Can the measles‑mumps‑rubella (MMR), hepatitis B, and hepatitis A vaccines be given simultaneously on the same visit?

MMR, Hepatitis B, and Hepatitis A Vaccines Can Be Administered Simultaneously

Yes, MMR, hepatitis B, and hepatitis A vaccines should be given together on the same visit at separate anatomic sites. 1

Core Guideline Recommendations

• All three vaccines can be administered simultaneously without compromising immune responses or increasing adverse events, according to ACIP guidelines. 2

• Simultaneous administration of MMR, hepatitis B vaccine, and other routine vaccines produces antibody responses equivalent to separate administration, with no clinically significant increases in adverse events. 2

• Inactivated vaccines (hepatitis A and hepatitis B) can be given at any time before, with, or after live vaccines (MMR) without interference. 1

Evidence Supporting Simultaneous Administration

• Clinical trials in children aged 12-15 months demonstrated that concomitant administration of MMR, varicella, and hepatitis vaccines showed comparable seroconversion rates (>93-100% for all antigens) with no significant safety concerns. 1

• A randomized multicenter study of 1,241 children found that coadministration of hepatitis A vaccine with MMR and varicella vaccines resulted in nearly all subjects (≥99%) achieving seroprotection after 2 doses, with no adverse impact on immunogenicity of any vaccine. 3

• Combined hepatitis A and B vaccination demonstrates immunogenicity at least similar to monovalent vaccines, with possibly improved tolerability profiles. 4

Administration Technique

• Administer each vaccine at separate anatomic sites using different syringes. 1

• Never mix vaccines in the same syringe unless specifically FDA-licensed for mixing. 1

• Use different limbs when possible to facilitate identification of any local reactions. 5

Clinical Advantages of Simultaneous Administration

• Simultaneous administration is particularly important when you anticipate the patient may not return for follow-up visits, which is common in adult vaccination. 1

• Approximately one-third of missed vaccination opportunities occur when vaccines are not given together during the same visit. 1

• Reduces the number of healthcare visits required and increases overall vaccination completion rates. 1

Safety Profile

• The most frequently reported adverse events are injection-site pain and redness, general fatigue, and headache—most are mild and transient. 4

• Simultaneous administration does not increase the frequency of adverse reactions compared to separate administration. 2

Documentation Requirements

• Document all three vaccines with dates and anatomic sites used in the patient's permanent medical record. 1

• Only doses with written documentation of the date of administration should be considered valid. 2