Can a 61-year-old male patient with a history of brain cancer receive the Covid-19 vaccine, Arexvy (assuming a medication or vaccine), and influenza (flu) vaccine at the same time?

Yes, this patient can safely receive all three vaccines simultaneously

A 61-year-old male with a history of brain cancer can receive the COVID-19 vaccine, Arexvy (RSV vaccine), and influenza vaccine at the same time, administered at separate anatomic sites. 1, 2

Evidence-Based Rationale

Guideline Support for Simultaneous Administration

• Inactivated vaccines, including COVID-19, influenza, and RSV vaccines (Arexvy), can be administered simultaneously or sequentially without safety concerns, according to CDC/ACIP recommendations 1, 2

• All three vaccines should be given at separate anatomic sites (different injection locations, preferably different limbs if possible) 1, 2

• The 2024-25 ACIP influenza guidelines specifically address Arexvy, noting it contains the AS01E adjuvant, and confirms that while data on coadministration with other adjuvanted vaccines are limited, influenza vaccination should not be delayed if simultaneous administration is needed 1

Cancer Patient Considerations

• Patients with cancer, including brain cancer, should be prioritized for COVID-19 vaccination and can receive vaccines even while on active treatment 1

• A large international survey of 965 brain tumor patients found that 84.5% received COVID-19 vaccines with no serious adverse events reported 3

• COVID-19 vaccines under Emergency Use Authorization are not considered investigational products and do not interfere with cancer treatment protocols 1

Safety Data on Simultaneous Administration

• VAERS surveillance of 2,449 reports following co-administration of mRNA COVID-19 and influenza vaccines revealed no unusual or unexpected patterns of adverse events 4

• A randomized controlled trial demonstrated that simultaneous administration of mRNA COVID-19 and influenza vaccines was noninferior to sequential administration for reactogenicity (25.6% vs 31.3% with moderate symptoms) 5

• Interestingly, concurrent administration may actually enhance antibody responses, with one study showing higher and more durable SARS-CoV-2 antibody levels when COVID-19 and influenza vaccines were given together 6

Practical Administration Algorithm

1. Administer all three vaccines at the same visit in separate anatomic sites 1, 2

2. Use different limbs when possible, especially since both Arexvy and adjuvanted influenza vaccines may cause more injection site reactions 1

3. Counsel the patient that he may experience increased local reactions (pain, redness at injection sites) and systemic symptoms (fever, fatigue, myalgia) compared to receiving vaccines separately, but these are typically mild-to-moderate and resolve within 4 days 1, 5

4. Do not delay vaccination to separate the doses—the benefits of timely protection outweigh theoretical concerns about adjuvant interactions 1

Important Caveats

• If adjuvanted or high-dose influenza vaccine is used, inject it in a different limb from the COVID-19 vaccine to minimize local reactions 1

• Monitor for 15-30 minutes post-vaccination as standard practice, particularly given the patient's cancer history 1

• The only contraindication would be severe allergic reaction to a previous dose of any of these vaccines—cancer history itself is not a contraindication 1, 3

• Systemic cancer treatments do not contraindicate inactivated vaccines, though immune response may be somewhat reduced depending on the specific therapy 1, 7