The vaccines and other medication
See Using COVID-19 vaccines in patients with anticoagulation and bleeding disorders for use in individuals receiving anticoagulant therapy.
See Using COVID-19 vaccines in patients taking immunosuppressive medicines for use of COVID-19 vaccines in people receiving immunosuppressant therapy.
The COVID-19 vaccine and other vaccines
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. The advice is that individuals should be given the COVID-19 vaccine even if they have recently received another inactivated or live vaccine (except shingles vaccine) to avoid further delay in protection. However, concurrent administration of more than one vaccine makes it difficult to attribute adverse effects to any particular product. Separating the vaccines by 1 or 2 days will avoid confusion over adverse effects.
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.
COVID-19 vaccine and influenza vaccine
Administering an influenza vaccine at the same time as a dose of a COVID-19 vaccine produced no safety concerns and preserves the immune response to both vaccines, according to results of the ComFluCOV study (BMJ 2021;375:n2411). The Green book advises where co-administration does occur, patients should be informed about the likely timing of potential adverse events relating to each vaccine. If the vaccines are not given together, they can be administered at any interval, although separating the vaccines by a day or two will avoid confusion over systemic side effects.
COVID-19 vaccine and shingles vaccine
Although, generally, the COVID-19 vaccine can be co-administered or closely administered with another inactivated or live vaccine an exception to this is the live attenuated shingles vaccine, where a 7 day interval should ideally be observed given the potential for an inflammatory response to COVID-19 vaccine to reduce the response to the live virus.
The vaccine and COVID-19 treatments
COVID-19 Vaccination Programme Information for Healthcare Professionals suggests that, as the COVID-19 vaccines are inactivated vaccines, COVID-19 treatments such as dexamethasone, convalescent plasma or monoclonal antibody treatment are not anticipated to contraindicate vaccine administration. Although theoretically, high levels of antibodies in the convalescent plasma could interfere with the immune response to the vaccine, passively acquired antibodies from the plasma treatment are not thought to persist for long, so by the time a person who has received this is well enough to receive a COVID-19 vaccination, these antibodies are likely to have gone.
The Green book chapter 14a suggests that based on limited evidence no specific interval is required between receipt of monoclonal antibodies to COVID-19 (e.g. Ronapreve) and COVID-19 vaccination, or vice versa. However, consideration should be given to advice on Vaccinating individuals with COVID-19 or with a history of COVID-19.
In addition, as COVID-19 vaccines do not contain a live virus, response to vaccination will not be affected by anti-viral medication.
The vaccine “in-syringe” with other products
The manufacturer’s information for all COVID-19 vaccines state they should not be mixed in the same syringe as other products.
- Reviewed and added advice about co-administration of different vaccines
- Details of interaction with monoclonal antibodies to COVID-19 added.
- Details of results of study assessing co-administration of influenza and COVID vaccines added.
- Changes to reflect new advice regarding recommended interval between vaccines