Vivotif (typhoid vacc,live,attenuated)
Typhoid Vaccine Oral Capsule,Delayed Release (Enteric Coated)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Typhoid vaccine is available as an oral live, attenuated vaccine (typhoid vaccine live oral Ty21a; Vivotif(R)) and a parenteral inactivated Vi polysaccharide vaccine (typhoid Vi polysaccharide vaccine; Typhim Vi(R)).
Typhoid vaccines stimulate active immunity to typhoid fever in individuals at high risk of exposure to Salmonella enterica serovar Typhi.
Response to Typhoid Vaccine Live Oral Ty21a
The exact mechanism by which typhoid vaccine live oral Ty21a elicits an immune response is not known; however, the oral vaccine is thought to produce a local immune response in the GI tract. Seroconversion rates in healthy US adults following primary immunization with 3 doses of typhoid vaccine live oral Ty21a are similar to those attained in residents of typhoid-endemic areas. Following ingestion, virulent strains of Salmonella Typhi can pass through the stomach acid barrier, colonize the intestinal tract, penetrate the intestinal lumen, and enter the lymphatic system and blood stream, resulting in infection.
It has been suggested that oral administration of typhoid vaccine containing a live, attenuated strain of the bacilli may elicit a local immune response in the intestinal tract while undergoing an aborted infection, with resultant protection against subsequent infection with a virulent strain. However, the ability of Salmonella Typhi to elicit a protective immune response depends on possession by the bacilli of a complete lipopolysaccharide. The ability of the live, attenuated strain present in the oral typhoid vaccine to produce a complete lipopolysaccharide is limited since this strain is deficient in enzymes essential for lipopolysaccharide biosynthesis; however, sufficient complete lipopolysaccharide apparently is produced to elicit an adequate immune response.
In addition, despite low levels of lipopolysaccharide biosynthesis by the vaccine strain, sufficient quantities of intermediates of this synthesis accumulate and induce cell lysis before the organism can gain a virulent phenotype.
In a series of field trials in Chile, efficacy of the live, attenuated vaccine (as enteric-coated capsules) given as a 1- or 2-dose regimen in school-aged children was 21 or 54%, respectively, after 33 months of surveillance. When a 3-dose regimen (as enteric-coated capsules) was administered on alternate days (short-schedule immunization) or 21 days apart (long-schedule immunization) in Chilean school-age children, vaccine efficacy was 67 or 49%, respectively, after 36 months of surveillance; after 48 months, efficacy of the short-schedule immunization was 69%. The level of immune protection was undiminished during the fifth year of surveillance.
Experience in individuals from areas without endemic disease (e.g., US residents) who travel to endemic regions also is limited, but seroconversion rates reported following a 3-dose primary immunization series with the live, attenuated vaccine in such individuals are comparable to those in residents of endemic areas. Because of the low incidence of typhoid fever in the US, efficacy studies are not possible in this population; however, evidence from antibody-titer studies suggests that the live, attenuated vaccine will provide protection to vaccine recipients residing in nonendemic areas such as the US. The duration of response after primary immunization with typhoid vaccine live oral Ty21a has not been established.
Response to Typhoid Vi Polysaccharide Vaccine
Administration of typhoid Vi polysaccharide vaccine stimulates immunity to Salmonella Typhi by inducing production of antibodies to the Vi antigen. Antibodies to the Vi antigen confer protection against typhoid fever. IM administration of a single dose of typhoid Vi polysaccharide vaccine in most healthy adults and children 2 years of age or older generally results in a 4-fold or greater increase in serum antibodies specific for the Vi antigen within 4 weeks.
Results of several US studies indicate that a single 25-mcg dose of Vi polysaccharide vaccine results in a 4-fold or greater increase in serum antibodies in 88-96% of healthy adults. Because baseline antibody titers from individuals from typhoid-endemic areas (i.e., Nepal, South Africa, Indonesia) indicate prior exposure to Salmonella Typhi, vaccine-induced antibody response in these individuals differs from that produced in ''typhoid naive'' populations (e.g., most travelers from the US). In studies conducted in Nepal, administration of a single 25-mcg dose of typhoid Vi polysaccharide vaccine in children 5-14 years of age, adolescents and adults 15-44 years of age, or adults 45-55 years of age produced a 4-fold or greater increase in antibody titers within 4 weeks in approximately 77, 79, or 63% of individuals, respectively.
A single 25-mcg dose of the vaccine produced a 4-fold or greater increase in serum antibodies within 4 weeks in about 96% of Indonesian children aged 2-5 years of age. The titer of antibody that is protective against typhoid has not been determined to date.
Limited evidence indicates that antibody titers against the Vi antigen remain elevated for at least 12 months following administration of typhoid Vi polysaccharide vaccine in children 5-15 years of age residing in typhoid-endemic areas and for at least 36 months in healthy US adults. Administration of an additional dose of typhoid Vi polysaccharide vaccine in healthy US adults 27-34 months after the initial dose produces antibody titers comparable to those obtained following the primary dose.
Efficacy of a single 25-mcg dose of typhoid Vi polysaccharide vaccine in preventing typhoid fever has been demonstrated in a series of field trials in typhoid-endemic areas. In a trial in Nepal in individuals 5-44 years of age, those who received the vaccine had 74% fewer cases of culture-confirmed Salmonella Typhi infection over a 20-month period follow-up period. Surveillance in immunized South African children indicated that vaccine efficacy was 61, 52, or 50% after 1, 2, or 3 years; overall vaccine efficacy was 55%.
USES: This vaccine is used to help prevent typhoid fever. Typhoid fever is an infection that can be spread by eating contaminated food or drinking contaminated water. This vaccine is recommended for people who are traveling to areas where the infection is common (such as Africa, Asia, Central/South America), those who are in close contact to someone with an ongoing typhoid infection, and those who work with the bacteria (Salmonella typhi) in a lab.
This vaccine contains live bacteria that have been weakened. It works by increasing the body's natural defense (immunity) against the bacteria. Vaccines may not fully protect everyone who receives them.
Generic name: typhoid vacc,live,attenuated
Pronunciation: (tye-FOYD vak-SEEN)
Drug class: Typhoid Vaccine
Therapeutic class: Biologicals
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Vivotif
Indications
The following indications are listed for Vivotif:
- Typhoid Vaccination
Also known as: Active Immunization Against Salmonella Typhi, Active Immunization For The Prevention Of Typhoid Fever, Typhoid Prevention.
Dosing
Dosing schedules (i.e., number of doses, timing prior to potential exposure to typhoid fever) differ between typhoid vaccine live oral Ty21a and typhoid Vi polysaccharide vaccine. Dosage recommendations for the specific preparation used should be followed.
Typhoid vaccine live oral Ty21a is administered orally.
Typhoid Vi polysaccharide vaccine is administered by IM injection.
| Drug label | Dosing type | Instructions |
|---|---|---|
| Vivotif Ec Capsule | Maintenance | Take 1 capsule by oral route every other day for 8 days. |
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Live Typhoid Vaccine/Antimicrobials
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)
CLINICAL EFFECTS: Vaccination may be ineffective.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)
DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)
Live Vaccines/Bevacizumab
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Systemic bevacizumab suppresses the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines. Immune response to vaccines may be decreased during periods of immunocompromise.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency. Intravitreal injections of small doses of bevacizumab for macular degeneration or macular edema are not expected to suppress immune function.
PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) Intravitreal injections of small doses of bevacizumab for macular degeneration or macular edema are not expected to suppress immune function. For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1)
Live Vaccines/Rebisufligene Etisparvovec
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Rebisufligene etisparvovec therapy may suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines. Immune response to vaccines may be decreased during periods of immunocompromise.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained.(1) The vaccine may result in illness.(1,2)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer of rebisufligene etisparvovec states that vaccines should be avoided 30 days prior to rebisufligene etisparvovec administration.(1)
DISCUSSION: Rebisufligene etisparvovec therapy may pose a risk for vaccine-derived infections and decrease the effectiveness of vaccines.(1)
Live Vaccines/Vusolimogene Oderparepvec
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: The interaction potential of live virus vaccines with vusolimogene oderparepvec is unknown.
CLINICAL EFFECTS: Concurrent administration of live vaccines with vusolimogene oderparepvec may alter the effectiveness or toxicities of either agent.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The manufacturer of vusolimogene oderparepvec states that vaccines containing live attenuated viruses should be avoided during vusolimogene oderparepvec therapy.(2) Patients should be advised that their cancer gene therapy may be delayed due to administration of vaccines.(3)
DISCUSSION: The concomitant use of live attenuated vaccines and vusolimogene oderparepvec has not been evaluated. The manufacturer's recommendation is based on vaccine guidance used in clinical trials.(2)
Live Vaccines; Live Bcg/Selected Immunosuppressive Agents
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: A variety of disease modifying agents suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(2)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1) Patients who receive anti-B cell therapies should not receive live vaccines for at least 6 months after such therapies due to a prolonged duration of immunosuppression. An exception is the Zoster vaccine, which can be given at least 1 month after receipt of anti-B cell therapies.(1) The US manufacturer of abatacept states live vaccines should not be given during or for up to 3 months after discontinuation of abatacept.(2) The US manufacturer of live BCG for intravesicular treatment of bladder cancer states use is contraindicated in immunosuppressed patients.(3) The US manufacturer of daclizumab states live vaccines are not recommended during and for up to 4 months after discontinuation of treatment.(4) The US manufacturer of guselkumab states that live vaccines should be avoided during treatment with guselkumab.(5) The US manufacturer of inebilizumab-cdon states that live vaccines are not recommended during treatment and after discontinuation until B-cell repletion. Administer all live vaccinations at least 4 weeks prior to initiation of inebilizumab-cdon.(6) The US manufacturer of ocrelizumab states that live vaccines are not recommended during treatment and until B-cell repletion occurs after discontinuation of therapy. Administer all live vaccines at least 4 weeks prior to initiation of ocrelizumab.(7) The US manufacturer of ozanimod states that live vaccines should be avoided during and for up to 3 months after discontinuation of ozanimod.(8) The US manufacturer of siponimod states that live vaccines are not recommended during treatment and for up to 4 weeks after discontinuation of treatment.(9) The US manufacturer of ustekinumab states BCG vaccines should not be given in the year prior to, during, or the year after ustekinumab therapy.(10) The US manufacturer of satralizumab-mwge states that live vaccines are not recommended during treatment and should be administered at least four weeks prior to initiation of satralizumab-mwge.(11) The US manufacturer of ublituximab-xiiy states that live vaccines are not recommended during treatment and until B-cell recovery. Live vaccines should be administered at least 4 weeks prior to initiation of ublituximab-xiiy.(12) The US manufacturer of etrasimod states that live vaccines should be avoided during and for 5 weeks after treatment. Live vaccines should be administered at least 4 weeks prior to initiation of etrasimod.(13) The US manufacturer of emapalumab-lzsg states that live vaccines should not be administered to patients receiving emapalumab-lzsg and for at least 4 weeks after the last dose of emapalumab-lzsg. The safety of immunization with live vaccines during or following emapalumab-lzsg therapy has not been studied.(14) The US manufacturer of sibeprenlimab-szsi states live vaccines should not be given within 30 days prior to initiation or during treatment with sibeprenlimab-szsi.(15)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1)
Vaccines/Pariglasgene Brecaparvovec
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Pariglasgene brecaparvovec therapy may decrease the effectiveness of vaccines. The mechanism is not known.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer of pariglasgene brecaparvovec states that vaccines should be avoided for 1 month prior to pariglasgene brecaparvovec administration.(1)
DISCUSSION: Pariglasgene brecaparvovec therapy may decrease the effectiveness of vaccines.(1)
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Live Vaccines/Brensocatib
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Brensocatib may suppress the immune system by inhibiting dipeptidyl peptidase-1 (DPP-1). Brensocatib prevents the activation of neutrophil serine proteases (NSPs) during neutrophil maturation in the bone marrow.(1) Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines. Immune response to vaccines may be decreased during periods of immunocompromise.(2)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained. The vaccine may result in illness. Immune response to live vaccines may be decreased during periods of immunocompromise.(2)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: The coadministration of live vaccines and brensocatib should be avoided.(1) The Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live-attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(2)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(2) The concomitant use of live attenuated vaccines and brensocatib has not been evaluated. Brensocatib may suppress the immune system by inhibiting dipeptidyl peptidase-1 (DPP-1).(1)
Live Vaccines/Leniolisib
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Leniolisib modifies the immune system. Immune response to live vaccines may be decreased during treatment with leniolisib.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained.(1)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: The manufacturer of leniolisib states live, attenuated vaccinations may be less effective if administered during leniolisib treatment.(1)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1)
Live Vaccines/Methotrexate (Low Strength Injection, Oral)
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: A variety of disease modifying agents such as methotrexate suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines. Immune response to vaccines may be decreased during periods of immunocompromise.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) CDC recommendations for zoster vaccine state it may be administered to patients receiving methotrexate if the dose is < or = to 0.4 mg/kg/week for treatment of rheumatoid arthritis, psoriasis, inflammatory bowel disease or other conditions.(1) For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1)
Live Vaccines/Systemic Corticosteroids; Corticotropin (Acth)
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Corticosteroids and corticotropin suppress the immune system. In severely immunocompromised patients, virus replication after administration of live, attenuated-virus vaccines can be enhanced and/or the immune response to the vaccine may be decreased.(1)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1)
PREDISPOSING FACTORS: Patients receiving immunosuppressive doses of corticosteroids or corticotropin for equal to or greater than 14 consecutive days.(1)
PATIENT MANAGEMENT: The Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are severely immunosuppressed, including those who are receiving or have received high-dose, systemic steroids for greater than or equal to 14 consecutive days. Live vaccines should be deferred for at least 1 month after discontinuation of high-dose systemic steroids administered for 14 consecutive days. When initiating immunosuppressives doses of corticosteroids, wait 4 weeks after a live vaccines is administered. However, if patients require therapy for chronic inflammatory conditions, do not delay therapy due to past vaccines. Patients who are vaccinated within the 14 days prior to initiating immunosuppressive therapy should be considered unvaccinated and should be revaccinated at least 3 months after immunosuppressive therapy is discontinued.(1) The US manufacturer of corticotropin(2) and triamcinolone(3) and the Australian manufacturer of dexamethasone(4) state that administration of live or live-attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids or corticotropin. The manufacturer of deflazacort states that live or live-attenuated vaccines should be administered at least 4 to 6 weeks prior to initiation of therapy with deflazacort.(5)
DISCUSSION: Many clinicians consider a dose equivalent to either 2 mg/kg of body weight or a total of 20 mg/day of prednisone as sufficiently immunosuppressive to raise safety concerns about live-virus vaccines.(1) Immunization procedures may be undertaken in patients receiving corticosteroids when the therapy is short term (less than 2 weeks); low to moderate dose; long-term, alternate-day treatment with short-acting preparations; maintenance physiologic doses (replacement therapy); or administered topically (skin or eyes), by aerosol, or by intra-articular, bursal, or tendon injection.(1) Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1)
Live Vaccines/Tuberculin Testing
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Measles infection and severe acute and chronic infections may induce an anergic state resulting in a false-negative tuberculin test. The live measles vaccine, as well as other live vaccines (e.g. smallpox, varicella, yellow fever) theoretically may also suppress response to tuberculin testing, though the degree of suppression may be less than that expected from acute infection with wild-type virus.(1-4)
CLINICAL EFFECTS: Tuberculin testing that is performed more than one day but less than 28 days after administration of a live vaccine may result in a false negative tuberculin response. Tuberculin testing may be administered simultaneously with live vaccines.(1-4)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The CDC states that live vaccines (e.g. MMR and varicella) and tuberculin testing may be administered within one day of each other at separate administration sites. If it has been more than one day since tuberculin testing has been administered, the live vaccine can be given at any interval after the tuberculin test. However, if the live vaccine has been administered more than one day previously and tuberculin testing is indicated, tuberculin testing should be deferred for at least 4-6 weeks.(1-4)
DISCUSSION: Suppression of response to tuberculin testing has been observed following measles infection, live measles vaccination, and live smallpox vaccination. The degree of suppression after live virus vaccination is likely to be less than that from an acute infection with wild-type virus. There is no data on suppression of response to tuberculin testing with other live vaccines. In the absence of data, the CDC recommends tuberculin testing within one day that a live vaccine is administered. Otherwise the tuberculin test should be deferred for at least 4-6 weeks.(1-4)
Live Vaccines; Live Bcg/Hydroxyurea
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Hydroxyurea may suppress the immune system.(1) Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(2)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(2) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(3)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies), treatments (e.g. radiation) and cytotoxic drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: Recommendations for administration of live vaccines in patients on hydroxyurea are dependent on the indication. The US manufacturers of hydroxyurea recommend avoiding live vaccine use in patients taking hydroxyurea. Evaluate hematologic status prior to and during treatment with hydroxyurea. Provide supportive care and modify the dose or discontinue hydroxyurea as needed.(1) The Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician. Patients who are vaccinated within the 14 days prior to initiating immunosuppressive therapy should be considered unvaccinated and should be revaccinated at least 3 months after immunosuppressive therapy is discontinued.(2) The ACIP recommendations state that routine vaccinations patients with secondary immunodeficiency such as sickle cell disease are likely effective. Live viral and bacterial vaccines are contraindicated in patients with generalized malignant neoplasm, immunosuppressive, or radiation therapy, depending on immune status.(4)
DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(2) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(2) A multicenter, randomized, double-blind, placebo-controlled trial in infants and young children with sickle cell disease (BABY HUG) studied the response to pneumococcal and measles, mumps, and rubella vaccines in patients using hydroxyurea. The authors concluded that hydroxyurea does not appear to have significant deleterious effects on the immune function of infants and children with sickle cell disease. Additional assessments of lymphocyte parameters of hydroxyurea-treated children may be warranted. No changes in current immunization schedules are recommended; however, for endemic disease or epidemics, adherence to accelerated immunization schedules for the measles, mumps, and rubella vaccine should be reinforced.(5)
Live Vaccines; Live Bcg/Teplizumab
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Teplizumab may cause lymphopenia and suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(1,2)
CLINICAL EFFECTS: The expected serum antibody response may not be obtained. The vaccine may result in illness.(1,2) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(3)
PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency.
PATIENT MANAGEMENT: The Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live-attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) Vaccination should ideally precede the initiation of teplizumab therapy by 8 weeks. Live vaccines are not recommended within the 8 weeks prior to, during, or for 52 weeks after stopping teplizumab therapy.(2)
DISCUSSION: Vaccinations may be less effective if administered within 8 weeks before, during, and for 52 weeks following teplizumab therapy.(2) Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Typhoid Vaccine Live Attenuated/Mefloquine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Mefloquine may attenuate the immunization response to vaccines with attenuated live bacteria.(1)
CLINICAL EFFECTS: Concurrent use may make the vaccine ineffective.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The manufacturer of mefloquine states that administration of vaccines which contain attenuated live bacteria should be completed three days before the initiation of mefloquine.(1) To optimize vaccine effectiveness, the Centers for Disease Control(CDC) recommends, when feasible, delay of antibacterial drug therapy for one week after the last dose of oral typhoid vaccine.(2) The manufacturer of oral typhoid Ty21a vaccine states concomitant treatment with mefloquine does not significantly reduce immune response rate.(3)
DISCUSSION: The manufacturer of mefloquine states that attenuation of immunization response to vaccines with attenuated live bacteria cannot be excluded and therefore the manufacturer of mefloquine states that vaccinations with vaccines containing attenuated live bacteria should be completed three days before the initiation of mefloquine.(1)
Typhoid Vaccine Live Attenuated/Proguanil
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Proguanil may attenuate the immunization response to oral typhoid Ty21a vaccines.(1)
CLINICAL EFFECTS: Concurrent use may make the vaccine ineffective.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The manufacturer of oral typhoid Ty21a vaccine states concomitant treatment with proguanil significantly reduced immune response rate. Proguanil should not be administered until 10 days or more after the final dose of oral typhoid Ty21a vaccine.(1) To optimize vaccine effectiveness, the Centers for Disease Control (CDC) recommends, when feasible, delay of antibacterial drug therapy for at least 3 days after the last dose of oral typhoid vaccine.(2) Fixed dose combination therapy atovaquone/proguanil for malaria prophylaxis may be given concomitantly with oral typhoid Ty21a vaccine.(1)
DISCUSSION: The manufacturer of oral typhoid Ty21a vaccine states simultaneous administration of proguanil decreased the immune response rate to the oral typhoid vaccine. The manufacturer of oral typhoid Ty21a vaccine states that vaccination should be completed ten days before the initiation of proguanil.(1)
Vaccines/Hepatitis B Vaccine (Fendrix)
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: No data is available on the concurrent administration of the hepatitis B vaccine Fendrix and other vaccines.(1)
CLINICAL EFFECTS: It is unknown if concurrent administration of the hepatitis B vaccine Fendrix and other vaccines will affect the efficacy of either vaccine.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The Swedish manufacturer of Fendrix states that since there is no data available for the concurrent administration of Fendrix with other vaccines, the administration of Fendrix and other vaccines should be separated by 2 to 3 weeks.(1)
DISCUSSION: No data is available on the concurrent administration of the hepatitis B vaccine Fendrix with other vaccines.(1)
Contraindications
*Typhoid vaccine live oral Ty21a: Hypersensitivity to any component of the vaccine or the enteric-coated capsule.
*Typhoid Vi polysaccharide vaccine: Hypersensitivity to any component of the vaccine.
- Immunosuppression
- Pregnancy
- Chronic diarrhea
- Persistent vomiting
- High fever >101 degrees fahrenheit
Adverse reactions
In individuals who received 3 doses of typhoid vaccine live oral Ty21a, the most common adverse effects included abdominal pain (6.4%), nausea (5.8%), headache (4.8%), fever (3.3%), diarrhea (2.9%), vomiting (1.5%), and skin rash (1%), with only nausea occurring at a substantially higher rate than placebo.
Within the first 48 hours of vaccination with the typhoid Vi polysaccharide vaccine, the most common local adverse effects experienced in adults were tenderness (98%) and pain (40.7%); the most common systemic adverse effects included malaise (24%) and headache (20.4%). In children, local reactions such as soreness and pain were the most common, and occurred in 13 and 14.3% of children, respectively. Feverishness (a subjective feeling of fever) occurred in 2.9% of children, and was the most common systemic adverse effect.
Rare or Very Rare
- Anaphylaxis
Rare or Very Rare
- Abdominal pain with cramps
- Diarrhea
- Fever
- Nausea
- Skin rash
- Urticaria
- Vomiting
Precautions
No enhanced messaging available.
No enhanced messaging available.
Data are not available regarding use of typhoid vaccine live oral Ty21a or typhoid Vi polysaccharide vaccine in pregnant women. Animal reproduction studies have not been performed with either vaccine, and it is not known whether the vaccines can cause fetal harm or affect reproduction capacity when administered to pregnant women.
The manufacturer of typhoid vaccine live oral Ty21a states that the vaccine should be used during pregnancy only when clearly needed. ACIP states that live vaccines generally are contraindicated during pregnancy.
Typhoid Vi polysaccharide vaccine should be used during pregnancy only when clearly needed. The manufacturer suggests that delaying vaccination until the second or third trimester is a reasonable precaution to minimize the possibility of teratogenicity.
Data are not available regarding use of typhoid vaccine live oral Ty21a or typhoid Vi polysaccharide vaccine in nursing women. It is not known whether typhoid vaccine live oral Ty21a is distributed into human milk. ACIP states that, although live vaccines multiply in the body, most have not been shown to distribute into human milk.
It is not known whether typhoid Vi polysaccharide vaccine is distributed into human milk. The manufacturer recommends that the vaccine be used with caution in nursing women. Although specific data are not available, ACIP states that non-live vaccines pose no risk for mothers who are breast-feeding or their infants.
The manufacturer makes no specific dosage recommendations in geriatric patients.
Pharmacokinetics of typhoid vaccine live oral Ty21a or typhoid Vi polysaccharide vaccine have not been evaluated in geriatric patients.
ICD codes
| Code | Type | Description |
|---|---|---|
| Typhoid vaccination | ||
| Z23 | ICD10CM | Encounter for immunization |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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