Low Rates of Co-Administration of Respiratory Vaccines Across the United States: Experiences from a Large Vaccination Ecosystem.
- 1Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
- 2Data Analytics, VaxCare, LLC, Orlando, FL 32801, USA.
- 3Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202, USA.
Abstract
Introduction
Giving more than one vaccine at a single visit is safe and is recommended by the Advisory Committee on Immunization Practices, but how often it happens in routine practice is not well described. We measured co-administration of influenza, COVID-19, and respiratory syncytial virus (RSV) vaccines where vaccine supply and on-site availability were consistent.Objective
To better characterize rates of co-administration and potential missed opportunities.Methods
We conducted a retrospective, cross-sectional analysis of records from a vaccine management platform serving more than 5000 clinics in 43 US states. Patients were age-eligible for at least one of the three vaccines, had a visit between 1 July 2023 and 30 April 2024, and received at least one. Those receiving two or more vaccines at one visit were compared with those receiving one using chi-squared tests. Multivariable logistic regression identified independent predictors of co-administration.Results
Of the 1,233,349 patients who received a respiratory vaccine, 50,582 active patients (4.1%) received two or more at the same visit. Rates were highest at health departments (13.4%), among Vaccines for Children (5.9%) and Medicaid (5.5%) beneficiaries, at the highest-volume clinics (5.2%), and among patients aged 51 to 64 years (5.0%). Influenza with COVID-19 accounted for 91.3% of co-administrations, influenza with RSV for 5.4%, and RSV with COVID-19 for 2.5%; 0.7% received all three. Cohorts differed by age, gender, insurance, clinic specialty, and clinic volume (all p < 0.0001). After multivariable adjustment, health department specialty remained the strongest independent predictor of co-administration with smaller independent associations for age, gender, insurance type, and clinic volume.Conclusions
Co-administration remained uncommon even where all three vaccines were stocked and available at the visit, so supply does not explain this shortfall. The settings and payer groups at either end of the range show where standing orders and visit prompts could recover missed opportunities.
Related
- Cost-effectiveness of 20-valent versus 15-valent pneumococcal conjugate vaccines for infants in the Netherlands, taking into account indirect effects and adult vaccination
- Immunogenicity and safety of an interchangeable vaccination schedule of two inactivated Japanese encephalitis vaccines: a multicentric, phase IV, open-label, randomized controlled trial
- Vaccination Administration Training Across Pharmacy Degree Levels: A Global Survey of Pharmacy Educators
- Safety of pairwise co-administration of influenza, PCV20, and RZV vaccines in adults aged ≥50 years: a post-marketing surveillance study using VAERS data
- Combined Vaccination with Recombinant HVT-ND and Live Newcastle Disease Vaccines Accelerates Early Immunity, Limits Virus Shedding and Reduces Transmission.
BibTeX
@article{carrico2026rates,
title = {{Low Rates of Co-Administration of Respiratory Vaccines Across the United States: Experiences from a Large Vaccination Ecosystem.}},
author = {Ruth Carrico and Chris Kemp and Salwa Rashid},
journal = {Vaccines},
year = {2026},
month = sep,
doi = {10.3390/vaccines14100844},
url = {https://europepmc.org/article/MED/42931373},
note = {CC BY},
}
RIS
TY - JOUR
TI - Low Rates of Co-Administration of Respiratory Vaccines Across the United States: Experiences from a Large Vaccination Ecosystem.
AU - Ruth Carrico
AU - Chris Kemp
AU - Salwa Rashid
PY - 2026
DA - 2026/09/24
JO - Vaccines
DO - 10.3390/vaccines14100844
UR - https://europepmc.org/article/MED/42931373
AB - Introduction Giving more than one vaccine at a single visit is safe and is recommended by the Advisory Committee on Immunization Practices, but how often it happens in routine practice is not well described. We measured co-administration of influenza, COVID-19, and respiratory syncytial virus (RSV) vaccines where vaccine supply and on-site availability were consistent.Objective To better characterize rates of co-administration and potential missed opportunities.Methods We conducted a retrospective, cross-sectional analysis of records from a vaccine management platform serving more than 5000 clinics in 43 US states. Patients were age-eligible for at least one of the three vaccines, had a visit between 1 July 2023 and 30 April 2024, and received at least one. Those receiving two or more vaccines at one visit were compared with those receiving one using chi-squared tests. Multivariable logistic regression identified independent predictors of co-administration.Results Of the 1,233,349 patients who received a respiratory vaccine, 50,582 active patients (4.1%) received two or more at the same visit. Rates were highest at health departments (13.4%), among Vaccines for Children (5.9%) and Medicaid (5.5%) beneficiaries, at the highest-volume clinics (5.2%), and among patients aged 51 to 64 years (5.0%). Influenza with COVID-19 accounted for 91.3% of co-administrations, influenza with RSV for 5.4%, and RSV with COVID-19 for 2.5%; 0.7% received all three. Cohorts differed by age, gender, insurance, clinic specialty, and clinic volume (all p < 0.0001). After multivariable adjustment, health department specialty remained the strongest independent predictor of co-administration with smaller independent associations for age, gender, insurance type, and clinic volume.Conclusions Co-administration remained uncommon even where all three vaccines were stocked and available at the visit, so supply does not explain this shortfall. The settings and payer groups at either end of the range show where standing orders and visit prompts could recover missed opportunities.
SN - 2076-393X
ER -