Simultaneous Administration of Influenza and Pneumococcal Vaccines

Primary Recommendation

• The CDC/ACIP recommends simultaneous administration of pneumococcal polysaccharide vaccine and inactivated influenza vaccine for all persons for whom both vaccines are indicated, as this approach elicits satisfactory antibody responses without increasing the incidence or severity of adverse reactions 3, 4

Administration Guidelines

• Administer influenza and pneumococcal vaccines at separate anatomic sites (different injection locations, preferably different limbs) 1, 2, 4
• Never mix vaccines in the same syringe unless specifically FDA-approved for mixing 4
• If using high-dose or adjuvanted influenza vaccines, inject in different limbs when possible to minimize local reactions 1

Evidence Supporting Same-Day Administration

• Both inactivated influenza vaccines and recombinant influenza vaccines can be administered concomitantly with pneumococcal vaccines without compromising immune responses 2, 5, 4
• One study in adults ≥65 years showed slightly lower seroprotection to one influenza B antigen at 4-6 weeks when IIV4 and PPSV23 were given together, but no significant difference at 6 months 2, 5

Special Considerations

• The CDC/ACIP recommends that Live Attenuated Influenza Vaccine (LAIV) can be administered simultaneously with pneumococcal vaccines 1, 2
• If not given simultaneously with other live vaccines, wait at least 4 weeks before administering another live vaccine 1, 2
• Co-administration of IIV with PCV13 in children 6-23 months increases fever risk on days 0-1 post-vaccination and slightly increases febrile seizure risk 2, 5

Clinical Algorithm

• Verify both vaccines are indicated for the patient based on age, risk factors, and vaccination history 6
• Prepare both vaccines for administration at the same visit 6
• Select separate anatomic sites (different arms preferred, especially if using adjuvanted flu vaccine) 1
• Administer both vaccines simultaneously 4
• Observe for 15 minutes post-vaccination as standard practice 6