Since You Asked – Is It Safe to Get the COVID Shot and the Flu Shot at the Same Time?

Question: I read an article that said getting the COVID-19 shot and the Flu shot at the same time can lead to stroke. Should I be scared?

Answer: Getting them both at the same time is safe for most people. Read to the end to find out who may be at an increased risk of stroke.

The NWHN had me, a Registered Nurse with a Master of Science in Nursing Education, review the study that is being cited in this recent flurry of articles. I have extensive training in reviewing medical journals and evaluating the quality of evidence in those journals. I concur that this study aligns with the CDC that most individuals have no higher risk of stroke from getting their Covid-19 vaccine and their flu shot at the same time. 

Why Get Vaccinated? What Are the Common Symptoms of Vaccination? What Are Some Common Myths About Vaccines? What Are Possible Health Complications From Getting Flu and COVID-19 Vaccines Together?

Vaccination Fast Facts 

• Vaccines can be given at the same time (co-administration) [1]. 
• It is safe to get a flu vaccine (flu shot) with other recommended vaccines at the same visit [1]. 
• Multiple vaccines should be given at separate places on the body, at least 1 inch apart [1]. 
• It is safe to get a flu shot and a Covid-19 shot at the same time [1]. 
• You may experience slightly more side effects when getting both shots at the same time, including fatigue, headache, and muscle aches [1]. 
• If you choose to wait between getting both shots, there is no recommended waiting time between vaccines, so when you get it is up to you [1].
• Three flu shots recommended for people 65 and older are either a higher dose or adjuvanted. According to the CDC, “An adjuvant is an ingredient added to a vaccine that helps create a stronger immune response to vaccination” [8].

Why Get Vaccinated? 

Flu [7]

• The flu shot can keep you from getting sick with the flu. When the flu shot is a similar virus to what is circulating in the wild, you’re 40-60% less likely to have to go to the doctor with the flu. 
• Over the last ten years, studies have found that flu shots reduced the risk of adults being admitted to the hospital or ICU anywhere from 40 to 82% 
• For those who got the flu shot but got sick and hospitalized with the flu, vaccinated patients had a 26% lower risk of going to the ICU and a 31% lower risk of death than unvaccinated patients. 
• Suppose you have chronic health conditions like heart disease, chronic lung disease, or diabetes. In that case, the flu shot can reduce your risks of heart attack or worsening of your chronic condition. 

Covid-19 [4]

• The Covid-19 shot can keep you from getting sick with Covid-19. 
• Getting your Covid shot is a safer way to build immunity to the Covid-19 virus than getting sick with Covid-19, since the shot gives more reliable immunity than getting sick with different strains. 
• The Covid-19 shots are effective at protecting from serious illness, hospitalization, and death from the Covid-19 virus, especially for those with chronic illness.  

What Are the Common Symptoms of Vaccination?

Common symptoms of the Flu shot, and Covid-19 vaccine include [3,6]: 

• Pain where you got the shot 
• Tiredness/sleepiness 
• Loss of appetite 
• Low-grade fever 
• Chills 
• Headache 
• Nausea 

What Are Some Common Myths About Vaccines?

• MYTH: The flu vaccine will give you the flu. Flu vaccines cannot cause the flu because they contain an inactivated (killed) virus, which means it cannot reproduce like the influenza virus [6]. 
• MYTH: You can’t get the flu shot if you’re pregnant. The flu shot is safe in pregnancy and reduces the risk of respiratory infection by 50%. It also protects your baby for several months after birth when they are too young to get the shot themselves [6]. 
• MYTH: Children can’t get the flu shot. Flu shots are recommended for everyone six months and older and are encouraged to get annual flu shots [6]. Studies from 2017-2022 have shown that the flu shot can significantly reduce a child’s risk of dying, has reduced flu-related hospitalization by 41% in a 2020 study, and has reduced the risk of severe life-threatening influenza by 75% in a 2022 study [6]. Even the nasal spray, which has a “live virus,” contains a weakened version that will not make you sick with influenza [6]. 

What Are Possible Health Complications From Getting Flu and COVID-19 Vaccines Together?

The Study

• A recent  study published in 2023 has been making headlines after it evaluated the risk of stroke following a Covid-19 shot with the flu shot. 
• The study by Lu et al. (2023) reviewed early data collected by the Vaccine Safety Datalink (VSD) that tracks rare and severe events following immunization. In January 2023, the CDC made a public communication that stated the VSD found a higher risk of ischemic stroke in people 65 or older within 21 days after they received the Pfizer-BioNTech Vaccine.
• The VSD noted a higher risk of stroke when the person got both the high-dose or adjuvanted flu shot at the same time as the Pfizer Covid-19 vaccine. 
• This study only included Medicare beneficiaries ≥ 65 years old who received a Covid-19 bivalent shot or a high-dose/adjuvanted flu shot and had a stroke during follow-up [9]. 
• The study had over five million patients in their primary review. After that, they performed a secondary subgroup analysis, which included over six million eligible Medicare beneficiaries ≥ 65 years old [9]. 

What the Study Found

• Outcomes of the primary study found no clear [statistically significant] increased risk of stroke following Covid-19 bivalent vaccination from either Pfizer or Moderna [9].  
• In their subgroup analysis, there was a higher risk of ischemic stroke following the Pfizer Covid-19 shot within 21 days following the shot , but only for those 85 and older [9]. The findings in this study are similar to what the VSD found in January 2023. 
• The results of this study found that receiving the bivalent Covid-19 shot alone did not increase the risk of stroke in those 65 to 84 [9]. 
• The study did find a small increased risk of stroke when receiving the high dose/adjuvanted flu shot alone.
• This study did not compare those who got the flu shot with those who got the flu virus. You have a higher risk of stroke from getting the influenza virus than getting the flu shot [9].
• To quote the study, “More studies are needed to better understand the association between influenza vaccination and [risk of] stroke” [9]. 

What Should I Do with This Information?

• The study concludes that with the known benefits of the Covid-19 and flu vaccines, the benefits of getting vaccinated outweigh the risks of getting sick with either Covid-19 or influenza for persons 65 and older [9].  

Sources

[1] CDC. (2023, November 3). Getting a flu vaccine and other recommended vaccines at the same time. Retrieved from https://www.cdc.gov/respiratory-viruses/whats-new/getting-vaccines-at-same-time.html#:~:text=Getting%20multiple%20vaccines%20at%20the%20same%20visit%20may%20increase%20the,a%20COVID%2D19%20vaccine%20alone. 

[2] CDC. (2023, November 3). Safety of COVID-19 vaccines. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html  

[3] CDC. (2023, September 29). When getting your vaccine. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect.html 

[4] CDC. (2023, September 22). Benefits of getting vaccinated. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html  

[5] CDC. (2023, August 25). Who needs a flu vaccine. https://www.cdc.gov/flu/prevent/vaccinations.htm  

[6] CDC. (2023, June 16). Misconceptions about flu vaccines. Retrieved from https://www.cdc.gov/flu/prevent/misconceptions.htm  

[7] CDC. (2022, September 13). Vaccine benefits. Retrieved from https://www.cdc.gov/flu/prevent/vaccine-benefits.htm  

[8] CDC. (2022, August 25). Adjuvanted flu vaccine. Retrieved from https://www.cdc.gov/flu/prevent/adjuvant.htm  

[9] Lu, Y., Matuska, K., Nadimpalli, G., Ma, Y., Duma, N., Zhang, H., Chiang, Y., Lyu, H., Chillarige, Y., Kelman, J., Forshee, R., Anderson, S. A. (2023). Evaluation of stroke risk following COVID-19 mRNA bivalent vaccines among U.S. adults aged ≥ 65 years. MedRxiv. Doi: https://doi.org/10.1101/2023.10.10.23296624