Can Shingrix (zoster vaccine) and Tdap (tetanus, diphtheria, and pertussis) vaccine be administered simultaneously?

From the Guidelines

Yes, Shingrix (recombinant zoster vaccine) and Tdap (tetanus, diphtheria, and acellular pertussis) vaccines can be administered at the same time, as they do not interfere with each other's immune response or safety profile, according to the most recent evidence 1. When given simultaneously, they should be administered at different injection sites, typically in separate limbs. This approach is convenient and helps ensure timely vaccination without requiring multiple healthcare visits. Both vaccines work through different immune mechanisms - Shingrix stimulates immunity against the varicella-zoster virus that causes shingles, while Tdap boosts protection against tetanus, diphtheria, and pertussis bacteria. Some patients might experience more pronounced side effects when receiving multiple vaccines at once, such as increased soreness at injection sites, fatigue, or mild fever, but these are generally temporary and manageable with over-the-counter pain relievers if needed. If you have specific health concerns or a history of severe reactions to vaccines, consult with your healthcare provider before receiving these vaccines together. Key considerations for administering these vaccines together include:

• Administering them at separate anatomical sites to minimize potential side effects
• Being aware of the potential for increased reactogenicity, although this is generally mild and temporary
• Considering the benefits of timely vaccination and the convenience of administering multiple vaccines at once, as supported by studies such as 1 and 1.

From the FDA Drug Label

Concomitant Administration with BOOSTRIX (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed) In an open-label clinical study (NCT02052596), subjects aged 50 years and older received 1 dose each of SHINGRIX and BOOSTRIX at Month 0 and 1 dose of SHINGRIX at Month 2 (n = 412; concomitant administration group), or 1 dose of BOOSTRIX at Month 0 and 1 dose of SHINGRIX at Months 2 and 4 (n = 418; sequential administration group).

Yes, Shingrix and Tdap (which is similar to Boostrix) can be given at the same time.

• The study showed no evidence for interference in the immune response to the antigen contained in SHINGRIX or the antigens contained in BOOSTRIX, with the exception of one of the pertussis antigens (pertactin).
• The clinical significance of the reduced immune response to pertactin is unknown 2.

From the Research

Co-administration of Shingrix and Tdap

• The co-administration of Shingrix (recombinant zoster vaccine) and Tdap (tetanus, diphtheria, and pertussis vaccine) has been evaluated in several studies 3, 4.
• A randomized trial found that co-administration of RZV and Tdap in adults aged ≥50 years did not interfere with the humoral immune response to RZV or 4 of the 5 Tdap antigens 4.
• The vaccine response rate to RZV was 97.8% in the co-administration group, and the non-inferiority criterion was met for the humoral response to RZV and for 4 Tdap antigens 4.
• Another study found that co-administration of RZV with other adult vaccines, including Tdap, does not significantly alter the reactogenicity, immunogenicity, or safety of RZV or the co-administered vaccine 3.
• The results suggest that Shingrix and Tdap can be given at the same time, and co-administration is a strategy to improve overall vaccine coverage 3, 4.

Safety and Immunogenicity

• The safety and immunogenicity of co-administering Shingrix and Tdap have been evaluated in several studies 3, 4.
• The studies found that co-administration of RZV and Tdap did not increase the risk of adverse events, and the reactogenicity profile was similar to that of sequential administration 3, 4.
• The immune responses to RZV and Tdap were non-inferior when the vaccines were co-administered compared to sequentially administered 3, 4.

Clinical Implications

• The findings of these studies have implications for clinical practice, suggesting that co-administration of Shingrix and Tdap is a safe and effective strategy to improve vaccine coverage 3, 4.
• Healthcare practitioners should consider routine co-administration of RZV with other adult vaccines, including Tdap, to improve vaccination coverage 3.