Is simultaneous vaccination always necessary?

In adolescents aged 11 to 14 years, must the human papillomavirus; meningococcal (MCV4); tetanus, diphtheria, and pertussis (Tdap); and, if needed, varicella vaccines be given simultaneously?

A speaker at a recent conference mentioned that because of the components of the MCV4 and Tdap, it was recommended that both be given at the same time or one month apart to allow a full antibody response. It is understood that a live vaccine (i.e., varicella) should have a one-month waiting period if it is not given with the other immunizations — live or attenuated. — Laurie L. Pieper, ARNP-c, Tempe, Ariz.

It is recommended that MCV4 be administered with other vaccines that are indicated during the same visit when feasible. There are two MCV4 vaccines available: Menactra (Sanofi aventis) and Menveo (Novartis). Both use a diphtheria protein as the conjugate protein.

In prelicensure studies, administering Td and MCV4 simultaneously, or Td first followed by MCV4 one month later, were acceptable safe practices. If simultaneous vaccination is not feasible, inactivated vaccines can be administered any time before or after a different inactivated or live vaccine.

Because Tdap (or Td) and MCV4 all contain diphtheria toxoid, a person who recently received one diphtheria toxoid-containing vaccine could theoretically have increased rates of adverse reactions after a subsequent diphtheria-toxoid-containing vaccination when diphtheria antibody titers remain elevated from the previous vaccination. — JoAnn Deasy, PA-C, MPH (154-03)