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

Evidence-Based Rationale

Inactivated vaccines, including COVID-19, influenza, and RSV vaccines, can be administered simultaneously or sequentially without safety concerns, according to CDC/ACIP recommendations 1, 2
All three vaccines should be given at separate anatomic sites (different injection locations, preferably different limbs if possible) 1, 2
The 2024-25 ACIP influenza guidelines specifically address Arexvy, noting it contains the AS01E adjuvant, and confirms that while data on coadministration with other adjuvanted vaccines are limited, influenza vaccination should not be delayed if simultaneous administration is needed 1

Patients with cancer, including brain cancer, should be prioritized for COVID-19 vaccination and can receive vaccines even while on active treatment 3
COVID-19 vaccines under Emergency Use Authorization are not considered investigational products and do not interfere with cancer treatment protocols 3

Administer all three vaccines at the same visit in separate anatomic sites 1, 2
Use different limbs when possible, especially since both Arexvy and adjuvanted influenza vaccines may cause more injection site reactions 1
Do not delay vaccination to separate the doses—the benefits of timely protection outweigh theoretical concerns about adjuvant interactions 1

If adjuvanted or high-dose influenza vaccine is used, inject it in a different limb from the COVID-19 vaccine to minimize local reactions 1, 4
Monitor for 15-30 minutes post-vaccination as standard practice, particularly given the patient's cancer history 3
The only contraindication would be severe allergic reaction to a previous dose of any of these vaccines—cancer history itself is not a contraindication 3
Systemic cancer treatments do not contraindicate inactivated vaccines, though immune response may be somewhat reduced depending on the specific therapy 3