Drug Interactions between mumps virus vaccine / rubella virus vaccine and RhoGAM

ADJUST DOSING INTERVAL: Administration of immune globulin preparations with, shortly before, or after live vaccines may impair the immune response to the vaccination(s). Injected live, attenuated virus vaccines (e.g., measles/mumps/rubella (MMR), measles/mumps/rubella/varicella (MMRV), monovalent varicella) may be affected by circulating antibodies present in immune globulin therapy or other blood products. The passive transfer of these antibodies may prevent replication of the vaccine virus, potentially reducing the vaccine's efficacy. In general, there appears to be minimal to no interaction between immune globulin preparations or blood products and the yellow fever vaccine, some live oral vaccines (e.g., rotavirus vaccine, oral typhoid vaccine), the live attenuated influenza vaccine (LAIV) and the Bacille Calmette-Guerin (BCG) vaccine. As this interaction is dependent upon the antibodies present in the immune globulin or blood product, it may be affected by the source used to create the product. Additionally, the vaccinations impacted may vary from country to country. Data on the immunogenicity and safety of all vaccinations (e.g., dengue vaccine, live attenuated oral cholera vaccine) after the administration of all different immune globulin preparations is not available.

MANAGEMENT: In general, administration of a live vaccine should be delayed until the passive antibody received from the immune globulin product has degraded, which can be product- and dose-dependent. 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 have exceptions to this general rule and other specific recommendations. According to the Advisory Committee on Immunization Practices (ACIP), measles- and varicella-containing vaccines may be administered either 2 weeks prior to or anywhere from 3 to 11 months after the receipt of an antibody-containing product, depending on the product and dosage regimen in question. They also recommend against delaying MMR, MMRV, or varicella vaccination in postpartum women who received anti-Rho(D) globulin or any other blood product during the last trimester of pregnancy or at delivery. 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 immune globulin preparations. Local guidelines and prescribing information for the products involved should be consulted for further recommendations.

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ADJUST DOSING INTERVAL: Administration of immune globulin preparations with, shortly before, or after live vaccines may impair the immune response to the vaccination(s). Injected live, attenuated virus vaccines (e.g., measles/mumps/rubella (MMR), measles/mumps/rubella/varicella (MMRV), monovalent varicella) may be affected by circulating antibodies present in immune globulin therapy or other blood products. The passive transfer of these antibodies may prevent replication of the vaccine virus, potentially reducing the vaccine's efficacy. In general, there appears to be minimal to no interaction between immune globulin preparations or blood products and the yellow fever vaccine, some live oral vaccines (e.g., rotavirus vaccine, oral typhoid vaccine), the live attenuated influenza vaccine (LAIV) and the Bacille Calmette-Guerin (BCG) vaccine. As this interaction is dependent upon the antibodies present in the immune globulin or blood product, it may be affected by the source used to create the product. Additionally, the vaccinations impacted may vary from country to country. Data on the immunogenicity and safety of all vaccinations (e.g., dengue vaccine, live attenuated oral cholera vaccine) after the administration of all different immune globulin preparations is not available.

MANAGEMENT: In general, administration of a live vaccine should be delayed until the passive antibody received from the immune globulin product has degraded, which can be product- and dose-dependent. 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 have exceptions to this general rule and other specific recommendations. According to the Advisory Committee on Immunization Practices (ACIP), measles- and varicella-containing vaccines may be administered either 2 weeks prior to or anywhere from 3 to 11 months after the receipt of an antibody-containing product, depending on the product and dosage regimen in question. They also recommend against delaying MMR, MMRV, or varicella vaccination in postpartum women who received anti-Rho(D) globulin or any other blood product during the last trimester of pregnancy or at delivery. 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 immune globulin preparations. Local guidelines and prescribing information for the products involved should be consulted for further recommendations.

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