Simultaneous Administration of Pneumonia, Influenza, and COVID-19 Vaccines

Yes, pneumonia (pneumococcal), influenza (flu), and COVID-19 vaccines can be safely administered simultaneously at the same visit. 1, 2

Safety and Efficacy of Simultaneous Administration

Inactivated vaccines (which include pneumococcal vaccines, inactivated influenza vaccines, and COVID-19 vaccines) can be safely and effectively administered simultaneously at separate anatomic sites 1
The simultaneous administration of pneumococcal polysaccharide vaccine and influenza vaccine elicits satisfactory antibody responses without increasing the incidence or severity of adverse reactions 1, 3
COVID-19 vaccines can be administered concurrently with influenza vaccines, as recommended by the Centers for Disease Control and Prevention 1, 2
Studies have shown that concurrent administration of influenza and COVID-19 vaccines results in similar immunogenicity to when the vaccines are administered separately 4, 2

When administering multiple vaccines simultaneously, they should be given at separate anatomic sites 1
If administering vaccines that might be more likely to cause injection site reactions (such as adjuvanted or high-dose influenza vaccines) along with COVID-19 vaccines, they should be administered in different limbs if possible 1, 2
Individual vaccines should not be mixed in the same syringe unless they are licensed for mixing by the FDA 1
Simultaneous administration is particularly important in certain situations, including:
- When there is imminent exposure to several infectious diseases
- When preparing for foreign travel
- When there is uncertainty that the person will return for further doses of vaccine 1

For live vaccines (such as live attenuated influenza vaccine/LAIV), if not administered simultaneously with other live vaccines, at least 4 weeks should pass between administrations 1, 2
Inactivated vaccines (like pneumococcal vaccines) do not interfere with the immune response to other inactivated vaccines or to live vaccines in most cases 1
Studies specifically examining pneumococcal and influenza vaccine co-administration have shown it to be safe and effective, with only mild to moderate local reactions being more common with co-administration compared to separate administration 3, 5
Recent research on co-administration of pneumococcal conjugate vaccine (PCV20) and quadrivalent influenza vaccine showed noninferiority of immune responses compared to separate administration 6

When vaccines are administered simultaneously, there may be a slightly increased rate of local reactions compared to when they are administered separately 3, 5
The frequency of local reactions tends to decrease with advancing age 3
When COVID-19 and influenza vaccines are administered concurrently, reactogenicity may be increased but is generally similar to that of COVID-19 vaccination alone 2, 4
Most reactions are mild or moderate in severity, with injection site pain being the most common local reaction and fatigue being the most common systemic event 6

Do not delay vaccination to administer vaccines separately when they can be given simultaneously, as this may lead to missed opportunities for vaccination 1
Do not mix vaccines in the same syringe unless specifically approved for mixing 1
Do not administer live vaccines within 4 weeks of each other if not given simultaneously (this applies to live attenuated influenza vaccine but not to inactivated influenza, pneumococcal, or COVID-19 vaccines) 1, 2
When administering multiple vaccines with increased reactogenicity (e.g., adjuvanted influenza vaccine and COVID-19 vaccine), use different limbs to minimize local reactions 1, 2