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Spacing and Simultaneous vaccine administration

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Spacing and Simultaneous vaccine administration


The general principles for spacing and simultaneous administration of vaccines are as follows:

  • attention should be paid to the recommended minimum interval etween subsequent vaccine doses (Table 2); decreasing the recommended inimum interval may negatively interfere with antibody response and protection;
  • increasing the recommended interval between subsequent vaccine doses does not diminish the effectiveness of the vaccine
  • there is no need to restart the series of any vaccine due to extended intervals: the series should be completed as soon as possible but not restarted (exception: oral typhoid vaccine should be given as
    recommended)
  • there are no contraindications to simultaneous administration of any vaccines, vaccines should be administered at different body sites; in the U.S., simultaneous administration of cholera and yellow fever vaccine is not recommended (due to decreased antibody response), the vaccines should be separated by at least 3 weeks
  • if various vaccines are not given simultaneously, the recommendations regarding spacing are as follows:
    a.   interval between two different live vaccines should be 4 weeks;

  1. no interval is recommended between different inactivated/toxoid/subunit vaccines or between live and inactivated/toxoid/subunit vaccines


The general principles for intervals between the receipt of antibody-containing blood products and vaccines are as follows:

  • inactivated/toxoid vaccines generally are not affected by circulating antibody to the antigen included in the vaccine
  • live vaccines may be affected by circulating antibody to the vaccine virus, therefore: when a vaccine has been administered first, wait 2 weeks before administer an antibody-containing blood product; when an antibody-containing blood product has been administered first, wait at least 3 months before administering a live vaccine.

    DTP/DT/DTaP
    4 weeks
    4 weeks
    6 months

    Haemophilus influenzae (Hib)
    4 weeks
    4 weeks

    Hepatitis A
    6 months

    Hepatitis B
    4 weeks
    8 weeks


    Measles-mumps-rubella (MMR)
    4 weeks
     
    Pneumococcal Vaccine, conjugated
    4 weeks
    4 weeks

    Pneumococcal Polysaccharide Vaccine
    5 years
    Poliomyelitis (IPV)
    4 weeks
    4 weeks

    Poliomyelitis (OPV)
    4 weeks
    4 weeks

    Varicella
    4 weeks

Minimum interval between subsequent vaccine doses, by vaccine type** for combination vaccines not included in the table, the minimum interval between doses is equal to the greatest interval of any of the individual antigens (Adapted from Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).