Simultaneous Administration of Pneumonia, Influenza, and COVID-19 Vaccines

Safety and Efficacy of Simultaneous Administration

The Centers for Disease Control and Prevention recommends that inactivated vaccines, including pneumococcal vaccines, inactivated influenza vaccines, and COVID-19 vaccines, can be safely and effectively administered simultaneously at separate anatomic sites 1, 2
The simultaneous administration of pneumococcal polysaccharide vaccine and influenza vaccine elicits satisfactory antibody responses without increasing the incidence or severity of adverse reactions, as recommended by the Centers for Disease Control and Prevention 3
COVID-19 vaccines can be administered concurrently with influenza vaccines, as recommended by the Centers for Disease Control and Prevention 2

When administering multiple vaccines simultaneously, they should be given at separate anatomic sites, as recommended by the Centers for Disease Control and Prevention 1, 2
Individual vaccines should not be mixed in the same syringe unless they are licensed for mixing by the FDA, as recommended by the Centers for Disease Control and Prevention 4
Simultaneous administration is particularly important in certain situations, including when there is imminent exposure to several infectious diseases, as recommended by the Centers for Disease Control and Prevention 5

For live vaccines, if not administered simultaneously with other live vaccines, at least 4 weeks should pass between administrations, as recommended by the Centers for Disease Control and Prevention 2
Inactivated vaccines do not interfere with the immune response to other inactivated vaccines or to live vaccines in most cases, as recommended by the Centers for Disease Control and Prevention 4

The Centers for Disease Control and Prevention recommends not delaying vaccination to administer vaccines separately when they can be given simultaneously, as this may lead to missed opportunities for vaccination 1, 4
The Centers for Disease Control and Prevention recommends not mixing vaccines in the same syringe unless specifically approved for mixing 4
The Centers for Disease Control and Prevention recommends not administering live vaccines within 4 weeks of each other if not given simultaneously, this applies to live attenuated influenza vaccine but not to inactivated influenza, pneumococcal, or COVID-19 vaccines 2

The Centers for Disease Control and Prevention recommends that COVID-19 and influenza vaccines can be administered concurrently, but at different anatomical sites 6, 7
Inactivated influenza vaccines (IIV4) and recombinant influenza vaccines (RIV4) can be given at the same time as COVID-19 vaccines 8, 9

When administering vaccines with increased reactogenicity (e.g., adjuvanted or high-dose influenza vaccines) along with COVID-19 vaccines, they should be injected into different limbs 8, 9
Live attenuated influenza vaccines (LAIV) can be given concurrently with other live or inactivated vaccines 6, 8
If two live vaccines are not given at the same time, there should be at least 4 weeks between vaccinations 8, 9

A study on the concurrent administration of high-dose influenza vaccine (HD-IIV4) and an mRNA COVID-19 booster shot showed similar reactogenicity to solo COVID-19 vaccination, no serious adverse events, and similar immune response between groups 8, 10
Healthcare providers should be aware of the potential for increased reactogenicity when administering vaccines concurrently 6, 8

The American Academy of Pediatrics recommends that for live attenuated influenza vaccine (LAIV), if not administered simultaneously with other live vaccines, a 4-week interval is recommended 11, 12
The American Academy of Pediatrics suggests that minor illnesses, with or without fever, are not contraindications to receiving either influenza or COVID-19 vaccines 12
The American Academy of Pediatrics advises that for patients with moderate to severe illness, including COVID-19, vaccination should be deferred until resolution of the acute illness 11, 12

The American Academy of Pediatrics recommends that for immunocompromised individuals, inactivated vaccines (both influenza and COVID-19) are generally preferred over live vaccines 12
The American Academy of Pediatrics suggests that pregnant individuals may receive inactivated influenza vaccines at any time during pregnancy to protect themselves and their infants 11
The American Academy of Pediatrics advises that for healthcare personnel who receive LAIV, they may continue to work in most hospital units using standard infection control techniques, but should restrict contact with severely immunocompromised patients for 7 days 12