Can tetanus, diphtheria, and acellular pertussis vaccine (Tdap), yellow‑fever vaccine, and inactivated polio vaccine (IPV) be administered concurrently at the same visit?

Concurrent Administration of Tdap, Yellow Fever, and IPV Vaccines

Yes, Tdap, yellow fever vaccine, and inactivated polio vaccine (IPV) can and should be administered simultaneously during the same visit when all three vaccines are indicated. 1

Core Principle of Simultaneous Vaccination

• If two or more vaccines are indicated, they should be administered during the same visit (simultaneous vaccination), as this increases the likelihood that patients will receive all recommended vaccinations. 1
• Inactivated vaccines (Tdap and IPV) may be administered simultaneously or at any interval before or after live vaccines (yellow fever) without contraindication. 1
• Each vaccine must be administered using a separate syringe at a different anatomic site. 1

Proper Administration Technique

• Tdap: 0.5 mL administered intramuscularly, preferably into the deltoid muscle 1
• IPV: 0.5 mL administered intramuscularly or subcutaneously (IM preferred) 2, 3
• Yellow fever: 0.5 mL administered subcutaneously
• Some experts recommend administering no more than two injections per muscle, separated by at least 1 inch. 1

Evidence Supporting Simultaneous Administration

• Clinical trials demonstrate that combined Tdap-IPV vaccines produce comparable immunogenicity and safety profiles to separately administered vaccines, confirming no interference between these antigens. 4, 2, 3
• Studies involving 806 adolescents and adults showed that dTpa-IPV combination was as immunogenic and well tolerated as licensed separate vaccines. 2
• Research with 1,207 participants demonstrated that TdaP-IPV is safe and immunogenic when given simultaneously. 3
• The 4-week spacing rule only applies when two live parenteral vaccines are given separately (not simultaneously); since Tdap and IPV are inactivated, no spacing considerations apply with yellow fever vaccine. 1, 5

Critical Safety Considerations

• Syncope can occur after vaccination and may be more common among adolescents and young adults; consider a 15-20 minute observation period following vaccination. 1
• Verify no history of anaphylaxis to any vaccine component before administration. 1
• Check for latex allergies, as some vaccine syringes may contain latex in the tip or plunger. 6

Common Pitfalls to Avoid

• Do not unnecessarily space these vaccines apart—spacing does not improve safety and delays protection against vaccine-preventable diseases. 1, 5
• Do not confuse the live-to-live vaccine spacing rule with inactivated-to-live administration; Tdap and IPV require no spacing from yellow fever vaccine. 1, 5
• Ensure proper documentation of all vaccine details (type, manufacturer, anatomic site, route, date of administration) to avoid unnecessary revaccination. 1
• Attention to proper vaccination technique, including appropriate needle length and standard routes of administration (IM for Tdap), minimizes the risk for adverse events. 1

Documentation Requirements

• Record the type of vaccine, manufacturer, anatomic site, route, and date of administration in the patient's permanent medical record. 1
• Provide the patient with a personal vaccination record to minimize administration of unnecessary vaccinations in the future. 1