Safety of pairwise co-administration of influenza, PCV20, and RZV vaccines in adults aged ≥50 years: a post-marketing surveillance study using VAERS data
Abstract
BackgroundWith the accelerating global aging of the population, the disease burden of influenza, pneumococcal disease, and herpes zoster among adults aged ≥50 years is increasing. Although guidelines such as those from the Advisory Committee on Immunization Practices (ACIP) recommend that influenza, 20-valent pneumococcal conjugate vaccine (PCV20), and recombinant zoster vaccine (RZV) vaccines can be co-administered, real-world post-marketing safety data on co-administration remain limited.MethodsBy analyzing 25,697 reports from the Vaccine Adverse Event Reporting System (VAERS), we compared adverse event profiles between three co-administration strategies (INF+PCV20, RZV+PCV20, INF+RZV) and their respective single-vaccine comparator groups. We jointly employed four disproportionality analysis algorithms (Empirical Bayes Geometric Mean (EBGM), Bayesian Confidence Propagation Neural Network (BCPNN), Proportional Reporting Ratio (PRR), and Reporting Odds Ratio (ROR)) for signal detection and further performed disease history network analysis of serious adverse event cases.ResultsCo-administration groups (n = 260–348) exhibited serious adverse event rates of 3.7%–5.5%, comparable to or lower than those in single-vaccine groups (3.5%–6.6%), with no deaths reported. The majority of adverse events were mild local reactions, with injection-site erythema occurring in 13.8%–16.6% of cases. Disease history network analysis of serious adverse event cases in co-administration groups demonstrated that cardiovascular diseases and metabolic disorders formed the central hubs of the disease co-occurrence networks.ConclusionThese findings indicate that, compared with single-dose administration, pairwise co-administration of INF, PCV20, and RZV in this dataset was associated with only transient reactogenicity and no evidence of excess serious adverse events.
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BibTeX
@article{li2026safety,
title = {{Safety of pairwise co-administration of influenza, PCV20, and RZV vaccines in adults aged ≥50 years: a post-marketing surveillance study using VAERS data}},
author = {Yihao Li and Yao Chen and Huilin Xia and Yuan Lu and Hang Zhou and Rongbin Yu and Peng Huang},
journal = {Frontiers in Immunology},
year = {2026},
month = nov,
doi = {10.3389/fimmu.2026.1859470},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1859470},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Safety of pairwise co-administration of influenza, PCV20, and RZV vaccines in adults aged ≥50 years: a post-marketing surveillance study using VAERS data
AU - Yihao Li
AU - Yao Chen
AU - Huilin Xia
AU - Yuan Lu
AU - Hang Zhou
AU - Rongbin Yu
AU - Peng Huang
PY - 2026
DA - 2026/11/05
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1859470
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1859470
AB - BackgroundWith the accelerating global aging of the population, the disease burden of influenza, pneumococcal disease, and herpes zoster among adults aged ≥50 years is increasing. Although guidelines such as those from the Advisory Committee on Immunization Practices (ACIP) recommend that influenza, 20-valent pneumococcal conjugate vaccine (PCV20), and recombinant zoster vaccine (RZV) vaccines can be co-administered, real-world post-marketing safety data on co-administration remain limited.MethodsBy analyzing 25,697 reports from the Vaccine Adverse Event Reporting System (VAERS), we compared adverse event profiles between three co-administration strategies (INF+PCV20, RZV+PCV20, INF+RZV) and their respective single-vaccine comparator groups. We jointly employed four disproportionality analysis algorithms (Empirical Bayes Geometric Mean (EBGM), Bayesian Confidence Propagation Neural Network (BCPNN), Proportional Reporting Ratio (PRR), and Reporting Odds Ratio (ROR)) for signal detection and further performed disease history network analysis of serious adverse event cases.ResultsCo-administration groups (n = 260–348) exhibited serious adverse event rates of 3.7%–5.5%, comparable to or lower than those in single-vaccine groups (3.5%–6.6%), with no deaths reported. The majority of adverse events were mild local reactions, with injection-site erythema occurring in 13.8%–16.6% of cases. Disease history network analysis of serious adverse event cases in co-administration groups demonstrated that cardiovascular diseases and metabolic disorders formed the central hubs of the disease co-occurrence networks.ConclusionThese findings indicate that, compared with single-dose administration, pairwise co-administration of INF, PCV20, and RZV in this dataset was associated with only transient reactogenicity and no evidence of excess serious adverse events.
SN - 1664-3224
ER -