How many vaccines can be given during an office visit?

With rare exceptions*, all vaccines can be administered at the same visit. There is no upper limit for the number of vaccines that can be administered during one visit. ACIP and AAP consistently recommend that all needed vaccines be administered during an office visit. Vaccination should not be deferred because multiple vaccines are needed. All live vaccines (MMR, varicella, live attenuated influenza, yellow fever, and oral typhoid) can be given at the same visit if indicated. If injectable or intranasal live vaccines are not administered during the same visit, they should be separated by 4 weeks or more.

When giving several injections at a single visit, separate IM vaccines by at least 1 inch in the body of the muscle, if possible, to reduce the likelihood of local reactions overlapping. Here are some helpful site maps for different ages so you can record where shots were given:

For infants and toddlers: www.eziz.org/PDF/IMM-718.pdf
For older children: www.aimtoolkit.org/docs/Giving_all_the_doses_12mths.pdf
For adults: eziz.org/assets/docs/ADA/IMM-718A.pdf
For details see the vaccine administration section of CDC’s “General Best Practices for Immunization”, available at www.cdc.gov/vaccines/hcp/imz-best-practices/vaccine-administration.html.

*There are 2 exceptions to this general rule:

1. If the 15-valent pneumococcal conjugate vaccine (PCV15, Vaxneuvance, Merck) and pneumococcal polysaccharide vaccine (PPSV23, Pneumovax, Merck) are to be given to a high-risk patient, these vaccines should not be given at the same visit. The PCV15 should be given first followed by PPSV23 at least 8 weeks later. If PPSV23 has already been given, wait 8 weeks (for a child) or 1 year (for an adult age 19 years or older) before giving PCV15 to avoid interference between the two vaccines.
2. Oral cholera vaccine should be administered before oral Ty21a vaccine (Vivotif, Bavarian Nordic): ACIP recommends at least 8 hours should separate oral cholera vaccine and the first dose of oral Ty21a to avoid any interference by the oral cholera vaccine buffer solution with the enteric-coated Ty21a vaccine dose.