Vaccination Guidelines for Adults with Asthma

Introduction to Simultaneous Vaccination

The American College of Physicians and the Advisory Committee on Immunization Practices (ACIP) recommend that influenza, pneumococcal conjugate vaccine (PCV), and Tdap vaccines can and should be administered simultaneously in adults with asthma during the same visit, using separate syringes at different anatomic sites 1, 2
The ACIP explicitly recommends that if two or more vaccines are indicated, they should be administered during the same visit, with each vaccine given using a separate syringe at a different anatomic site, to increase the likelihood that adults will receive all recommended vaccinations 1, 2

Tdap can be co-administered with influenza vaccine and pneumococcal vaccines according to recent international guidelines 3
Studies demonstrate that Tdap administered simultaneously with trivalent inactivated influenza vaccine is safe, though pain at the Tdap injection site occurred slightly more frequently with simultaneous administration (67%) versus separate administration (61%) 4
Adults with asthma are at increased risk for severe complications from influenza and have been specifically identified as a priority population for annual influenza vaccination, according to the American College of Physicians and the ACIP 5

The American College of Physicians and the ACIP recommend annual influenza vaccination for adults with chronic pulmonary disease, including asthma, due to their higher risk for influenza-related complications 5

Confirm the patient has not received Tdap previously, and use Td instead for routine boosters, as recommended by the ACIP 1, 2
Check timing of last tetanus-containing vaccine, with a routine interval of 10 years, according to the ACIP and the Centers for Disease Control and Prevention (CDC) 6, 7
Use separate syringes for each vaccine, and administer at different anatomic sites, such as the deltoid muscles of different arms, as recommended by the ACIP 1, 2
Administer no more than two injections per muscle, separated by at least 1 inch, according to the ACIP 1, 2
Tdap dose is 0.5 mL administered intramuscularly, preferably into the deltoid muscle, as recommended by the ACIP and the CDC 1, 2

Do not administer Tdap to patients with a history of serious allergic reaction (anaphylaxis) to any vaccine component or encephalopathy within 7 days of a previous pertussis-containing vaccine, as recommended by the ACIP and the CDC 1, 2, 8
Moderate or severe acute illness with or without fever is a precaution; defer vaccination until the acute illness resolves, according to the ACIP and the CDC 9
A single dose of Tdap can be given at intervals shorter than 10 years when protecting against pertussis is a priority, though the standard interval is 10 years, as recommended by the ACIP and the CDC 10, 1
Do not give tetanus boosters more frequently than every 10 years for routine immunization to avoid Arthus reactions, according to the ACIP and the CDC 6
Do not use pediatric DTaP formulations in adults; use Tdap or Td instead, as recommended by the ACIP and the CDC 1, 2, 6

Despite long-standing recommendations, influenza vaccination coverage among adults with asthma and other high-risk conditions remains low, with approximately 90% of unvaccinated adults with high-risk conditions may have missed at least one opportunity to receive influenza vaccine through their healthcare provider, according to the American College of Physicians and the ACIP 5
Simultaneous administration of all indicated vaccines maximizes the opportunity to protect these vulnerable patients, as recommended by the ACIP and the CDC 5