Is it safe to administer meningococcal (MenACWY), Human Papillomavirus (HPV) and Tetanus, diphtheria, and pertussis (Tdap) vaccines together?

From the Guidelines

Yes, it is safe to administer meningococcal (MenACWY), Human Papillomavirus (HPV), and Tetanus, diphtheria, and pertussis (Tdap) vaccines together in the same visit. These vaccines can be given simultaneously at different injection sites without reducing their effectiveness or increasing adverse effects, as demonstrated by a study published in Pediatrics in 2017 1. This practice is common and recommended, especially for adolescents who typically receive these vaccines between ages 11-12 years, with HPV requiring multiple doses. Administering these vaccines together increases the likelihood of completing recommended immunization schedules and provides timely protection against these preventable diseases. Some key points to consider include:

• The immune system is capable of responding to multiple vaccines at once, generating separate immune responses to each vaccine component.
• Concurrent administration of meningococcal vaccine (MenACWY-CRM) with Tdap and quadrivalent HPV vaccine (4vHPV) yielded similar immune responses when compared with the response of each individual vaccine given independently, as shown in the 2017 study 1.
• There was no increase in adverse effects when all 3 vaccines were administered together, according to the same study 1.
• Each vaccine should be administered using a separate syringe at a different anatomic site, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. Some patients may experience mild side effects such as soreness at injection sites, low-grade fever, or fatigue, but these are generally short-lived and can be managed with over-the-counter pain relievers if needed. Overall, the benefits of administering these vaccines together, including increased protection against preventable diseases and improved completion of recommended immunization schedules, outweigh the potential risks.

From the FDA Drug Label

Among the 8 reported cases of Bell’s palsy, 6 cases occurred in persons who received MENVEO concomitantly with one or more of the following vaccines: Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Adsorbed (Tdap), a human papillomavirus vaccine, and Influenza Vaccine.

The administration of meningococcal (MenACWY), Human Papillomavirus (HPV), and Tetanus, diphtheria, and pertussis (Tdap) vaccines together may be associated with an increased risk of Bell's palsy. However, all reported cases of Bell's palsy resolved. Key points:

• The safety of co-administering these vaccines has been evaluated in a postmarketing observational safety study.
• The study found a statistically significant increased risk of Bell's palsy in the period 1 to 84 days post-vaccination compared with the control period.
• The overall adjusted relative incidence of Bell's palsy was 2.9 (95% CI: 1.1-7.5) 2.

From the Research

Safety of Co-Administering Meningococcal, HPV, and Tdap Vaccines

• The safety and efficacy of co-administering meningococcal, HPV, and Tdap vaccines have been evaluated in several studies 3, 4, 5, 6.
• A study published in 2019 found that concomitant administration of quadrivalent HPV, Tdap, and quadrivalent meningococcal conjugate vaccines did not impact the immunogenicity of Tdap and meningococcal vaccines, or safety 4.
• Another study published in 2011 demonstrated that co-administration of HPV-16/18 AS04-adjuvanted vaccine with Tdap and/or meningococcal conjugate vaccine did not interfere with the immune response to any of the vaccines and had an acceptable safety profile 5.
• A 2015 study compared the immunogenicity and safety of a 9-valent human papillomavirus vaccine administered either concomitantly or nonconcomitantly with meningococcal and Tdap vaccines, and found that concomitant administration was generally well tolerated and did not interfere with the antibody response to any of the vaccines 6.

Immunogenicity of Co-Administered Vaccines

• The immunogenicity of co-administered vaccines has been evaluated in several studies 4, 5, 6.
• A study published in 2019 found that non-inferiority of immune responses to HPV4 + Tdap + MenACWY vs. HPV4 + Tdap + Placebo was demonstrated, with seroconversion rates ranging between 98.0% and 99.7% for HPV types 6,11,16, and 18 4.
• Another study published in 2011 found that co-administration of HPV-16/18 AS04-adjuvanted vaccine with Tdap and/or meningococcal conjugate vaccine did not interfere with the immune response to any of the vaccines 5.
• A 2015 study found that geometric mean titers for all HPV types, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes, and geometric mean titers for pertussis antigens were all noninferior in the concomitant group compared with the nonconcomitant group 6.

Recommendations for Co-Administration

• The Advisory Committee on Immunization Practices recommends routine vaccination of adolescents aged 11-12 years with three vaccines, including tetanus, diphtheria, and acellular pertussis vaccine; quadrivalent meningococcal conjugate vaccine; and human papillomavirus vaccine 3.
• Providers should make strong recommendations for all routine vaccines and review adolescent vaccination records to verify if adolescents are up to date with all recommended vaccines 3.