Is it safe to administer flu and shingles (Herpes Zoster) vaccines together?

Co-administration of Influenza and Shingles Vaccines

Yes, it is safe to administer flu and shingles (Herpes Zoster) vaccines together at the same visit. 1, 2

Evidence Supporting Co-administration

The Advisory Committee on Immunization Practices (ACIP) provides clear guidance on this matter:

• Studies of live attenuated zoster vaccine and inactivated influenza vaccines (IIV3 or IIV4) among persons aged ≥50 years have shown similar antibody responses whether the vaccines were administered concomitantly or 4 weeks apart 1
• Specific clinical trials have demonstrated that Shingrix (recombinant zoster vaccine) can be safely co-administered with quadrivalent influenza vaccine without compromising the immune response to either vaccine 2, 3
• An open-label clinical study (NCT01954251) showed no evidence of interference in the immune response when Shingrix and quadrivalent influenza vaccine (FLUARIX QUADRIVALENT) were administered concomitantly 2

Administration Guidelines

When administering both vaccines at the same visit:

• Give the injections at different anatomical sites 1
• If using an adjuvanted influenza vaccine (such as Fluad Quadrivalent/aIIV4) and Shingrix (which contains the AS01B adjuvant), consider administering them in different limbs if possible 1
• Both inactivated influenza vaccines (IIV4) and recombinant influenza vaccines (RIV4) can be safely co-administered with Shingrix 1

Potential Side Effects

While co-administration is safe, patients should be informed about potential side effects:

• Slightly increased reactogenicity (injection site or systemic reactions) may occur with concurrent administration compared to giving the vaccines separately 1, 4
• Most reactions are mild to moderate in severity and short in duration 4
• No serious adverse events have been observed in studies of co-administration 3

Special Considerations

For patients receiving the adjuvanted recombinant zoster vaccine (Shingrix):

• Shingrix requires a two-dose series (typically given 2-6 months apart) 2
• If co-administering with influenza vaccine, the first dose of Shingrix can be given with the influenza vaccine, followed by the second Shingrix dose according to the recommended schedule 2
• The FDA label for Shingrix specifically mentions that co-administration with quadrivalent influenza vaccine showed no evidence of interference in immune response to either vaccine 2

Benefits of Co-administration

Co-administration offers several advantages:

• Increases vaccination coverage rates by reducing missed opportunities 4
• Improves efficiency of vaccine delivery 4
• Reduces the number of healthcare visits required 4

Algorithm for Decision-Making

1. Determine if both vaccines are indicated for the patient
2. Check for contraindications to either vaccine
3. If no contraindications exist, proceed with co-administration
4. Administer at different anatomical sites
5. If using adjuvanted vaccines, consider using different limbs
6. Inform patient about potential for increased mild-to-moderate local reactions
7. Schedule follow-up for second dose of Shingrix if applicable

The evidence strongly supports that co-administration of influenza and herpes zoster vaccines is both safe and effective, with no compromise to the immune response of either vaccine.