Since vaccines and immunizations now fall under your pharmacy budget, a call comes to you in the pharmacy regarding administration of vaccines. The tech asks if there's any problem administering different vaccines together (i.e. at the same time).

What's your answer/guidance? Why or why not?

SELECT  here for discussion

Generally, there is NO problem giving different vaccines at the same time (at different sites). The general rule per CDC guidance (Epidemiology
and prevention of vaccine-preventable diseases) is, "There are NO contraindications to simultaneous administration of any vaccines EXCEPT
cholera and yellow fever." Simultaneous administration of yellow fever and cholera vaccines decreases the antibody response to both vaccines. It's
recommended these vaccines be separated by at least 3 weeks.

What about vaccines with antibody containing blood products? Inactivated (killed) vaccines are generally NOT AFFECTED by circulating
antibody to the antigen. Live, attenuated vaccines may be affected by circulating antibody to the antigen. If the administration of an immune
globulin preparation (IVIG, RhoGam®, etc) becomes necessary because of exposure or potential exposure to disease, live-virus vaccines can be given
simultaneously with the immune globulin at a site remote from that chosen for the immune globulin.

The following elaborates a couple of specific cases, see below:

AFFECTED                                          NOT AFFECTED
Mumps, Measles, and Rubella (MMR)        Oral polio vaccine (OPV)
Varicella (chicken pox)                          Oral Typhoid
Rubella

The response to rubella vaccine can be affected by Rho(D) immune globulin (RhoGam®). It is not a contraindication and providers may decide
the concern about lowered immunogenecity is less than the risk of an active rubella infection in a post-partum mother. Women who receive RhoGam® AND rubella vaccine should be tested for seroconversion 6-8 weeks after vaccination. Breast-feeding mothers who've been recently immunized should be cautioned there is a risk, although very small, of infecting their nursing infant with rubella. Infants infected through breast-feeding generally show
normal response to rubella/MMR at 12-15 months of age (the normal time for MMR vaccination in the recommended childhood immunization schedule).

Pregnant women (or women who plan to become pregnant within 3 months) should NOT be immunized with rubella or MMR.

REFERENCES
    -    CDC: General recommendations on immunization. MMWR 1989; 38:205-214, 219-227.
    -    Product Information: RhoGAM(TM), Rho(D) immune globulin (human). Ortho Diagnostic Systems Inc., Raritan, NJ, 1995.
    -    MMWR: General recommendations on immunization. MMWR 1989; 38:205-214, 219-227.