Drug Interactions between cholera vaccine, live and typhoid vaccine, live

ADJUST DOSING INTERVAL: Coadministration of Ty21a typhoid vaccine (oral live, attenuated) gastroresistant capsule formulation (Vivotif) with the cholera vaccine (oral live, attenuated) (Vaxchora) may affect the transit of the typhoid vaccine through the gastrointestinal tract. Reduced typhoid vaccine efficacy may occur. The interaction has been attributed to the buffer in the cholera vaccine which may affect how the typhoid vaccine oral gastroresistant capsules move through the gastrointestinal tract. Upon oral administration, the oral typhoid vaccine must undergo limited replication in vivo to induce a protective immune response, and the buffer on the cholera vaccine may interfere with this process. According to the manufacturer of inactivated oral cholera vaccine (Dukoral), preliminary data from a clinical study that included a limited number of volunteers did not demonstrate an interaction with the antibody response to Dukoral when simultaneously administered with a live oral vaccine (enterocapsules) against typhoid. However, clinical data are not available with the cholera vaccine (oral live, attenuated) and the clinical significance is unclear.

MANAGEMENT: The US Centers for Disease Control and Prevention advises taking the first dose of Ty21a typhoid vaccine (oral live, attenuated) gastroresistant capsule formulation (Vivotif) at least 8 hours after the administration of the cholera vaccine (oral live, attenuated) (Vaxchora). Some authorities recommend an interval of at least 2 hours between the administration of these vaccines. Local guidelines and prescribing information for individual vaccines should also be consulted.