Shingles vaccine and COVID-19 vaccine

A 7-day interval should be observed, ideally, between shingles vaccination and COVID-19 vaccination.

According to Immunisation Against Infectious Disease (the Green Book) this is based on the potential for an inflammatory response to the COVID-19 vaccine to interfere with the response to the live virus in the older population and because of the potential difficulty of attributing systemic side effects to the newer adjuvanted shingles vaccine.

Influenza vaccine and COVID-19 vaccine

Guidance depends on the specific COVID-19 vaccine to be administered.

Novavax COVID-19 vaccine

Separate administration of Novavax COVID-19 vaccine and influenza vaccine by at least 7 days.

A study showed some attenuation of the antibody response to COVID-19. As the clinical significance of this interaction is unknown administration should be separated.

Comirnaty and Spikevax COVID-19 vaccines

Comirnaty and Spikevax vaccines can be administered at the same time as influenza vaccine.

Other vaccines and COVID-19 vaccines

Other than the exceptions above COVID-19 vaccine can be given without regard to timing of other live and inactivated vaccines, to avoid further delays in protection.

COVID-19 Vaccination Programme Information for Healthcare Professionals and Immunisation Against Infectious Disease (the Green Book) suggest interference between inactivated vaccines with different antigenic content is likely to be limited to a slightly attenuated immune response to one of the vaccines. There is no evidence of any safety concerns, although it may make attribution of any adverse events more difficult. Similar considerations also apply to co-administration of COVID-19 vaccines with live vaccines (other than shingles).

COVID-19 vaccines and other medication

See Using COVID-19 vaccines in patients with anticoagulation and bleeding disorders for use in individuals receiving anticoagulant therapy.

See for use of COVID-19 vaccines in people receiving immunosuppressant therapy.

Practical considerations

COVID-19 vaccination programme advises where more than one vaccine is given at the same time, they should preferably be given in different limbs. Where this is not possible, they should be given at least 2.5cm apart and the site at which each vaccine was given should be clearly documented in the patient’s records. Patients should be informed about the likely timing of potential adverse events relating to each vaccines.

If the vaccines are not given together, they can be administered at any intervals (see influenza and shingles exceptions above), although separating the vaccines by 1 or 2 days will avoid confusion over adverse effects.

The manufacturer’s information for all COVID-19 vaccines state they should not be mixed in the same syringe as other products.

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