Drug Interactions between HyperTET S/D and poliovirus vaccine, live, trivalent

ADJUST DOSING INTERVAL: Administration of immune globulin (Ig) preparations concurrently with, shortly before, or shortly after a live viral vaccine may interfere with the immune response to the vaccination. Ig preparations often contain significant amounts of antibodies to infectious agents that are prevalent in the general population, such as measles or varicella zoster, due to natural disease or following vaccination. The passive transfer of these antibodies close to the administration of the vaccine may prevent replication of the vaccine virus and stimulation of immunity. Likewise, vaccine virus replication and stimulation of immunity generally occurs 1 to 2 weeks after vaccination with a live, attenuated viral vaccine. Receipt of an antibody-containing Ig preparation following immunization with a live, attenuated viral vaccine during this time frame could interfere with the stimulation of immunity. In general, there appears to be minimal to no interaction between Ig preparations or blood products and the yellow fever vaccine, some live oral vaccines (rotavirus, typhoid), the live, attenuated influenza vaccine (LAIV), and the Bacille Calmette-Guerin (BCG) vaccine. This interaction may be affected by the source used to create the Ig or blood product and the vaccinations impacted may vary from country to country. Data on the immunogenicity and safety of all vaccinations with, shortly before, or shortly after the administration of all the different Ig preparations are not available.

MANAGEMENT: In general, live, attenuated viral or bacterial vaccine administration should be separated from immune globulin (Ig) preparations by either delaying the vaccine until the passive antibodies received from the Ig product have degraded (product- and dose-dependent), or delaying the Ig product until the vaccine has stimulated immunity. If rapid protection is required, vaccination should proceed, but additional dose(s) of the vaccine and/or laboratory testing to ensure vaccine efficacy may be advised. Immunization guidelines vary by country and may include exceptions to this general rule, along with other specific recommendations. According to the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, measles- and varicella-containing vaccines may be administered either 2 weeks prior to, or 3 to 11 months following the receipt of an antibody-containing Ig product, with timing dependent upon the product and dosage administered. They also recommend against delaying measles, mumps, rubella (MMR), varicella (V), or MMRV vaccination in postpartum women who received anti-Rho(D) globulin or any other blood product during the last trimester of pregnancy or at delivery, though testing for immunity to rubella and/or measles at least 3 months after vaccination may be appropriate. In addition, administration of the dengue vaccine (including pre-vaccination testing) should be delayed by 12 months in those who have received blood products or other Ig preparations. Local guidelines and prescribing information for the products involved should be consulted for further recommendations.