short period after vaccination may improve immune response — but only under clinician supervision.

Mycophenolate

Mycophenolate can reduce antibody responses, particularly to COVID-19 vaccines. Any decision about pausing therapy must balance flare risk against improved vaccine response.

B-cell–depleting therapy (e.g., rituximab)

This is where timing is most critical. Rituximab significantly reduces B cells, which are needed to produce antibodies.

Vaccinate before starting rituximab when possible.
If already receiving rituximab, vaccines may work better several months after infusion and before the next cycle.

Even with careful timing, immune response may still be reduced. That uncertainty is important to discuss with your rheumatologist.

Insurance and Medicare coverage basics

Cost is a common concern. The good news: vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) are generally covered.

Private insurance: Under the Affordable Care Act, ACIP-recommended vaccines are typically covered without cost-sharing when delivered in-network.
Medicare Part B: Covers influenza, pneumococcal, COVID-19, and hepatitis B vaccines.
Medicare Part D: Covers shingles (Shingrix) and RSV vaccines, with no cost-sharing under current law.

If you are unsure which part applies, your pharmacist or clinician’s office can verify coverage before administration.

What we still don’t know

Research continues, but important questions remain:

How durable vaccine protection is in patients on specific biologics.
Whether additional booster doses are needed in certain medication groups.
How newer therapies such as anifrolumab affect long-term immune memory.

Most evidence in lupus comes from observational studies rather than large randomized trials focused exclusively on this population. That means we know vaccination reduces infection risk overall — but precise effectiveness varies by medication and individual immune response.

Practical checklist for patients and caregivers

Review your vaccination record at least once a year.
Ask your rheumatologist if you are considered moderately or severely immunocompromised under CDC criteria.
If starting rituximab or another B-cell–depleting therapy, discuss vaccines beforehand.
Avoid live vaccines if you are on significant immunosuppression unless your clinician specifically recommends them.
Confirm insurance coverage before scheduling.
Call your rheumatologist if you are unsure about timing.

What this means for readers

For most adults living with lupus in the United States, staying up to date on influenza, COVID-19, pneumococcal, and shingles vaccines remains an important part of preventive care.

The 2026 CDC Adult Immunization Schedule reinforces that immunocompromised adults — including many people with lupus — may need specific timing considerations, especially around B-cell–depleting therapy.

The bottom line: vaccines are generally safe and recommended, but timing matters. A quick call to your rheumatologist before scheduling can help you get the most protection possible.

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.