COVID-19, pneumococcal and influenza vaccines given together kept most antibody responses intact

Design

Randomised, open-label, multicentre phase 4 non-inferiority trial

Population

1,404 adults in China, half aged 60 or over

Primary outcome

Antibody titres and seroconversion after co-administration vs separate administration

Effect

Non-inferiority met for SARS-CoV-2 and pneumococcal geometric mean titres; less consistent for influenza A(H1N1) seroconversion

Adults were randomised to receive an inactivated COVID-19 vaccine with PPV23 on day 0 and with quadrivalent influenza vaccine on day 28, or to receive the vaccines separately. Equal numbers of younger and older adults took part.

Antibody responses were largely preserved with co-administration. Pneumococcal responses met non-inferiority for every serotype. Influenza A(H1N1) and the second COVID-19 dose were less consistent, and the age-stratified results should be read cautiously.

The trial supports what many immunisation programmes already allow: giving respiratory vaccines at the same visit. The specific COVID-19 vaccine used is not the one most Indian adults receive, but the principle applies to inactivated vaccines generally.

• Antibody levels for pneumococcal serotypes and SARS-CoV-2 met non-inferiority when vaccines were given together.
• Seroconversion was less consistent for influenza A(H1N1) and the second COVID-19 dose.
• Mild local reactions were slightly more frequent; no vaccine-related serious events occurred.
• Half the participants were 60 or older, the group most in need of pneumococcal and influenza vaccines.
• Use separate limbs or sites when giving several injections at one visit.

Why it matters

Every extra visit loses patients, and older adults who most need pneumococcal and influenza vaccines are the least likely to come back.

Don't overread it

The COVID-19 vaccine was an inactivated Chinese product, and responses to influenza A(H1N1) were less consistent.

The statistics, in plain English

Non-inferiority means co-administration was not meaningfully worse than separate administration within a pre-set margin. It does not mean identical; a few endpoints did not meet the margin.

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