Evidence for COVID and flu shots on the same day
Statement date: March 2021
ATAGI: Considerations for shortening the interval between or same-day administration of a dose of influenza vaccine and COVID-19 vaccine
There are circumstances where shortening the intervals between or co-administering a dose of influenza vaccine and COVID-19 vaccine are justified, such as:
- if adherence to the recommended minimum interval will likely lead to an individual or a target population for both these vaccines missing the opportunity of receiving any of these vaccine doses
- if there is an imminent need of receiving either of these vaccines due to prevailing local epidemiological situations, with regards to either influenza or COVID-19
- if by the time COVID-19 vaccine doses become available to a certain population, the onset of influenza season is imminent – Ideally forward planning should ensure these groups receive the influenza vaccine dose with a minimum interval of 14 days ahead of the anticipated first dose of COVID-19 vaccine.
For all patient groups, COVID-19 vaccines should not routinely be given if any other vaccination has been received within the last 7 days, as set out in the Green Book Chapter 14a on COVID-19 vaccination. However, adjacent or co-administration can occur where this would cause delay or reduce access to either influenza or COVID-19 vaccine for certain patient groups e.g. care homes, housebound patients and hard to reach or vulnerable groups.
Green Book Chapter 14a – COVID-19 – SARS-CoV-2
Co-administration with other vaccines
Although no data for co-administration of COVID-19 vaccine with other vaccines exists, in the absence of such data first principles would suggest that interference between inactivated
Chapter 14a – 16
COVID-19 – SARS-Cov-2
Chapter 14a – COVID-19 – SARS-CoV-2 7 May 2021
vaccines with different antigenic content is likely to be limited (see Chapter 11). Based on experience with other vaccines any potential interference is most likely to result in a slightly attenuated immune response to one of the vaccines. There is no evidence of any safety concerns, although it may make the attribution of any adverse events more difficult.
Because of the absence of data on co-administration with COVID-19 vaccines, it should not be routine to offer appointments to give this vaccine at the same time as other vaccines. Based on current information about the first COVID-19 vaccines being deployed, scheduling should ideally be separated by an interval of at least 7 days to avoid incorrect attribution of potential adverse events.
As all of the early COVID-19 vaccines are considered inactivated (including the non-replicating adenovirus vaccine), where individuals in an eligible cohort present having received another inactivated or live vaccine, COVID-19 vaccination should still be considered. The same applies for other live and inactivated vaccines where COVID-19 vaccination has been received first or where a patient presents requiring two vaccines. In most cases, vaccination should proceed to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment. In such circumstances, patients should be informed about the likely timing of potential adverse events relating to each vaccine.