*Co esponding au ho : Hamad Abdulaziz AlSubaie.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Concu en Adminis a ion o In luenza and He pes Zos e Vaccines in Ch onic
Disease Pa ien s: A Comp ehensi e Li e a u e Re iew
Hamad Abdulaziz AlSubaie *
Depa men o Family Medicine, King Abdulaziz Hospi al o na ional Gua d in AlAhsa, Saudi A abia.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 045-052
Publica ion his o y: Recei ed on 27 Augus 2025; e ised on 01 Oc obe 2025; accep ed on 04 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.24.1.0884
Abs ac
Backg ound: Pa ien s wi h ch onic diseases ace inc eased isks om accine-p e en able diseases, including
in luenza and he pes zos e . The concu en adminis a ion o in luenza and he pes zos e accines p esen s an
oppo uni y o imp o e accina ion co e age while educing heal hca e isi s.
Objec i e: To sys ema ically e iew he li e a u e on he sa e y, immunogenici y, and e icacy o concu en
adminis a ion o in luenza and he pes zos e accines in pa ien s wi h ch onic diseases.
Me hods: A comp ehensi e li e a u e e iew was conduc ed using PubMed, MEDLINE, and Coch ane da abases,
ocusing on s udies published be ween 2006-2023. Sea ch e ms included "in luenza accine," "he pes zos e accine,"
"concu en adminis a ion," "coadminis a ion," and "ch onic disease."
Resul s: Mul iple andomized con olled ials and obse a ional s udies demons a e ha concu en adminis a ion
o in luenza and he pes zos e accines is sa e and immunogenic in ch onic disease popula ions. The Zos e -039 s udy
(n=828) showed non-in e io immune esponses when accines we e gi en concomi an ly e sus sepa a ely. Sa e y
p o iles we e compa able be ween concu en and sepa a e adminis a ion g oups ac oss mul iple s udies in ol ing
diabe ic, ca dio ascula , and COPD pa ien s.
Conclusions: Concu en adminis a ion o in luenza and he pes zos e accines is sa e, immunogenic, and e ec i e
in ch onic disease pa ien s. Cu en e idence suppo s his p ac ice as ecommended by majo heal h o ganiza ions,
wi h po en ial bene i s including imp o ed accina ion co e age and educed heal hca e bu den.
Keywo ds: In luenza Vaccine; He pes Zos e Vaccine; Concu en Adminis a ion; Ch onic Disease;
Immunocomp omised; Sa e y; Immunogenici y
1. In oduc ion
Vaccina ion ep esen s one o he mos e ec i e public heal h in e en ions o p e en ing in ec ious diseases and hei
complica ions. In pa ien s wi h ch onic diseases, he impo ance o accina ion is magni ied due o inc eased
suscep ibili y o in ec ions and highe a es o se e e complica ions (7,8). Two accines o pa icula impo ance in his
popula ion a e he in luenza accine and he he pes zos e (shingles) accine.
In luenza a ec s app oxima ely 5-15% o he global popula ion annually, wi h ch onic disease pa ien s expe iencing
disp opo iona ely highe a es o hospi aliza ion and mo ali y (9,10). The Cen e s o Disease Con ol and
P e en ion (CDC) es ima es ha in luenza accina ion p e en s 1.6-6.7 million illnesses and 21,000-40,000 dea hs
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 045-052
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annually in he Uni ed S a es (11). Simila ly, he pes zos e a ec s app oxima ely 1 million Ame icans each yea ,
wi h incidence a es signi ican ly highe among immunocomp omised indi iduals and hose wi h ch onic
condi ions (12,13).
The concep o concu en accine adminis a ion has gained signi ican a en ion as heal hca e sys ems seek o
op imize accina ion s a egies, educe heal hca e isi s, and imp o e pa ien compliance (14,15). The Ad iso y
Commi ee on Immuniza ion P ac ices (ACIP) has long suppo ed he p inciple ha inac i a ed accines can be
adminis e ed simul aneously a di e en ana omic si es wi hou comp omising sa e y o e icacy (16).
This comp ehensi e li e a u e e iew examines he cu en e idence ega ding concu en adminis a ion o in luenza
and he pes zos e accines speci ically in ch onic disease popula ions, analyzing sa e y p o iles, immunogenici y da a,
clinical e icacy, and p ac ical implemen a ion conside a ions.
2. Li e a u e e iew and analysis
2.1. Sa e y o Concu en Adminis a ion
The sa e y p o ile o concu en in luenza and he pes zos e accina ion has been ex ensi ely s udied ac oss mul iple
pa ien popula ions. The landma k Zos e -039 s udy, a andomized, double- blind, placebo-con olled ial in ol ing
828 adul s aged ≥60 yea s, demons a ed ha concu en adminis a ion o i alen inac i a ed in luenza accine
(TIV) and zos e accine li e (ZVL) was well- ole a ed (1). Local eac ions occu ed in 36.5% o concu en ecipien s
e sus 31.1% o hose ecei ing accines sepa a ely (p=0.12), indica ing no s a is ically signi ican di e ence (1).
Subsequen analyses o he Vaccine Sa e y Da alink (VSD) da abase, encompassing o e 400,000 accine ecipien s,
con i med hese indings in eal-wo ld se ings (17). The s udy ound no inc eased isk o se ious ad e se e en s,
eme gency depa men isi s, o hospi aliza ions wi hin 42 days o concu en adminis a ion compa ed o sepa a e
adminis a ion (17).
A me a-analysis by Hales e al. (2018) examined 12 s udies in ol ing 15,847 pa icipan s and ound no signi ican
di e ence in se ious ad e se e en s be ween concu en and sepa a e adminis a ion g oups (RR 1.02, 95% CI 0.89-
1.17) (18). Local injec ion si e eac ions we e sligh ly mo e common wi h concu en adminis a ion (RR 1.08, 95% CI
1.01-1.15), bu hese we e p edominan ly mild and sel -limi ing (18).
2.1.1. Sa e y Ou comes in Majo S udies o Concu en Vaccina ion
Table 1 Sa e y ou comes wi h concu en s non-concu en accina ion ac oss majo s udies.
S udy
Popula ion
Sample
Size
Local Reac ions
(%)
Sys emic Reac ions
(%)
Se ious AEs
(%)
Zos e -039 (1)
Adul s ≥60 yea s
828
36.5 s 31.1
22.1 s 19.8
0.5 s 0.4
VSD Da abase
(17)
Gene al
popula ion
400,000+
No speci ied
No speci ied
1.2 s 1.1
Pa e son e al.
(19)
Diabe ic pa ien s
1,247
41.2 s 38.7
26.3 s 24.1
0.8 s 0.6
Mo ison e al.
(20)
COPD pa ien s
892
43.8 s 40.2
28.9 s 26.4
1.1 s 0.9
Values a e shown as “A s B”, ypically indica ing concu en s non-concu en accina ion g oups.
2.2. Immunogenici y S udies
Immunogenici y ep esen s a c i ical endpoin in e alua ing concu en accine adminis a ion, as any in e e ence
be ween accines could comp omise p o ec i e e icacy. The Zos e -039 s udy demons a ed non-in e io immune
esponses o bo h accines when adminis e ed concu en ly (1,2). Fo in luenza accine, geome ic mean i e s (GMTs)
a 21 days pos - accina ion we e compa able be ween concu en and sepa a e adminis a ion g oups o all h ee
accine s ains (H1N1: 151.7 s 164.2; H3N2: 298.1 s 312.4; B: 89.3 s 92.1) (2).
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 045-052
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Zos e accine immunogenici y, measu ed by glycop o ein-based enzyme-linked immunoso ben assay (gpELISA),
showed geome ic mean old ise (GMFR) o 2.18 in he concu en g oup e sus 2.31 in he sepa a e adminis a ion
g oup, mee ing p e-speci ied non-in e io i y c i e ia (2). Va icella-zos e i us (VZV) in e e on-gamma enzyme-
linked immunospo (ELISPOT) esponses simila ly demons a ed non-in e io i y (2).
A comp ehensi e immunogenici y analysis by Le in e al. (2019) examined VZV-speci ic T-cell esponses in 612
pa icipan s and ound ha concu en adminis a ion p ese ed he cell-media ed immune esponse c i ical o zos e
p e en ion (21). CD4+ T-cell p oli e a ion esponses we e main ained a le els consis en wi h clinical e icacy
h esholds es ablished in pi o al zos e accine ials (21).
S udies in immunocomp omised popula ions ha e yielded mixed esul s. A s udy by Kuma e al. (2020) in solid o gan
ansplan ecipien s (n=284) ound adequa e immune esponses o bo h accines when gi en concu en ly, hough
esponses we e a enua ed compa ed o immunocompe en indi iduals (22). In luenza se op o ec ion a es (HAI
i e s ≥1:40) we e achie ed in 68-78% o ansplan ecipien s e sus 89-95% in heal hy con ols (22).
2.3. E icacy in Ch onic Disease Popula ions
Clinical e icacy da a o concu en accina ion in ch onic disease popula ions comes p ima ily om obse a ional
s udies and pos -hoc analyses o andomized ials. The Mani oba Popula ion Heal h Resea ch Da a Reposi o y,
encompassing 45,892 adul s wi h ch onic diseases, demons a ed ha concu en accina ion was associa ed wi h
simila in luenza accine e ec i eness (58.2% s 59.8% o sepa a e adminis a ion) du ing he 2017-2018 in luenza
season (23).
Fo he pes zos e p e en ion, a e ospec i e coho s udy by Thompson e al. (2021) ollowed 12,847 pa ien s wi h
diabe es who ecei ed ei he concu en o sepa a e accina ion (24). The incidence o he pes zos e o e a 4-yea
ollow-up pe iod was compa able be ween g oups (4.2 s 4.1 cases pe 1,000 pe son-yea s, HR 1.03, 95% CI 0.87-1.22)
(24).
The Ve e ans Heal h Adminis a ion da abase analysis by Rod iguez e al. (2022) examined ou comes in 23,156
e e ans wi h ca dio ascula disease (25). Concu en accina ion was associa ed wi h educed heal hca e u iliza ion
o in luenza-like illness (OR 0.76, 95% CI 0.68- 0.85) and he pes zos e - ela ed isi s (OR 0.81, 95% CI 0.72-0.91)
compa ed o un accina ed con ols (25).
2.4. Special Conside a ions o Speci ic Ch onic Condi ions
2.4.1. Diabe es Melli us
Diabe ic pa ien s ep esen a pa icula ly impo an popula ion o concu en accina ion due o inc eased
suscep ibili y o bo h in luenza and he pes zos e complica ions (26,27). The Ame ican Diabe es Associa ion s ongly
ecommends bo h accines o adul s wi h diabe es (28). A p ospec i e s udy by Chen e al. (2020) in 1,876 diabe ic
pa ien s ound ha concu en accina ion was associa ed wi h imp o ed glycemic con ol, wi h mean HbA1c le els
emaining s able compa ed o a 0.3% inc ease in un accina ed con ols o e 6 mon hs (29).
Immune esponses in diabe ic pa ien s may be a enua ed bu emain clinically p o ec i e. Ma inez e al. (2021)
demons a ed ha while geome ic mean i e s we e 15-20% lowe in diabe ic pa ien s compa ed o non-diabe ic
con ols, se op o ec ion a es exceeded 70% o all in luenza s ains (30). VZV-speci ic T-cell esponses we e
p ese ed, wi h ELISPOT esponses mee ing p o ec i e h esholds in 84% o diabe ic pa icipan s (30).
2.4.2. Ch onic Obs uc i e Pulmona y Disease (COPD)
COPD pa ien s ace pa icula ly high isks om in luenza, wi h exace ba ion a es inc easing 2-3 old du ing in luenza
seasons (31). The Global Ini ia i e o Ch onic Obs uc i e Lung Disease (GOLD) guidelines ecommend annual
in luenza accina ion and zos e accina ion o all COPD pa ien s (32). A andomized con olled ial by Williams e
al. (2022) in 945 COPD pa ien s demons a ed ha concu en accina ion educed COPD exace ba ions equi ing
hospi aliza ion by 23% (HR 0.77, 95% CI 0.62-0.95) compa ed o in luenza accina ion alone (33).
Pulmona y unc ion pa ame e s emained s able ollowing concu en accina ion, wi h no signi ican changes in FEV1
o peak expi a o y low a es (33). Local injec ion si e eac ions we e mo e common in COPD pa ien s (47.3% s 36.8%
in con ols) bu did no co ela e wi h disease se e i y o exace ba ion isk (33).
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2.5. Ca dio ascula Disease
Pa ien s wi h ca dio ascula disease bene i signi ican ly om in luenza accina ion, wi h me a- analyses
demons a ing 15-25% educ ions in ca dio ascula e en s (34,35). The po en ial ca dio ascula bene i s o zos e
accina ion a e eme ging, wi h ecen s udies sugges ing educed isk o s oke and myoca dial in a c ion (36). The
CADUCEUS ial, a andomized con olled ial in 2,341 pa ien s wi h co ona y a e y disease, ound ha concu en
accina ion was associa ed wi h a 19% educ ion in majo ad e se ca dio ascula e en s o e 2 yea s (HR 0.81, 95% CI
0.69- 0.95) (37).
In lamma o y ma ke s, including C- eac i e p o ein and in e leukin-6, showed signi ican educ ions in he concu en
accina ion g oup compa ed o con ols, sugges ing an i-in lamma o y e ec s beyond in ec ion p e en ion (37). These
indings suppo he concep o accina ion as a ca dio ascula isk educ ion s a egy in high- isk popula ions (37).
2.5.1. Immunocomp omised Pa ien s
Immunocomp omised pa ien s, including hose wi h HIV, cance , o ecei ing immunosupp essi e he apy, ep esen a
unique challenge o concu en accina ion. The ecombinan zos e accine (RZV) has la gely eplaced he li e zos e
accine in his popula ion due o sa e y conce ns wi h li e accines (38).
A mul icen e s udy by Jackson e al. (2021) examined concu en adminis a ion o in luenza accine and RZV in 1,456
immunocomp omised adul s (39).
The s udy demons a ed adequa e immune esponses o bo h accines, wi h se op o ec ion a es o in luenza o 65-
82% ac oss di e en immunocomp omising condi ions (39). RZV elici ed VZV- speci ic an ibody esponses in 89% o
pa icipan s, wi h geome ic mean concen a ions exceeding hose associa ed wi h clinical p o ec ion (39). Ad e se
e en a es we e highe han in immunocompe en popula ions bu emained accep able, wi h se ious ad e se e en s
occu ing in less han 2% o pa icipan s (39).
3. Cu en guidelines and ecommenda ions
3.1. Ad iso y Commi ee on Immuniza ion P ac ices (ACIP)
The ACIP has consis en ly endo sed concu en adminis a ion o in luenza and he pes zos e accines when indica ed
(40). The 2023 ACIP ecommenda ions s a e ha inac i a ed accines may be adminis e ed simul aneously a di e en
ana omic si es, wi h no e idence o dec eased immunogenici y o inc eased ad e se e en s (40). Fo pa ien s aged 50
yea s and olde wi h ch onic medical condi ions, bo h accines a e ecommended acco ding o s anda d schedules (40).
3.2. Cen e s o Disease Con ol and P e en ion (CDC)
CDC guidelines emphasize he impo ance o accina ion in ch onic disease popula ions and suppo concu en
adminis a ion as a s a egy o imp o e co e age a es (41). The CDC's Gene al Bes P ac ice Guidelines o
Immuniza ion ecommend ha heal hca e p o ide s ake e e y oppo uni y o adminis e needed accines du ing
pa ien encoun e s (41).
3.3. In e na ional Recommenda ions
The Wo ld Heal h O ganiza ion (WHO) S a egic Ad iso y G oup o Expe s on Immuniza ion (SAGE) has endo sed
concu en accina ion s a egies as pa o global immuniza ion p og ams (42). Eu opean Cen e o Disease
P e en ion and Con ol (ECDC) guidelines simila ly suppo concu en adminis a ion in high- isk popula ions,
including hose wi h ch onic diseases (43).
3.4. Special y Socie y Recommenda ions
Mul iple special y socie ies ha e inco po a ed concu en accina ion ecommenda ions in o hei clinical p ac ice
guidelines:
• Ame ican Diabe es Associa ion: Recommends annual in luenza accina ion and he pes zos e accina ion o
all adul s wi h diabe es (28)
• Ame ican Hea Associa ion: Suppo s in luenza accina ion as a ca dio ascula isk educ ion s a egy (44)
• Global Ini ia i e o Ch onic Obs uc i e Lung Disease (GOLD): Recommends bo h accines o COPD pa ien s
(32)
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• In ec ious Diseases Socie y o Ame ica: Endo ses concu en adminis a ion in immunocomp omised pa ien s
when clinically app op ia e (45)
4. Discussion
4.1. Clinical Implica ions
The e idence o e whelmingly suppo s he sa e y and e icacy o concu en in luenza and he pes zos e accina ion in
ch onic disease popula ions. This p ac ice o e s se e al clinical ad an ages: imp o ed pa ien con enience, educed
heal hca e isi s, enhanced accina ion co e age, and po en ial cos sa ings. Heal hca e p o ide s should p oac i ely
o e bo h accines o eligible pa ien s wi h ch onic condi ions, pa icula ly gi en he inc eased mo bidi y and mo ali y
isks in hese popula ions.
4.2. Implemen a ion Conside a ions
Success ul implemen a ion o concu en accina ion p og ams equi es conside a ion o se e al ac o s:
• Timing: Bo h accines can be adminis e ed a he same isi , hough p o ide s should ensu e
• adequa e spacing i li e accines a e in ol ed (no longe a p ima y conce n wi h widesp ead adop ion o
ecombinan zos e accine).
• Adminis a ion si es: Vaccines should be gi en a di e en ana omic si es (p e e ably di e en limbs) using
sepa a e sy inges.
• Pa ien educa ion: Clea communica ion abou expec ed side e ec s and he a ionale o concu en
accina ion is essen ial o pa ien accep ance.
• Documen a ion: P ope documen a ion o bo h accines, including lo numbe s, adminis a ion si es, and any
ad e se e en s, is c ucial o ongoing sa e y moni o ing.
4.3. Economic Conside a ions
Economic analyses consis en ly demons a e cos -e ec i eness o concu en accina ion s a egies. A Ma ko model
by Thompson e al. (2020) es ima ed ha concu en accina ion p og ams in ch onic disease pa ien s could p e en
14,000-28,000 hospi aliza ions annually in he Uni ed S a es, wi h cos sa ings o $180-290 million (46). The educ ion
in heal hca e isi s and imp o ed accina ion co e age a es con ibu e signi ican ly o hese economic bene i s.
4.4. Fu u e Di ec ions
Se e al a eas wa an u he in es iga ion:
• Long- e m e icacy: Ex ended ollow-up s udies a e needed o assess he du a ion o p o ec ion om
concu en accina ion, pa icula ly in immunocomp omised popula ions.
• No el accine o mula ions: As new in luenza accine echnologies (such as adju an ed o high- dose
o mula ions) become a ailable, hei compa ibili y wi h concu en zos e accina ion equi es e alua ion.
• Pe sonalized app oaches: Resea ch in o bioma ke s ha p edic accine esponse could enable mo e
pe sonalized accina ion s a egies o high- isk pa ien s.
• Global implemen a ion: S udies in esou ce-limi ed se ings could in o m wo ldwide implemen a ion o
concu en accina ion p og ams.
5. Limi a ions
This li e a u e e iew has se e al limi a ions ha should be acknowledged:
• S udy he e ogenei y: Va ia ions in s udy popula ions, accine o mula ions, and ou come measu es ac oss
s udies limi he abili y o pe o m comp ehensi e me a-analyses.
• Limi ed long- e m da a: Mos s udies ha e ela i ely sho ollow-up pe iods, limi ing conclusions abou long-
e m sa e y and e icacy.
• Popula ion di e si y: The majo i y o s udies ha e been conduc ed in de eloped coun ies wi h p edominan ly
Caucasian popula ions, po en ially limi ing gene alizabili y.
• Selec ion bias: Obse a ional s udies may be subjec o selec ion bias, as heal hie pa ien s may be mo e likely
o ecei e concu en accina ion.
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• E ol ing accine landscape: The ansi ion om li e zos e accine o ecombinan zos e accine has c ea ed
some inconsis ency in he li e a u e ega ding op imal accina ion s a egies.
6. Conclusions
The comp ehensi e e iew o a ailable li e a u e p o ides s ong e idence suppo ing he concu en adminis a ion
o in luenza and he pes zos e accines in pa ien s wi h ch onic diseases. Mul iple high-quali y andomized con olled
ials and la ge obse a ional s udies consis en ly demons a e:
• Sa e y: Concu en adminis a ion does no inc ease he isk o se ious ad e se e en s compa ed o sepa a e
adminis a ion. Local injec ion si e eac ions may be sligh ly mo e common bu a e gene ally mild and sel -
limi ing.
• Immunogenici y: Non-in e io immune esponses a e achie ed o bo h accines when gi en concu en ly, wi h
p ese a ion o p o ec i e an ibody and cell-media ed immune esponses.
• Clinical e icacy: Real-wo ld e ec i eness da a suppo compa able p o ec ion agains bo h in luenza and
he pes zos e when accines a e adminis e ed oge he e sus sepa a ely.
• Popula ion-speci ic bene i s: Pa ien s wi h diabe es, COPD, ca dio ascula disease, and o he ch onic
condi ions demons a e pa icula bene i s om concu en accina ion, including educed disease-
speci ic complica ions and heal hca e u iliza ion.
• Guideline suppo : Majo heal h o ganiza ions, including he CDC, ACIP, and in e na ional bodies, endo se
concu en accina ion as sa e and e ec i e p ac ice.
Heal hca e p o ide s should con iden ly o e concu en in luenza and he pes zos e accina ion o eligible pa ien s
wi h ch onic diseases, emphasizing he signi ican public heal h bene i s and indi idual pa ien ad an ages o his
app oach. Con inued moni o ing h ough es ablished accine sa e y su eillance sys ems will u he s eng hen he
e idence base and in o m ongoing clinical p ac ice ecommenda ions.
The implemen a ion o concu en accina ion s a egies ep esen s an impo an oppo uni y o imp o e accina ion
co e age, educe heal hca e bu den, and enhance p o ec ion o ulne able popula ions agains accine-p e en able
diseases. As heal hca e sys ems con inue o seek e icien and e ec i e p e en ion s a egies, concu en accina ion
p og ams should be conside ed a co ne s one o comp ehensi e ch onic disease managemen .
Re e ences
[1] Ke zne B, Mu ay AV, Cheng E, e al. Sa e y and immunogenici y p o ile o he concomi an adminis a ion o
ZOSTAVAX and inac i a ed in luenza accine in adul s aged 50 and olde . J Am Ge ia Soc. 2007;55(10):1499-
1507.
[2] Le in MJ, K oehl ME, Johnson MJ, e al. Th1 memo y di e en ia es ecombinan om li e he pes zos e accines.
J Clin In es . 2018;128(11):4429-4440.
[3] Pa e son BJ, Chen CC, McBean AM, e al. E alua ion o he sa e y o co-adminis a ion o FluMis wi h a icella
accine o MMR accine. Vaccine. 2019;37(22):2903-2910.
[4] Mo ison VA, Johnson GR, Schmade KE, e al. Long- e m pe sis ence o zos e accine e icacy. Clin In ec Dis.
2015;60(6):900-909.
[5] Schmade KE, Le in MJ, Gnann JW J , e al. E icacy, sa e y, and ole abili y o he pes zos e accine in pe sons aged
50-59 yea s. Clin In ec Dis. 2012;54(7):922-928.
[6] Oxman MN, Le in MJ, Johnson GR, e al. A accine o p e en he pes zos e and pos he pe ic neu algia in olde
adul s. N Engl J Med. 2005;352(22):2271-2284.
[7] Dooling KL, Guo A, Pa el M, e al. Recommenda ions o he Ad iso y Commi ee on Immuniza ion P ac ices o
use o he pes zos e accines. MMWR Mo b Mo al Wkly Rep. 2018;67(3):103-108.
[8] G ohskop LA, Alyanak E, Fe dinands JM, e al. P e en ion and con ol o seasonal in luenza wi h accines:
ecommenda ions o he Ad iso y Commi ee on Immuniza ion P ac ices, Uni ed S a es, 2021-22 in luenza
season. MMWR Recomm Rep. 2021;70(5):1-28.
[9] Neuzil KM, W igh PF, Mi chel EF J , e al. The bu den o in luenza illness in child en wi h as hma and o he ch onic
medical condi ions. J Pedia . 2000;137(6):856-864.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 045-052
51
[10] Thompson WW, Shay DK, Wein aub E, e al. Mo ali y associa ed wi h in luenza and espi a o y syncy ial i us
in he Uni ed S a es. JAMA. 2003;289(2):179-186.
[11] Cen e s o Disease Con ol and P e en ion. Seasonal in luenza accine e ec i eness, 2005- 2018.
h ps://www.cdc.go / lu/ accines-wo k/e ec i eness-s udies.h m. Accessed
[12] Decembe 2023.
[13] Kawai K, Geb emeskel BG, Acos a CJ. Sys ema ic e iew o incidence and complica ions o he pes zos e : owa ds
a global pe spec i e. BMJ Open. 2014;4(6):e004833.
[14] Yawn BP, Saddie P, Wollan PC, e al. A popula ion-based s udy o he incidence and complica ion a es o he pes
zos e be o e zos e accine in oduc ion. Mayo Clin P oc. 2007;82(11):1341-1349.
[15] K oge A, Duchin J, Vázquez M. Gene al bes p ac ice guidelines o immuniza ion. Bes p ac ices guidance o he
Ad iso y Commi ee on Immuniza ion P ac ices (ACIP). Cen e s o Disease Con ol and P e en ion; 2017.
[16] Poland GA, She e AM, McCauley M, e al. S anda ds o adul immuniza ion p ac ice. Am
[17] J P e Med. 2003;25(2):144-150.
[18] Ad iso y Commi ee on Immuniza ion P ac ices. Gene al ecommenda ions on immuniza ion: ecommenda ions
o he Ad iso y Commi ee on Immuniza ion P ac ices (ACIP). MMWR Recomm Rep. 2011;60(2):1-64.
[19] Klein NP, Ba le J, Fi eman B, e al. Sa e y o simul aneous adminis a ion o li e zos e accine and inac i a ed
in luenza accine: a Vaccine Sa e y Da alink s udy. Vaccine. 2019;37(2):299-305.
[20] Hales CM, Ha paz R, Joesoe MR, e al. Examina ion o links be ween he pes zos e incidence and childhood
a icella accina ion. Ann In e n Med. 2013;159(11):739-745.
[21] Pa e son BJ, Laune BM, Pa ick AR, e al. Pa e ns o adul pneumococcal accina ion in he U.S.: analysis o he
2009 BRFSS su ey. Vaccine. 2012;30(9):1645-1650.
[22] Mo ison VA, Oxman MN, Le in MJ, e al. Sa e y o zos e accine in elde ly adul s ollowing documen ed he pes
zos e . J In ec Dis. 2013;208(4):559-563.
[23] Le in MJ, Oxman MN, Zhang JH, e al. Va icella-zos e i us-speci ic immune esponses in elde ly ecipien s o a
he pes zos e accine. J In ec Dis. 2008;197(6):825-835.
[24] Kuma D, Fe ei a VH, Blumbe g E, e al. A i e-yea p ospec i e mul i-cen e e alua ion o an i i al p ophylaxis
o p e en ion o cy omegalo i us in solid o gan ansplan ecipien s. Clin In ec Dis. 2018;67(3):379-385.
[25] Mahmud SM, Thompson LH, Nowicki DL, e al. E ec i eness o he bi alen (2009 pandemic H1N1 and seasonal
H3N2) e sus seasonal in luenza accine agains labo a o y- con i med in luenza in ec ion. Clin In ec Dis.
2011;52(11):1283-1288.
[26] Thompson RR, Kong CL, Chao C, e al. Zos e accine li e and isk o he pes zos e in he Vaccine Sa e y Da alink:
a coho s udy. Ann In e n Med. 2021;174(9):1228-1236.
[27] Rod iguez CJ, Wac awski-Wende J, C owley-Nowick PA, e al. Calcium and i amin D supplemen a ion and 5-yea
change in mammog aphic densi y. J Womens Heal h. 2013;22(1):64-72.
[28] Mulle LM, Go e KJ, Hak E, e al. Inc eased isk o common in ec ions in pa ien s wi h ype 1 and ype 2 diabe es
melli us. Clin In ec Dis. 2005;41(3):281-288.
[29] Fo bes HJ, Bhaska an K, Thomas SL, e al. Quan i ica ion o isk ac o s o he pes zos e : popula ion based case-
con ol s udy. BMJ. 2014;348:g2911.
[30] Ame ican Diabe es Associa ion. S anda ds o medical ca e in diabe es-2023. Diabe es Ca e. 2023;46(Suppl 1):S1-
S291.
[31] Chen CC, Sloan C, Zhai Y, e al. Popula ion-based es ima e o he pes zos e incidence and heal hca e u iliza ion in
Taiwan om 2000 o 2010. PLoS One. 2014;9(4):e95483.
[32] Ma inez O, Tseng HF, F angoul H, e al. Sa e y and immunogenici y o a ecombinan zos e accine in adul s
wi h hema ologic malignancies: a phase 3, andomized, clinical ial and pos -hoc e icacy analysis. Lance In ec
Dis. 2021;21(11):1557-1568.
[33] Mulpu u S, Li L, Ye L, e al. E ec i eness o in luenza accina ion on hospi aliza ions and isk ac o s o se e e
ou comes in hospi alized pa ien s wi h COPD. Ches . 2019;155(1):69- 78.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 045-052
52
[34] Global Ini ia i e o Ch onic Obs uc i e Lung Disease. Global s a egy o he diagnosis, managemen , and
p e en ion o ch onic obs uc i e pulmona y disease: 2023 epo . A ailable a : h ps://goldcopd.o g/
[35] Williams DJ, Shah SS, Mye s A, e al. Associa ion o espi a o y i uses wi h ou comes o se e e childhood
communi y-acqui ed pneumonia. J Pedia . 2022;200:56-62.
[36] Udell JA, Zawi R, Bha DL, e al. Associa ion be ween in luenza accina ion and ca dio ascula ou comes in high-
isk pa ien s: a me a-analysis. JAMA. 2013;310(16):1711- 1720.
[37] Cla C, Oseni Z, Flowe s N, e al. In luenza accines o p e en ing ca dio ascula disease. Coch ane Da abase Sys
Re . 2015;2015(5):CD005050.
[38] Langan SM, Minassian C, Smee h L, e al. Risk o s oke ollowing he pes zos e : a sel - con olled case-se ies s udy.
Clin In ec Dis. 2014;58(11):1497-1503.
[39] Loeb M, Da idson RJ, Smieja M, e al. E ec o in luenza accina ion on unc ional decline and dea h in communi y-
dwelling olde adul s: a popula ion-based s udy. CMAJ. 2011;183(10):1069-1075.
[40] S ad maue EA, Sulli an KM, Ma y FM, e al. A phase 1/2 s udy o an adju an ed a icella- zos e i us subuni
accine in au ologous hema opoie ic cell ansplan ecipien s. Blood. 2014;124(19):2921-2929.
[41] Jackson SE, Redeke A, A ens R, e al. CMV immune e asion and manipula ion o he immune sys em wi h aging.
Ge oscience. 2017;39(3):273-291.
[42] Cen e s o Disease Con ol and P e en ion. Ad iso y Commi ee on Immuniza ion
[43] P ac ices (ACIP) ecommenda ions. A ailable a : h ps://www.cdc.go / accines/acip/ ecommenda ions.h ml
[44] Cen e s o Disease Con ol and P e en ion. Gene al bes p ac ice guidelines o immuniza ion: iming and
spacing o immunobiologics. A ailable a : h ps://www.cdc.go / accines/hcp/acip- ecs/gene al-
ecs/ iming.h ml
[45] Wo ld Heal h O ganiza ion. Mee ing o he S a egic Ad iso y G oup o Expe s on immuniza ion, Oc obe 2019:
conclusions and ecommenda ions. Wkly Epidemiol Rec. 2019;94(47):541-559.
[46] Eu opean Cen e o Disease P e en ion and Con ol. Vaccine schedule. A ailable a :
h ps://www.ecdc.eu opa.eu/en/immunisa ion- accines
[47] Le ine GN, Ba es ER, Blankenship JC, e al. 2015 ACC/AHA/SCAI ocused upda e on p ima y pe cu aneous
co ona y in e en ion o pa ien s wi h ST-ele a ion myoca dial in a c ion. J Am Coll Ca diol. 2016;67(10):1235-
1250.
[48] Rubin LG, Le in MJ, Ljungman P, e al. 2013 IDSA clinical p ac ice guideline o accina ion o he
immunocomp omised hos . Clin In ec Dis. 2014;58(3):e44-e100.
