Flu, Pneumococcal Vaccines Can Be Safely Co-Administered

The inactivated quadrivalent influenza vaccine (IIV4) and the 23-valent pneumococcal polysaccharide vaccine (PPV23) can be safely co-administered among individuals with a high risk for complications of influenza and pneumococcal infection, according to a recent study.

For their study, the researchers evaluated 334 adult participants age 50 years or older living in France and Belgium during the 2014-2015 influenza season. Patients were randomly assigned to receive either co-administration or separate administration of each vaccine.

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Hemagglutination inhibition (HI) titers for IIV4 and 22F-inhibition enzyme-linked immunosorbent assay (ELISA) for PPV23 were used to assess immunogenicity. Co-primary objectives included demonstration of non-inferiority of co-administration compared with separate administration based on geometric mean titer (GMT) ratio for each influenza strain in the IIV4 and geometric mean concentration (GMC) ratio for the pneumococcal serotypes 1, 3, 4, 7F, 14, and 19A.

Results indicated that the study had met its co-primary objectives. The researchers noted that the upper limit of the 95% confidence interval of the GMT and GMC ratios (separate administration over co-administration) had been 2.0 or less for all 4 IIV4 antigens and the 6 studied PPV23 serotypes, respectively. Additionally, the immunogenicity of the IIV4 and PPV23 were similar regardless of co-administration or separate administration.

A post-hoc analysis of participants age 60 years or older demonstrated that the immunogenicity of IIV4 was similar among high-risk adults with comorbidities, including diabetes, morbid obesity, or respiratory, heart, kidney, liver, or neurological diseases, compared with those without comorbidities.

The researchers noted that both vaccines had acceptable safety and reactogenicity profiles. The most commonly reported symptom was pain, which occurred more often with co-administration vs separate administration.

“The IIV4 and PPV23 can be co-administered without reducing antibody responses reflecting protection against influenza or pneumococcal disease,” the researchers concluded. “Co-administration of PPV23 at the annual influenza vaccination visit may improve uptake. Comorbidities had no impact on IIV4 immunogenicity, supporting its value in older adults with chronic medical conditions.”

—Christina Vogt


Ofori-Anyinam O, Leroux-Roels G, Drame M, et al. Immunogenicity and safety of an inactivated quadrivalent influenza vaccine co-administered with a 23-valent pneumococcal polysaccharide vaccine versus separate administration, in adults ≥50 years of age: Results from a phase III, randomized, non-inferiority trial. Vaccine. 2017;35(46):6321-6328.