Can COVID-19 vaccine be co-administered with other childhood or adolescent immunizations?
Given the importance of routine vaccination, significant decreases in adolescent immunization rates during the pandemic, and the need for rapid uptake of COVID-19 vaccines, the AAP supports co-administration of routine childhood and adolescent immunizations with COVID-19 vaccines (or vaccination in the days before or after) for children and adolescents who are behind on or due for immunizations (based on the CDC/AAP Recommended Child and Adolescent Immunization Schedule) and/or at increased risk from vaccine-preventable diseases.
When co-administering with other vaccines, it is recommended that a different injection site (at least 1 inch apart) be used. If co-administered with a more reactogenic vaccine (eg. Adjuvanted or high dose influenza vaccine and COVID-19 vaccine), consider using a different limb.
Is co-administration acceptable for all populations of children and adolescents, including those who are immunocompromised?
Since the mRNA COVID-19 vaccines are not live vaccines, it is expected that the safety and efficacy will be similar to other vaccines that are co-administered. Immunocompromising conditions are not contraindications to receipt of the mRNA COVID-19 vaccines. In general, simultaneously administered vaccines are recommended to ensure optimal age-specific protection and fewer medical visits. As with all vaccines, patients should be informed about the likely timing of potential side effects and adverse events related to each vaccine.
Are there any differences or concerns with co-administration of COVID-19 vaccine with live attenuated vaccines?
No. The mRNA COVID-19 vaccines are not live vaccines and no additional safety or efficacy issues are expected with co-administration with live attenuated vaccines. Co-administration is particularly important for children and adolescents who are behind on routinely recommended vaccines because it promotes timely receipt of vaccination and reduces the number of medical visits for the patient.
Can I administer a COVID-19 vaccine to a patient who is currently or was recently sick with COVID-19?
COVID-19 vaccination should be deferred for patients with a current SARS-CoV-2 infection until they recover from their acute illness and the criteria to discontinue isolation has been met. Patients who are asymptomatic should receive COVID-19 vaccine following their recommended isolation period. This also applies to people who become infected with COVID-19 between their first and second dose of vaccine, or those who are due for a booster.
Individuals who recently had SARS-CoV-2 infection and have concluded their isolation period may consider delaying a primary series dose or their first or second COVID-19 vaccine booster dose by 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination may result in an improved immune response to vaccination.
How do I manage adverse events related to administration of COVID-19 vaccine?
Anaphylaxis has been observed following receipt of COVID-19 vaccines, but this has been rare. Consider observing people with the following medical histories for 30 minutes after COVID-19 vaccination to monitor for allergic reactions:
Patients should be seated or lying down during vaccinations, as syncope (fainting) may occur, as with any vaccine – especially in adolescents. Consider observing vaccine recipients – particularly adolescents – for 15 minutes after vaccination. If syncope develops, patients should be observed until symptoms resolve.
Pediatricians and their teams should be familiar with the signs and symptoms of immediate-type allergic reactions, including anaphylaxis, and have the resources and skills to address these events at the time of vaccine administration.
Healthcare providers who administer COVID-19 vaccines are required by law to report to VAERS:
- Any adverse event (AE) listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination
- Any AE listed by the vaccine manufacturer as a contraindication to further doses of the vaccine
- Vaccine administration errors, whether or not associated with an AE
- Cases of Multisystem Inflammatory Syndrome
- Cases of COVID-19 that result in hospitalization or death
Healthcare providers who administer COVID-19 vaccines are encouraged to report:
- Any additional clinically significant AEs following vaccination, even if they are not sure whether the vaccine caused the event
- Additional selected AEs and/or any revised safety reporting requirements per FDA’s conditions of authorized use of vaccine(s) throughout the duration of any COVID-19 vaccine’s Emergency Use Authorization (EUA) or any approved COVID-19 vaccine as outlined in the Fact Sheet for Healthcare Providers
Information on how to report adverse events following vaccination can be found here. A video overview of the Vaccine Adverse Event Reporting System (VAERS) and how to use it can be viewed here.
Also consider explaining the rare risk of myocarditis and pericarditis following receipt of Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines, especially to males ages 12–39 years. Counseling should include the need to seek care if symptoms of myocarditis or pericarditis develop after vaccination, particularly in the week after vaccination. See CDC COVID-19 vaccination and myocarditis and pericarditis.