Mitchel Rothholz, RPh, MBA: Are there any physician concerns about vaccination and co-administration of influenza vaccine with COVID-19 and other vaccines? Do you have any guidance you can provide to pharmacists to address a patient’s concerns about co-administration?
Jeff Goad, PharmD, MPH: I don’t know if there’s still confusion out there, but when the first COVID-19 vaccines came out, the recommendation was not to give them with other vaccines. Sometimes I still hear a bit of it seeping around. Try to put COVID-19 and flu and the other vaccines back in the context of general recommendations. For adults, there are no contraindications for simultaneous administration.
Sometimes when I give patients 5 or 6 vaccines at once for travel, they say, “Why don’t I come tomorrow or the day after tomorrow and give it out?” I say, “Do you want your arm to hurt for a week or two days? Because either way, your arm is going to hurt for a few days.” Let them know that this is the most common side effect of the vaccine. Certainly there are other adverse events that you need to counsel them on, but this is what they focus on. Convince them to understand that your arms will hurt for a few days, but then you will be protected against both diseases.
Mitchel Rothholz, RPh, MBA: What are your recommendations for multiple vaccine administration for locations and notation?
Jeff Goad, PharmD, MPH: There’s still a soft recommendation to do them in different arms when giving COVID-19 vaccines, but technically general recommendations could override that and say you could do 2 intramuscular vaccines in the deltoids. Nothing stands in the way of that. It’s more of a gentle recommendation to place it in the 2 arms. There’s not much science behind it.
Mitchel Rothholz, RPh, MBA: If you’re doing it in the same arm, remember to do it an inch apart, right?
Jeff Goad, PharmD, MPH: Yes absolutely.
John Beckner, Rph: Jeff, how far are we from a combination of COVID-19 and the flu vaccine?
Jeff Goad, PharmD, MPH: If you could get COVID-19 to stop mutation, we could get one. If you look at some FDA and CDC hearings [Centers for Disease Control and Prevention] Speaking of which, as soon as they formulate BA.2.12.1, here comes BA.4 or BA.5. BA.4 is out and BA.5 is in. Then here comes the new sub-variant of BA.2. I don’t know if we can get to a combination vaccine in the near future. Maybe we could get to something like this once it stabilizes and doesn’t mutate as often, more like a flu vaccine, but I’m not optimistic in the short term.
Mitchel Rothholz, RPh, MBA: It is being worked on. But like Jeff said, it’s liquid.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: We will strongly recommend getting both vaccines at the same visit if receiving a COVID-19 vaccine and the flu vaccine. It is a conversation with the patient and finding out what they are comfortable with. You’re right: you’re going to have a sore arm whether we wait, and it might take longer because you’re just lengthening it. We tell patients that you will definitely have a sore arm. Especially when we look at COVID-19 [vaccines]some people have experienced significant arm pain over a long period of time.
Anecdotally, we patients said, “One of these vaccines may harm your arm more than the other vaccine. What is your preference for which arm?” Let her know. I still have patients who say, “I’d rather just have a sore arm that really hurts.” Have this conversation with the patient. But the main conversation revolves around getting both vaccines in the same visit.
Mitchel Rothholz, RPh, MBA: Another COVID-19 booster is available this fall. Some patients said, “I’ll wait until the vaccine is out, and I’ll get them both at that time.” How do you recommend pharmacists answer that question when that comes up?
Jeff Goad, PharmD, MPH: It was a valid question [because we didn’t know] when the next vaccine came out. It’s like a serial vaccination. If we were talking about hepatitis B, you would say, “You don’t need to restart the vaccine for an expired interval.” Let’s say you didn’t complete your third dose and you waited 5 years to get your third dose. We skip the third dose. But between dose #2 and #3 you were at risk of disease. You could have gotten hepatitis B because you didn’t have full protection. It’s the same argument. We protect from what we can protect now. If you have the booster dose, you’re still entitled to the second booster dose, or maybe your third booster dose, depending on your schedule so far, in the fall or early winter. People should get the available vaccines now.
John Beckner, Rph: Someone asked me the same question the other day and I told them so. I feel a lot better now.
Mitchel Rothholz, RPh, MBA: The standard answer is that you should get what’s available to you. Jeff, to reiterate what you said, you want protection now, not embarrassment.
Transcript edited for clarity.