My patient is age 70 and due for a second dose of recombinant zoster vaccine (Shingrix, GSK). The patient also is eligible for, and wants to receive, a current COVID-19 vaccine dose. What should we advise our patient about scheduling the second Shingrix dose?

Your patient may choose to receive the vaccines at the same visit or separately, without regard to the timing interval. In general, when deciding whether to coadminister other vaccines with COVID-19 vaccine, you should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines.

When multiple vaccines are administered at a single visit, administer each injection in a different syringe and at a different injection site. For adolescents and adults, the deltoid muscle may be used for more than one injection, though injection sites should be at least one inch apart. It is generally preferable to administer reactogenic vaccines such as Shingrix and COVID-19 vaccine in different arms, if possible. If the patient prefers both injections in the same deltoid, that is also acceptable.

Immunize.org has developed a one-page guide to administering multiple intramuscular vaccinations to an adult at one visit: www.immunize.org/catg.d/p2030.pdf.