Administer the Vaccine(s)

Often, more than one vaccine is needed during the same doctor’s visit, requiring more than one shot. If multiple vaccines are administered at a single visit, administer each injection in a different injection site. For infants and younger children receiving more than two injections in a single limb, the thigh is the preferred site because of the greater muscle mass. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. Best practices for multiple injections include:

• Prepare each injectable vaccine using a separate syringe.
• Label each syringe with the name and the dosage (amount) of the vaccine, lot number, the initials of the preparer, and the exact beyond-use time, if applicable.
• Use combination vaccines (e.g., DTaP-IPV-HepB or DTaP-IPV/Hib) to reduce the number of injections, when appropriate.
  • Do NOT mix more than one vaccine in the same syringe in an effort to create a “combination vaccine.”
• Separate injection sites by 1 inch or more, if possible.
• Administer vaccines that are known to be painful when injected (e.g., MMR, HPV) last. Because pain can increase with each injection, the order in which vaccines are injected matters. Injecting the most painful vaccine last when multiple injections are needed can decrease the pain associated with the injections.
• Administer vaccines that may be more likely to cause a local reaction (e.g., tetanus-toxoid-containing and PCV13) in different limbs, if possible.

Additional information on coadministration of vaccines can be found at: Pinkbook: Vaccine Administration | CDC

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COVID-19 vaccine and coadministration with other vaccines

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CDC and the Advisory Committee on Immunization Practices (ACIP) guidance states COVID-19 vaccines can be given during the same visit with other vaccines, including flu vaccine, if the recipient is eligible for the vaccines.

Considerations for Coadministration of COVID-19 Vaccines and Other Vaccines

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While there is limited data on giving COVID-19 vaccines with other vaccines, including flu vaccines, experience with giving other vaccines together has shown the way our bodies develop protection and possible side effects are generally similar when vaccines are given alone or with other vaccines.

Consider:

• Whether the patient is behind or at risk of becoming behind on recommended vaccines.
• Their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures).
• The reactogenicity profile of the vaccines (It is unknown whether reactogenicity of COVID-19 vaccine is increased with coadministration, including with other vaccines known to be more reactogenic, such as adjuvanted vaccines or live vaccines).

COVID-19 vaccine has been associated with enhanced local/injection site reactions l (e.g., pain, swelling, redness). If possible, administer COVID-19 vaccine and other reactogenic vaccines (e.g., MenB, Tdap) in different limbs. Clinical information and materials on COVID-19 vaccine products can be found here.

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