Can Gardasil (Human Papillomavirus vaccine), Shingrix (Recombinant Zoster vaccine), and Tdap (Tetanus, diphtheria, and pertussis vaccine) be administered simultaneously?

From the Guidelines

Yes, Gardasil (HPV vaccine), Shingrix (shingles vaccine), and Tdap (tetanus, diphtheria, and pertussis vaccine) can be administered at the same time, as they have different mechanisms of action and target different diseases, allowing them to be given simultaneously without reducing their effectiveness or significantly increasing side effects 1.

Key Considerations

• When receiving multiple vaccines at once, they should be administered at different injection sites - typically in separate limbs when possible.
• This approach is both safe and efficient, reducing the number of healthcare visits needed to complete recommended vaccinations.
• Some people may experience more pronounced side effects when receiving multiple vaccines simultaneously, such as soreness at injection sites, mild fever, or fatigue, but these are generally temporary and manageable with over-the-counter pain relievers if needed.
• The most recent guidance supports the concomitant administration of inactivated vaccines, including those like Shingrix and Tdap, with other vaccines protecting against different diseases 1.
• It is essential to discuss your specific health situation with your healthcare provider, who can recommend the most appropriate vaccination schedule for your needs, considering factors such as age, health status, and potential interactions with other vaccines or medications 1.

Administration Guidance

• There is no minimum interval required between receipt of a tetanus toxoid– or diphtheria toxoid– containing vaccine and Tdap when Tdap is otherwise indicated 1.
• A single dose of Tdap should be given to adults of any age who have not received Tdap previously, including those aged 65 years or older, who are health care personnel, or who have or anticipate having close contact with an infant younger than 12 months 1.
• In general, inactivated vaccines, including RZV (similar to Shingrix), may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against a different disease 1.

From the Research

Vaccine Co-Administration

• The question of whether Gardasil, Shingrix, and Tdap can be given at the same time is addressed in several studies 2, 3.
• A study on the immunogenicity and safety of human papillomavirus-16/18 AS04-adjuvanted vaccine coadministered with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine and/or meningococcal conjugate vaccine found that coadministration did not interfere with the immune response to any of the vaccines and had an acceptable safety profile 2.
• Another study evaluated the immunogenicity and safety of the adjuvanted recombinant zoster vaccine (RZV) and the reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine (Tdap) when co-administered in adults aged ≥50 years, and found that co-administration did not interfere with the humoral immune response to RZV or 4 of the 5 Tdap antigens 3.
• However, it is essential to note that these studies did not specifically examine the co-administration of Gardasil, Shingrix, and Tdap together 2, 3.

Vaccine Safety and Efficacy

• The safety and efficacy of vaccines are crucial considerations when administering multiple vaccines simultaneously 4, 5, 6.
• A review of vaccines for preventing infections in adults with haematological malignancies found that herpes zoster vaccines may reduce infection risk for up to 21 months, but the certainty of the evidence is low 4.
• Another study found that vaccination coverage among adults in the United States remains low for most routinely recommended vaccines, and increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults 5, 6.

Recommendations and Guidelines

• The Advisory Committee on Immunization Practices (ACIP) provides recommendations on vaccine administration, including co-administration of vaccines 5, 6.
• Healthcare providers should incorporate vaccination needs assessment, recommendation, and offer of vaccination into routine clinical practice for adult patients to improve vaccination rates and narrow racial/ethnic disparities in vaccination coverage 5, 6.