Prepare for Patients Needing Multiple Vaccines

November 2023

Patients will ask about getting multiple vaccines at the same time...with COVID-19, flu, and RSV immunizations in full swing.

Listen for concerns...and pull in your pharmacist to share facts.

They can address conflicting data making headlines with newer vaccines (COVID-19, RSV)...but explain the latest CDC recommendation is that COVID-19, flu, and RSV vaccines CAN be given at the same time.

Be aware, there’s no max number of vaccines a patient can get at one visit. Consider patient risks and likelihood of a return visit...to avoid a missed opportunity.

Note that getting multiple vaccines at the same visit generally doesn’t impact efficacy...and children often get many vaccines.

If you’re an immunizer and giving more than one vaccine, use different arms...especially with vaccines that might cause local reactions (COVID-19, Tdap, etc).

When using the same arm, separate injection sites by at least 1 inch...to make it easier to identify local reactions.

Try to inject the most painful vaccine (HPV, MMR, etc) last in an arm by itself, if possible.

Keep in mind, different vaccines shouldn’t be combined in a single syringe. But give FDA-approved combo vaccines if possible. For instance, pick the combo hep A/B series (Twinrix) for adults who need both.

If patients opt to get vaccines at different visits, tell them to come back at any time for inactivated vaccines (COVID-19, RSV, etc).

But separate live vaccines (FluMist, MMR, varicella, etc) by at least 4 weeks if they’re not given during the same visit.

Keep a callback list or make reminder calls for follow-up vaccines.

Let patients know to expect arm soreness or pain for a couple days after any intramuscular vaccine...and that flu-like symptoms (aches, fever, etc) are possible. But these shouldn’t be confused with the illness the vaccine is trying to prevent.

Acetaminophen or NSAIDs should be saved for AFTER vaccination if needed...these work quickly to treat symptoms if they occur.

Access our Immunization Resource Hub for the latest updates, charts, and resources addressing vaccine administration, myths, and hesitancy.

Key References

  • CDC. Timing and Spacing of Immunobiologics. August 1, 2023. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html (Accessed October 3, 2023.)
  • CDC. Use of COVID-19 Vaccines in the United States. October 6, 2023. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html (Accessed October 18, 2023.)
  • Wolicki, J, Miller E. Vaccine Administration. In: Hall E, Wodi AP, Hamborsky J, et al, Eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Washington, DC. Public Health Foundation, 2021:69-96.
Pharmacy Technician's Letter. November 2023, No. 391102



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