Double shot season: Doctors say it’s safe to get flu and COVID-19 vaccinations at the same time

Don’t be surprised when scheduling a COVID-19 vaccine booster to hear a provider also offer a flu shot in the same appointment. Several reasons back a jab in each arm.

U.S. experts are urging Americans to get all the vaccines they’re eligible for this winter, including coronavirus vaccinations or a booster and that flu shot. The Centers for Disease Control and Prevention has advised that both COVID-19 and influenza vaccinations can be safely administered at once. And providers are concerned this year about lower influenza vaccine rates in certain ages.

Although influenza wasn’t a big factor in 2020, it is more likely to be this year. Flu cases have emerged in certain parts of the U.S., including more than 700 cases among people on the University of Michigan-Ann Arbor campus. This year, the influenza vaccines are designed against four different viruses.

Several Spokane health care professionals answered questions about taking both vaccines: Dr. Rob Lichfield, a Providence Urgent Care medical director; Dr. Gretchen LaSalle, a MultiCare family physician; Dr. Francisco Velázquez of the Spokane Regional Health District; and Jennifer Robinson, Washington State University pharmacy associate dean.

Should you get both vaccines simultaneously?

Lichfield: You have folks who are very motivated to get any immunization that’s being offered, but there is also certainly a group who almost has vaccination fatigue. It is really important to get both. Last year, we didn’t really see a lot of flu in North America, but I am expecting it, and we’re already seeing flu this year, so I’d say this year is even more important than getting it last year. It is very safe to get them together. The vaccines are actually quite different.

LaSalle: Hopefully, doctors are saying you should get the flu shot at the same time as your COVID vaccine for convenience and to protect people as much as possible. It’s perfectly fine to do them together. There is no longer a waiting period. … Whenever people have multiple shots given at the same time, they are probably a little bit more likely to experience the aftereffects of vaccination – achiness, feeling tired, maybe a low-grade fever and fatigue – because your immune system is kicking into gear, which is a good thing. It’s developing antibodies to protect you. As long as people know to expect that, it worries them less, and they’re less likely to think they’re getting sick from the vaccines. Neither one of these vaccines can give you flu or COVID illness.

Velázquez: Earlier in the pandemic when we had little knowledge about the vaccines, there was an earlier recommendation to put some time between the two, but as we learned more, the co-administration of the flu shot and the COVID-19 vaccine or booster is recommended. … Obviously, you need to ask (your) physician based on your current condition, but the recommendation is that co-administration is not only highly recommended but is a good practice because ideally you want to give the individual however many vaccines they’re eligible for in a single visit.

Robinson: Check with health care providers or pharmacists who have access to check, are you behind on your vaccinations? … There are advantages to getting both done at once because right now pharmacies and clinics are getting slammed by people who need their booster. They’re extending the number of people who can get boosters, depending on underlying health conditions and working with your health care provider. I think there’s still debate whether you should get boostered with the same vaccine you took before or if you should mix (such as Moderna, then Pfizer).

Why, if influenza wasn’t an issue last year?

Lichfield: Most of us are fairly certain the reason we didn’t see the flu much last year was because of the isolating and essentially the masking, social distancing and community cooperation to minimize the spread of COVID, which also happens to be exceptionally effective in preventing flu. This year, largely and understandably, communities have needed to open up more, and we’ve had to adapt to new patterns being back to schools and businesses open but still wearing masks. I’m hoping for not a bad flu season, but I expect we will have a flu season. … Regular surgical masks are pretty effective at preventing spread of influenza and COVID, and they’re particularly effective at preventing what’s called droplet spread. They’re not perfectly effective at what’s called aerosolized spread. They do help, but wearing a mask unfortunately isn’t perfect.

LaSalle: The reason we didn’t see the flu much last year is because of all the public health measures that we were really good at last year. Now that people are sort of less adherent to those measures as strictly as last year, we are starting to see some flu and other respiratory viruses come back. At the University of Michigan, there was a flu outbreak, so we know it’s coming. The strain (in Michigan) is I believe the H3N2, Influenza A strain, which has the potential to be a little more serious as far as likely to put people in the hospital and cause serious illness. A less important reason is to increase the chance of taking flu out of the equation in trying to figure out what your symptoms represent. If we have flu, respiratory viruses and COVID circulating, and they all have similar presentations of cough, fever and fatigue, it’s hard to know what’s what.

Velázquez: This year, because we have more activities and schools open, and we’re engaged in a lot more activity, it’s very important that we get our flu shot in addition to the COVID vaccine. We have seen around the country somewhat of a decrease in the number of immunized patients for the flu, particularly those who are between 6 months and 12, and those who are 13 to 17. Many of those are the children and young adults in schools and participating in activities, so we obviously want to make sure we protect them. The good news is we saw an increase overall in patients 50 to 65-plus getting immunization for the flu as compared with last year. For younger adults 18 to 49 or so, it’s kind of flat.

Robinson: I think we worry about influenza every single year. It’s a serious upper respiratory infection and, with the exception of 2020, there’s quite a bit of death. The other concern is influenza and COVID can look a lot like each other, so if you’re protecting yourself against COVID, you should also protect yourself against influenza. They are both diseases that are preventable.

What are misconceptions?

Lichfield: There’s a potential to be lulled into a sense of security because we didn’t have influenza last year, but in all of our struggles and the health care system being packed, there can be some very dire circumstances if you coupled another big COVID surge with a significant flu prevalence in any community. It’s important to acknowledge the very real risk of both and to do everything we can to prevent it. In some ways, you could make the argument that influenza is a much more universally dangerous illness to humans. COVID is particularly devastating for older folks but hasn’t shown thankfully as being super dangerous for kids, although we’re seeing more children admitted with delta.

Velázquez: If you’re a little concerned about a reaction, you can ask your provider to use different arms. One of the questions people ask is, what if I have allergies? Again, every person is different, but there is no indication for allergies in general. If you have had allergic reactions and you’re getting a flu vaccine, do it at a doctor’s office or clinic so they can monitor you for any potential side effects. The COVID-19 vaccine is very specific. The flu shot is very specific for influenza, so one doesn’t protect you for the other.

LaSalle: A lot of people think influenza is the stomach flu and it’s not; influenza is respiratory. The side effects that some people have after the vaccine – achy, tired, mild fever – they can think very easily that they’re getting sick from their vaccine, and you can’t at all. … We start at 6 months for flu shots. With influenza, everybody is at risk, but people who are elderly, young infants, pregnant women and those with comorbid conditions are at highest risk. All of us need to get a flu vaccine to protect ourselves and others.

Robinson: People have the perfect opportunity to get that vaccine now to get the coverage (it’s not too late), so they’re protected before a potential winter or spring flu season hits. Usually, we see higher levels here in January, February, March, but it varies each year (and a pharmacist student might give that shot). This year, they’ve given out 21,238 vaccines – influenza vaccine and the COVID vaccine. With COVID vaccines, that’s 19,589 of them, and then 1,649 influenza shots over the last couple of months.