Can the shingles vaccine and influenza vaccine be administered together?

Co-administration of Shingles and Influenza Vaccines

Yes, the shingles vaccine and influenza vaccine can be safely administered together at the same visit, as both vaccines are routinely recommended to be given simultaneously to increase immunization rates. 1

Evidence for Co-administration

Recombinant Zoster Vaccine (RZV, Shingrix)

• RZV (an inactivated vaccine) can be given concomitantly with seasonal influenza vaccine without compromising safety or efficacy 1
• Simultaneous administration of inactivated vaccines is recommended as an effective approach to increase immunization rates 1
• There is no evidence that inactivated vaccines interfere with immune responses to other inactivated vaccines 1, 2

Live Zoster Vaccine (ZVL, Zostavax)

• ZVL (a live vaccine) can also be given concomitantly with seasonal influenza vaccine 1
• If live vaccines are not administered simultaneously, a minimum interval of 4 weeks should be maintained between administrations 1

Administration Guidelines

• When administering multiple vaccines simultaneously, they should be given at separate anatomic sites 2
• Individual vaccines should not be mixed in the same syringe unless specifically licensed for mixing 2
• Delaying vaccination to administer vaccines separately is not recommended as this may lead to missed opportunities for vaccination 2

Potential Considerations

Adverse Events

• When vaccines are administered simultaneously, there may be increased reactogenicity (local and systemic reactions) 1
• A cohort study found that adverse reactions were more frequently reported when pneumococcal vaccine (PPSV23) was co-administered with RZV, suggesting potential for increased reactogenicity with multiple vaccines 1

Impact on Future Vaccination Behavior

• One study found that patients who received concurrent influenza and zoster vaccines were less likely to receive an influenza vaccine the following year (87.3% vs 91.3%) 3
• This reduced willingness may be due to misattribution of systemic side effects caused by the zoster vaccine to the influenza vaccine 1, 3

Practical Recommendations

• Consider patient education about expected side effects when administering both vaccines simultaneously to prevent misattribution of side effects 3
• For vaccines with increased reactogenicity (like RZV), consider administering them in different limbs from other vaccines 2
• Provider recommendation is strongly associated with increased vaccination rates for both influenza and shingles vaccines 4, 5
• Co-administration can help increase overall vaccination rates, particularly important for older adults who have lower uptake of shingles vaccination compared to influenza vaccination 6

Special Populations

• The same co-administration principles apply to patients with autoimmune conditions and those living with HIV, though timing may need to be adjusted relative to immunosuppressive medications 1

By following these guidelines, healthcare providers can safely and effectively administer both shingles and influenza vaccines during the same visit, improving vaccination rates and protection against these preventable diseases.