Breaking Down the Benefits and Risk of Co-Administration of COVID-19 and Flu Vaccines

Sebastian Hamilton, MBA, PharmD, RPh, chief pharmacy officer of operations and community & ambulatory partnerships and PGY-1/PGY-2 health system pharmacy administration and leadership + MBA residency program director president at Boston Medical Center and Massachusetts Board of Registration in Pharmacy spoke with Drug Topics® on administering a double vaccination for COVID-19 and influenza.

How can pharmacists reassure or encourage patients that getting both shots at once is safe?

Hamilton recommended having a quick conversation with patients to see how comfortable they are with vaccinations in general, and to discover why they are considering getting both vaccines, such as for a job requirement or being a responsible family member. “From here you will be better prepared with the appropriate response to underscore reassurance or encouragement that getting both vaccinations are safe and effective when taken together,” he said.

Specifically, he noted that pharmacists can explain to patients that:

• Although flu and COVID-19 are both respiratory illnesses, each is caused by a different virus. Immunity can be obtained from each illness quicker by receiving these vaccines at the same time.
• Both vaccines are proven to be safe and effective protection against each illness even when administered together. This is supported and recommended by the CDC.
• The vaccines have either been approved (influenza vaccines) or authorized for emergency use (COVID-19 vaccines) by the FDA.
• It’s convenient to get both together. He recommended phrasing it to patients as, “life happens and you may delay getting the other vaccination, so get it while you are here now.”

Have additional side effects from getting both shots been reported? What should pharmacists tell patients to watch for?

Hamilton said it’s important to explain to patients what side effects are to be expected from vaccination for transparency. “Tell patients that it’s normal to experience mild symptoms after receiving either vaccination alone, so both vaccinations at the same time will be no different,” he said. He added that pharmacists should be specific about side effects, which include symptoms like tiredness, body aches and pains, low-grade fever, headaches, and a sore arm at the injection site, which is almost a certainty in all cases,.

“Share that while these may cause a level of discomfort, they are self-limiting – and that patients should contact their doctor if they persist beyond 72 hours. Reassure patients that these symptoms are just an indication that their immune system is working as expected to create protection from the viruses if and when they are exposed to them,” he advised. He added that if a patient has a history of these symptoms when receiving vaccinations, it’s encouraged to be proactive by planning for a day or so of rest after getting the shots.

Is it better for the vaccines to be administered in the same arm or one in each arm? Why?

Hamilton explained that there is no difference in immune response or better protection afforded whether the vaccines are received in the same arm versus one in each arm. “The key difference here comes down to one’s personal preference and comfort level,” Hamilton told Drug Topics®. “However, the most frequently reported side effect experienced by patients when receiving vaccinations is soreness at the injection site. If patients are vaccinated with both vaccines in the same arm at the same time, this is likely to cause more discomfort in that arm versus if 1 vaccine is administered in each arm. Due to the likeliness of this, it is fine for the pharmacists to recommend one shot in each arm,” Hamilton said.

What are some reasons patients may resist getting both shots at once? How can pharmacists persuade patients to get both vaccines?

Hamilton said the biggest reason patients may resist getting both shots is because of anticipatory anxiety about side effects they may have previously had, or heard about from others. “Pharmacists can help ease anxiety by listening to the patient share concerns. Tell them that the sooner they get vaccinated with both vaccines, the quicker their body develops antibodies to protect them if and when they are exposed,” he advised. Hamilton said patients can be reassured by telling them that the discomfort from the shot will be less impactful than catching the actual virus without being vaccinated.

“Patients can be encouraged to decrease this window of opportunity by getting both vaccines now,” he said.

Patients who are still concerned and do not want to get both vaccines should have this decision treated as a valid choice by pharmacists, Hamilton said. “If the patient is considering passing on getting both at the same time, let them know that they can also space the vaccinations apart, as long as they follow through and get both vaccinations at the earliest convenience.”

Other than obvious reasons, such as a bad reaction to a previous vaccine, there are no reasons for patients not to be offered both the flu and COVID booster at the same time, Hamilton explained

He added that children can also get both vaccines at the same time. Pharmacists should be mindful of the side effects that may be experienced that are similar to adults, such as arm pain. “Pharmacists should make sure the child has a positive experience in general and also so they can brag to their friends that getting their vaccines was relatively uneventful,” Hamilton noted.

He stressed that pharmacists should be aware of the child’s age as a consideration for receiving the COVID-19 vaccine as it stands today. “For ages 6 and over, flu vaccination co-administered with the COVID-19 booster is recommended,” he said.

Reference

1. Centers for Disease Control and Prevention (CDC). Frequently asked influenza (flu) questions: 2022-2023 season. https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm. Updated October 17, 2022. Accessed October 25, 2022.