Can Flu and Pneumococcal Vaccines Be Given Together?
Yes, influenza and pneumococcal vaccines can and should be administered together at the same visit—they are safe to give simultaneously and do not interfere with each other's effectiveness. 1
Evidence Supporting Concurrent Administration
The CDC explicitly states that pneumococcal vaccine may be administered at the same time as influenza vaccine (by separate injection in the other arm) without an increase in side effects or decreased antibody response to either vaccine. 1
Safety Profile When Given Together
- Studies in elderly populations demonstrate that simultaneous administration causes only mild, self-limited reactions 2
- Local reactions increase modestly when both vaccines are given together (441 per 1,000 vaccinations) compared to influenza vaccine alone (284 per 1,000), representing an additional 157 reactions per 1,000—but these are predominantly mild 2
- Fever rates remain very low: 24 per 1,000 with both vaccines vs. 10 per 1,000 with influenza alone 2
- No serious adverse reactions have been observed with concurrent administration 2, 3
Immunologic Efficacy When Co-Administered
- Influenza vaccine antibody responses are not diminished when given with pneumococcal vaccine—seroconversion rates and geometric mean titers remain equivalent 3
- Pneumococcal antibody responses show no statistically significant reduction when administered simultaneously with influenza vaccine 3
- A large clinical trial (Study 7) with nearly 1,800 participants aged ≥65 years demonstrated noninferiority for all 20 pneumococcal serotypes and all 4 influenza strains when PCV20 was given concomitantly with adjuvanted influenza vaccine (Fluad Quadrivalent) 4
Clinical Benefits of Concurrent Administration
Giving both vaccines together provides additive mortality benefit beyond either vaccine alone. 5
- Adjusted mortality rate in elderly patients receiving both vaccines was 17.9 per 1,000 person-years compared to 24.7 per 1,000 in unvaccinated individuals—a 27% reduction 5
- Among elderly with chronic diseases, mortality was 42.1 per 1,000 with both vaccines vs. 58.1 per 1,000 unvaccinated 5
- Influenza vaccine alone reduced mortality by only 16%, demonstrating the added value of pneumococcal vaccination 5
Practical Implementation
Administration Technique
- Give each vaccine as a separate injection in different anatomic sites (e.g., one in each deltoid) 1
- Use standard intramuscular technique for both vaccines 1
Important Caveat About Pneumococcal Vaccines
While influenza vaccine can be given with pneumococcal vaccines, different pneumococcal vaccines should NOT be co-administered with each other on the same day. 1, 6
- PCV13, PCV15, PCV20, PCV21, and PPSV23 must be spaced appropriately (typically ≥1 year for immunocompetent adults, ≥8 weeks for immunocompromised) 1, 6
- This restriction applies only to pneumococcal vaccines given together—not to pneumococcal vaccines given with influenza vaccine 1
Current Pneumococcal Vaccine Recommendations for Context
- Adults ≥50 years should receive a single dose of PCV20 or PCV21 (preferred) or PCV15 followed by PPSV23 7, 6
- All adults ≥65 years should receive PPSV23 if not previously given 1, 8
- The 2024 ACIP guidelines expanded age-based pneumococcal vaccination to include adults ≥50 years 7
Bottom Line for Clinical Practice
Administer influenza and pneumococcal vaccines together whenever a patient is due for both—this approach is safe, effective, improves vaccination coverage, and provides superior mortality reduction compared to either vaccine alone. 1, 2, 5 The only vaccines that cannot be given together are different types of pneumococcal vaccines. 1, 6