Flu season has arrived, and for anyone who received their last COVID-19 vaccine in July or earlier, so has the time for a booster.
Many provinces have already begun offering both the new bivalent COVID-19 vaccine that targets the Omicron strain and the annual influenza vaccine. Others, such as Ontario, will offer the flu shot beginning in November. Both vaccines are safe, and available free of charge.
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Someone due for both their COVID-19 booster and their flu shot might be wondering if it’s possible to save time by getting both shots together. Public health advice on combining vaccinations has changed over the course of the pandemic, so a bit of confusion is natural.
Here’s what Health Canada, the National Advisory Committee on Immunization and pharmacists are saying right now.
CAN YOU BOOK A FLU SHOT AND COVID-19 BOOSTER AT THE SAME TIME?
According to the National Advisory Committee on Immunization, COVID-19 vaccines can be given at the same time as, or any time before or after, other vaccines. This includes live, non-live, adjuvanted or unadjuvanted vaccines.
NACI previously recommended that COVID-19 vaccines be given at least 28 days before and 14 days after other vaccines, but changed its position in September 2021 after reviewing the evolving data around COVID-19 vaccination.
Dr. Tiana Tilli is a clinical pharmacist and lecturer at the University of British Columbia’s Pharmacists’ Clinic. She was one of many pharmacists administering COVID-19 vaccines at a time when NACI advised against giving them in combination with over vaccines.
Tilli said in the early days of COVID-19 vaccines, health-care professionals and researchers wanted to observe the vaccines’ side effects without interference from the side effects of other vaccines.
“We didn’t want to muddy the picture. We wanted to have really robust post-marketing surveillance,” she told CTVNews.ca in a phone interview on Friday.
“Now we’ve had COVID vaccines around for a while and so we have the data we need from that perspective, and so now we’re comfortable saying you can get them on the same day or any amount of time after (another vaccine).”
Provinces and territories have their own strategies for delivering vaccinations, so consult your doctor or pharmacist to find out how to book both vaccines in one appointment.
IS IT SAFE?
Health Canada has not identified any specific safety concerns for people receiving routine vaccines at the same time or within days of each other.
Natalie Crown, pharmacist and director of the doctor of pharmacy program at the University of Toronto, compared getting the two shots together to other circumstances where people receive more than one vaccine at a time, such as for travel.
“It’s not uncommon to give vaccines together,” she said. “I think the key message for Canadians is that getting the flu vaccine and the COVID-19 vaccine is safe, and we don’t have information to suggest it affects the effectiveness of one vaccine or the other. So they can be given together.”
ARE SIDE EFFECTS WORSE FOR PEOPLE WHO RECEIVE BOTH SHOTS AT ONCE?
Health Canada warns there is a possibility of increased temporary side effects when a COVID-19 vaccine and another vaccine are given at the same time or within days of each other, but Tilli said that shouldn’t deter anyone from getting both vaccinations in one appointment.
She said the side effects from receiving both shots at once might be worse than the usual side effects associated with the flu shot, but not noticeably worse than side effects associated with the COVID-19 vaccine.
“Everyone’s going to be different,” she said. “But I would expect it to be fairly similar to what people’s previous COVID vaccine side effects were.”
As for how those side effects might feel, Crown said it varies somewhat based on how each individual’s immune system responds to the vaccine, but they’re generally mild.
“You can expect to have a slightly sore arm for usually a day or two, and some people…may feel more tired than usual, they may feel achy,” Crown said. “That’s just a sign our body is mounting the immune response we want it to in response to a vaccine.”
SHOULD YOU GET BOTH VACCINES IN THE SAME ARM OR ONE IN EACH?
Health Canada says vaccines given during the same visit should be administered at different injection sites. Crown clarified that the two sites could be different arms or different points on the same arm.
“You can get both vaccines in the same arm,” she said, explaining that the deltoid muscle, the muscle into which flu and COVID-19 vaccines are injected, is large enough to accommodate two injection sites an inch or so apart.
“Typically what the provider will do is they’ll space out the injection site a bit.”
Both Crown and Tilli said they would accommodate patients whether they wanted their vaccinations together in the same arm or in separate arms. It mostly comes down to whether someone wants post-vaccination pain in one or both arms.
WHAT ARE THE ADVANTAGES OF GETTING THEM AT THE SAME TIME?
There are potential benefits to both individuals and the health-care system when people who are eligible get both vaccines at once.
According to Health Canada, administering flu shots at the same time as COVID-19 vaccines will help ease the rollout of the influenza vaccine program in the fall and winter and make it easier for everyone to receive their shots.
“For individuals, I think it’s more convenient to just have to go in once,” Tilli said. “If people are worried about side effects…you only have to kind of experience it once. And then I think the most important thing is we’re getting that faster protection.”
That faster protection, Tilli said, benefits other Canadians and the health-care system.
“The quicker we can get people protected, hopefully the less increase in cases and the less effect we see on hospital capacity.”