Yes, Prevnar 13 and flu vaccine can be given at the same time
Prevnar 13 (PCV13) can be safely administered concomitantly with seasonal influenza vaccine using separate syringes at different injection sites. This is explicitly supported by both ACIP guidelines and FDA drug labeling, with clinical trial data confirming safety and adequate immune responses.
Guideline Recommendations
The 2010 ACIP guidelines for PCV13 clearly state that "PCV13 can be administered at the same time as other routine childhood vaccinations if administered in a separate syringe at a separate injection site" 1. This recommendation extends to influenza vaccines based on the general principle that inactivated vaccines do not interfere with immune responses to other inactivated vaccines 1.
For influenza vaccines specifically, the 2022 ACIP influenza guidelines confirm that "IIV4s and RIV4 may be administered simultaneously or sequentially with other inactivated vaccines" with the requirement that injectable vaccines given concomitantly be administered at separate anatomic sites 2.
The FDA-approved Prevnar 13 drug label explicitly documents that "In adults, Prevnar 13 was administered concomitantly with US-licensed inactivated influenza vaccines, trivalent and quadrivalent" in clinical studies 3. The label further states that "the safety profile of Prevnar 13 when administered concomitantly with seasonal inactivated influenza vaccine, quadrivalent, to PPSV23 previously vaccinated adults ≥50 years of age was generally consistent with the known safety profile of Prevnar 13" 3.
Clinical Evidence
Adults
A randomized clinical trial of 882 adults ≥50 years old who had previously received PPSV23 demonstrated that immune responses to all 13 pneumococcal serotypes and all 4 influenza strains were noninferior when PCV13 and quadrivalent influenza vaccine were given together compared to sequential administration 4. While pneumococcal antibody responses were generally slightly lower with coadministration, functional antibody responses (measured by opsonophagocytic activity) showed greater similarity between groups 5.
Another study in elderly adults (≥65 years) comparing concomitant PCV13+IIV3 versus PPV23+IIV3 found comparable immunogenicity and safety profiles, with both groups meeting regulatory criteria for influenza vaccine responses 6.
Children
The 2016-2017 AAP/Pediatrics guidelines acknowledge that during 2010-2012, there were increased reports of febrile seizures in young children (6-23 months) who received IIV3 and PCV13 concomitantly 7. However, the maximum additional risk was only 30 febrile seizure cases per 100,000 children vaccinated compared to separate-day administration 7.
Importantly, FDA's Post-Licensure Rapid Immunization Safety Monitoring program found no significant increase in febrile seizures with concomitant administration during the 2010-2011 season 7. The AAP concluded that "the benefits of timely vaccination with same-day administration of IIV and PCV outweigh the risk of febrile seizures, which rarely have any long-term sequelae" 7.
Practical Administration
- Use separate syringes for each vaccine 1, 2
- Administer at different anatomic sites (e.g., different arms if possible) 2
- Never mix vaccines in the same syringe 3
- For vaccines that might cause more injection site reactions (like adjuvanted influenza vaccines), consider administering in different limbs 2
Important Caveats
Do not confuse PCV13 (Prevnar 13) with PPSV23 (Pneumovax 23). The safety and efficacy of concurrent administration of PCV13 and PPSV23 has not been studied, and concurrent administration of these two pneumococcal vaccines is not recommended 1.
The slight reduction in pneumococcal antibody concentrations with coadministration is generally offset by adequate functional antibody responses, and the clinical significance remains uncertain 2, 5. The convenience of simultaneous administration and improved vaccination coverage typically outweigh these minor immunologic differences.
For live attenuated influenza vaccine (LAIV), the same principles apply—it can be given simultaneously with PCV13, though if not given simultaneously, at least 4 weeks should pass before administering another live vaccine 8, 2.