Co-administration of vaccines for adults: a guide for immunisation providers

This guide is designed to support immunisation providers in co-administering vaccines to adults aged 18 years and over. It should be used in conjunction with the Australian Immunisation Handbook (‘the Handbook’), which provides detailed advice on vaccine dosage, administration, contraindications and precautions.

While most vaccines can be co-administered (i.e. given at the same visit) with other vaccines at the same National Immunisation Program (NIP) schedule point, separate injection sites should be used where possible. If the same muscle is used to administer more than one vaccine, ensure a 2.5 cm distance between injection sites. If live parenteral vaccines cannot be administered on the same day, they should be given at least 4 weeks apart.

In accordance with the Handbook, immunisation providers should:

screen people before vaccination
obtain valid consent
ensure the correct equipment and procedures are in place.

Refer to the NIP Schedule and NCIRS’ immunisation schedules for information about all funded and recommended vaccines for adults in Australia.

All vaccines administered should be reported to the Australian Immunisation Register.

Last updated: 3 July 2026

Vaccine	Co-administration with other vaccines	Exceptions to co-administration, any recommended interval between vaccines and further advice
Cholera	Yes	If inactivated oral cholera vaccine and oral live attenuated typhoid vaccine are administered on the same day, they should be given at least 8 hours apart. This is because the buffer in the cholera vaccine may affect how the capsules of oral typhoid vaccine move through the gastrointestinal tract.
COVID-19	Yes	mRNA COVID-19 vaccines and replicating mpox vaccines (such as ACAM2000) both carry a small risk of myocarditis, but the risk from non-replicating MVA-BN mpox vaccines (such as Jynneos) remains unknown. If the timing of MVA-BN is not urgent, consider administering MVA-BN mpox vaccine and mRNA COVID-19 vaccines 4 weeks apart. For children aged 6 months to <5 years, it is preferable to separate administration of COVID-19 vaccine from other vaccines by 7 to 14 days, due to a theoretical increased risk of adverse events, including fever. However, COVID-19 vaccines can be co-administered if separation of vaccines would be logistically challenging.
Diphtheria-tetanus-pertussis (whooping cough)	Yes	N/A
Hepatitis A	Yes	N/A
Hepatitis B	Yes	N/A
Haemophilus influenzae type b (Hib)	Yes	N/A
Human papillomavirus (HPV)	Yes	N/A
Influenza (flu)	Yes	The likelihood of local and systemic adverse events may increase when adjuvanted vaccines (such as Fluad) are co-administered. Co-administration studies have shown slightly lower antibody responses to certain strains contained in RSV and influenza vaccines when the vaccines are administered together compared with when they are administered separately. The clinical significance of these decreased antibody responses is uncertain.
Japanese encephalitis	Yes	N/A
Measles-mumps-rubella (MMR)	Yes	N/A
Meningococcal ACWY and meningococcal B	Yes	N/A
Mpox	Yes	Replicating mpox vaccines (such as ACAM2000) and mRNA COVID-19 vaccines both carry a small risk of myocarditis, but the risk from non-replicating MVA-BN mpox vaccines (such as Jynneos) remains unknown. If the timing of MVA-BN is not urgent, consider administering MVA-BN mpox vaccine and mRNA COVID-19 vaccines 4 weeks apart.
Pneumococcal (15vPCV, 20vPCV, 21vPCV)	Yes	A co-administration study showed lower antibody responses to most pneumococcal serotypes and influenza subtypes when 21vPCV and influenza vaccine were administered together compared with when they were administered separately. The clinical significance of these decreased antibody responses is uncertain.
Poliomyelitis	Yes	N/A
Q fever	Yes	N/A
Rabies and other lyssaviruses	Yes	N/A
Respiratory syncytial virus (RSV)	Yes	The likelihood of local and systemic adverse events may increase when adjuvanted vaccines (such as Arexvy) are co-administered. Co-administration studies have shown slightly lower antibody responses to certain strains contained in RSV and influenza vaccines when the vaccines are administered together compared with when they are administered separately. The clinical significance of these decreased antibody responses is uncertain.
Typhoid	Yes	If inactivated oral cholera vaccine and oral live attenuated typhoid vaccine are administered on the same day, they should be given at least 8 hours apart. This is because the buffer in the cholera vaccine may affect how the capsules of oral typhoid vaccine move through the gastrointestinal tract.
Varicella (chickenpox)	Yes	N/A
Yellow fever	Yes	N/A
Zoster (herpes zoster)	Yes	N/A

Useful links

Australian Government

Australian Immunisation Handbook – Australian Government Department of Health, Disability and Ageing
National Immunisation Catch-up Calculator – Australian Government Department of Health, Disability and Ageing
ATAGI statements – Australian Government Department of Health, Disability and Ageing
Diseases and surveillance – Australian Centre for Disease Control
Communicable diseases prevention and control – Australian Centre for Disease Control

NCIRS

34 views