Can an older adult with potential underlying health conditions receive the Covid (Coronavirus) vaccine and the shingles (Herpes Zoster) vaccine at the same time?

Can COVID-19 and Shingles Vaccines Be Given Simultaneously?

Yes, COVID-19 and shingles vaccines can be safely administered at the same time, given at separate anatomic sites. This applies to both the recombinant zoster vaccine (RZV/Shingrix) and live zoster vaccine (ZVL/Zostavax), though RZV is the preferred shingles vaccine for older adults.

Evidence-Based Rationale

For Recombinant Zoster Vaccine (RZV/Shingrix)

Inactivated vaccines, including RZV and COVID-19 vaccines, may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against a different disease. 1 This is classified as a "good practice statement" by current guidelines.

• Both COVID-19 vaccines and RZV are inactivated vaccines, which do not interfere with immune responses to each other 1
• A cohort study found no significant difference in herpes zoster risk among individuals who received RZV with versus without concomitant vaccination 1
• The CDC specifically lists COVID-19 vaccine and RZV as inactivated vaccines that can be given together 1

For Live Zoster Vaccine (ZVL/Zostavax)

If the patient is receiving the live attenuated zoster vaccine (less commonly used now), live vaccines given by the parenteral route, including ZVL, may be administered concomitantly with other injected live vaccines 1. Since COVID-19 vaccines are inactivated, not live, they can be given with ZVL without timing restrictions 1.

Practical Administration Guidelines

Administer both vaccines at the same visit in separate anatomic sites (different injection locations, preferably different limbs if possible) 2, 3:

• Use different arms when feasible to minimize confusion about local reactions 2
• Do not mix vaccines in the same syringe 4, 3
• Monitor for 15-30 minutes post-vaccination as standard practice 2

Important Clinical Considerations

Reactogenicity Management

Although immune responses are adequate when vaccines are given on the same day, adverse reactions were more frequently reported when vaccines were co-administered 1. This is particularly relevant for RZV, which is known to cause more systemic side effects than many other vaccines.

• Patients should be counseled that they may experience more pronounced local and systemic reactions when receiving both vaccines simultaneously 1
• This increased reactogenicity does not indicate reduced safety or efficacy 1

Special Populations

For older adults with underlying health conditions:

• Cancer patients can receive both vaccines even while on active treatment 1, 2
• COVID-19 vaccines are not considered investigational and do not interfere with cancer treatment protocols 2
• Immunocompromised patients should receive RZV (not the live ZVL vaccine) 1

Timing Alternatives

If the patient prefers to separate the vaccines:

• There is no required waiting period between COVID-19 and RZV vaccines since both are inactivated 1, 3
• However, delaying vaccination to separate doses is not recommended, as this creates missed opportunities for protection 4, 3

Common Pitfalls to Avoid

• Do not delay either vaccine to administer them separately – the benefits of timely protection outweigh concerns about simultaneous administration 4, 3
• Do not confuse RZV (recombinant, inactivated) with ZVL (live attenuated) – RZV is now the preferred vaccine for most adults ≥50 years 1
• Do not withhold vaccines due to minor illnesses – mild illness is not a contraindication 4
• Be aware that some research has identified a small increased risk of herpes zoster reactivation following COVID-19 vaccination 5, 6, which paradoxically supports concurrent administration of the shingles vaccine for additional protection

Bottom Line Algorithm

1. Confirm vaccine types: COVID-19 (inactivated) + RZV/Shingrix (inactivated, preferred) = safe to give together
2. Administer at same visit: Different anatomic sites (separate arms preferred) 2, 3
3. Counsel patient: Expect potentially increased local/systemic reactions, but this is safe 1
4. Monitor: Standard 15-30 minute observation period 2
5. Do not delay: Simultaneous administration is preferred over sequential dosing 4, 3