Before the show starts, we've got a small update for this episode. Yes, in September 2025, the NHS changed its guidance for the co-administration of COVID-19 immunizations. The latest NHS advice is that it is now okay to have the COVID-19 immunization at the same time as the RSV, respiratory, and situal virus immunization. As you'll hear in the show, this is different from what the NHS advised when we recorded the show, so we wanted to make you aware of the updated guidance. It goes to show just how quickly things change. Okay, on with the show. Welcome to Copybreak, the audio equivalent of T and biscuits. Warm, comforting, and slightly habit-forming. Today we are talking double-axe, and that's not Antendek or the two Ronnies. We are going to be talking about flu and COVID immunizations. Or the Cheesentomato of immunization better together and surprisingly effective. A bit like Sultan vinegar or fish and chips, these classic combinations that just work. One visit, two jabs, and lots of protection. And before you ask, you don't need to bring both arms, but it definitely will help. We'll cover the facts, tackle the questions, and explain why code-ministering immunizations isn't just effective. It's a no-brainer. So whether you belong to team Jam and then cream on your scones, or you belong to team Cream and then Jam on your scones, stick with us because double really doesn't even better. Let's get going, shall we? I'm Dr Jeff Ham and I'm Dr Sam again me. And this is season one of Coffee Break. We are two general practitioners from beautiful dogs that are the United Kingdom, and we are happy to have you here with us for another Coffee Break. In our show we give you helpful and useful health and wellness information in short and easily digestible episodes. That's right and hopefully in a fun and enjoyable way as well. In today's VARSEE of Health Information we hope to be your trusty island of reliable and impartial independent, unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Pay Coffee Break! Okay, so it's interesting isn't it because when we started the podcasts, we started and they came about because it was COVID, we had the pandemic. And I think it's fitting then, isn't it, that our first episode back. We're going to be talking about COVID again. Yeah, absolutely. And before COVID, we didn't have anything to do with immunizations for COVID because we didn't ever think we needed it. And now we do. Yep, definitely. And increasingly, patients are going to be offered their COVID and their flu immunizations together, I think, rather than what people been used to having them as two septupoinements on two separate days. Yeah, that's right. And I suppose by together we mean two separate immunization injections, but it might not be impossible that they'll be combined into one injection in the future. Definitely. Yeah, so I could see that coming maybe, but I think, as you say, Sam, we're a long way off from that. And getting both together is what is referred to as co-administration. It's felt to be more convenient for patients and it helps you because you don't then have to make a second appointment. Yeah, absolutely. So we are seeing that it is increasingly common practice for it to happen. And you may remember that in the early days of COVID immunizations, as a patient, you will be advised to wait seven days between your COVID and then your influenza immunization. And the main reason was it was to make it easier to see if if you did get a potential side effect. You might have been able to tell whether it came from the new COVID immunization or the influenza immunization at the time. And the same reason for why you would have been asked to avoid having the COVID immunization at the same time as or recently having had COVID infection. Yes, definitely. However, thinking back to COVID immunizations and flu immunizations in the pandemic, there were certain settings when we did actually do code administration. And it was felt in certain circumstances. It was a lot easier and probably was going to be more beneficial. So we kind of had a look and we thought, well, is there any data? Have there been any studies carried out to look at the effectiveness of COVID administration? And interestingly, there was a study carried out at the Bristol Child Centre, the University of Bristol and University Hospitals Bristol and Western NHS Foundation Trust, supported by clinical research network west of England and funded by the National Institute for Health Research. Now they noted that in the early pandemic, it wasn't known how many, if any, boosters of the COVID immunization would be needed. And if they did need to happen, then how would that actually interact? How would that fit in with the annual immunization schedule? Their study was called the Combining Influence and COVID-19 Vaccination or ComFlu COB study. And they looked at code ministering the most widely used COVID and blue immunizations at that time given in the UK. And 679 volunteers took part across 12 NHS sites in England and Wales. And there was listening to different groups. So one group had COVID and blue code ministered at the same time and then he came back to have a the SIBO's saline injection at a second visit. And the other group had COVID and saline at the same time. And then came back for the flu immunization at their second visit. So everybody had two visits, everybody had two lots of immunizations, everybody had two lots of injections, it was just which order they had them in. Now the commonest side effects were pain at the injection site. Now we see this with all immunizations and fatigue, again very common with immunization. And in some combinations, there was an increase in those volunteers reporting at least one side effect when coming both together. So if you had the COVID and the flu immunizations, then it was felt people reported that they were more likely to have one or more side effects. However, really importantly the reactions were mostly mild or moderate. And even more importantly, the immune responses to both COVID and blue were preserved when given together as well. So having them together, you might get slightly more side effects, potentially the side effects of mild, but you're still going to have that really good immune response to both. Yeah, absolutely. It's really interesting, isn't it? And perhaps now is a good time to talk about those reactions because we do commonly get asked about I had the influenza or the COVID vaccination and I felt like it gave me the illness itself. And we know that with these particular immunizations, if you've given them injection form, which the vast majority of people are, then you're given the non-live version. So it's actually physically impossible for you to actually develop the condition itself. And therefore the symptoms you develop are an immune system reaction, aren't they? So related to how your immune system reacts to the immunization. Next year, it tells us that your immune system is appropriately responding to the immunization. Yes, I agree completely. And so then just looking elsewhere at other resources, the NHS website, which is obviously a brilliant resource for anybody to go and look at themselves. For both COVID and influenza immunizations, it says you can have the flu immunization at the same time as other immunizations, such as COVID-19 and shingles. And in the winter, you can have the COVID-19 immunization at the same time as the influenza immunization. The only small thing to notice that if you have the RSV respiratory sensitial virus immunization at the same time as either the influenza or COVID immunization, then it's actually possibly less effective for the RSV immunization. So they should be given separately. Definitely. And finally, I think it's worth saying that it is suggested that immunizations are given in separate arms, one on the left, one on the right, and what we normally tend to advise and what you'll probably be advised is that your flu immunization probably goes in your dominant and your COVID immunization in your other arm, although taken advice from the clinicians giving the immunizations on the day you go. So yes, there might be an individual reason why you do need to have both immunizations in a single arm, which of course you can discuss with your clinician doing the immunization at the time. Exactly. Yeah. And we just had one other point, which was that this is not a not a new concept. Let's look at the child, UK immunization schedule, and in fact it's used internationally, isn't it? But there's a wide range of combined immunizations that are given routinely from eight weeks.
weeks of age. So we know that this is a effective procedure to do. And as an adult, if you need a tetanus booster, then you'll find you no longer have a single tetanus immunization, and it's combined with diphtheria and polio. So again, another example of routine immunization is given as code administration rather than separately now. So Sam, what's your take home points? I think what I would say, Jeff, is that we've clearly seen an outlined here that co-administering immunizations is effective, and not only that it saves you as a patient time in terms of booking appointments. Definitely, yeah, I'd agree, and I would say it's going to be something that I think we see more of, it's going to be more commonly used, and I think increasingly so in future. This has been an episode of Coffee Break, and we hope you've enjoyed it. And if you have, then I hope you'll join us for another Coffee Break soon. Remember, if you want to get in touch with us, or if you have any ideas or suggestions, then please feel free to email us at the show. At
[email protected] You can listen to us and subscribe to the show on any of the podcast platforms and via your computer, smartphone and home smart devices. We have used a variety of resources for the information in the show to try and assure that it is up to date and the most applicable. We have also put any information links we have discussed in the show notes. Coffee Break is a coffee break production and is edited and produced by me.jf.com. It's created written and hosted by.jf.com and me. Dr. Sam McGinley. All the content we provide in the show is for General Information Purbs' Only. The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. The content should not be relied upon as a substitute for professional medical or healthcare advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters.
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