Drug Interaction Report

ADJUST DOSING INTERVAL: Administration of vaccinia immune globulin intravenous, human (VIGIV) with, or shortly before, or shortly after live viral vaccines may impair the immune response to the vaccination(s). Injected live, attenuated virus vaccines, particularly measles/mumps/rubella (MMR), measles/mumps/rubella/varicella (MMRV), or monovalent varicella, may be affected by circulating antibodies present in VIGIV. 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 (Ig) preparations or blood products and the yellow fever vaccine, some live oral vaccines (e.g., rotavirus, typhoid), the live attenuated influenza vaccine (LAIV), and the Bacille Calmette-Guerin (BCG) vaccine. As this interaction is dependent upon the antibodies present in VIGIV, it may be affected by the source used to develop the VIGIV product. Additionally, the vaccinations impacted may vary from country to country. Data on the immunogenicity and safety of all vaccinations (e.g., dengue vaccine) given concurrently with or shortly before or after the administration of VIGIV are not available.

MANAGEMENT: Immunization with live virus vaccines should be deferred until approximately 3 months after the administration of VIGIV. People who received VIGIV shortly after live virus vaccination should be revaccinated 3 months after the administration of the Ig. In general, most immunization guidelines indicate that live virus vaccines can be safely administered 2 to 3 weeks prior to Ig products. Local immunization guidelines and prescribing information for the specific products involved should be consulted for further recommendations.

ADJUST DOSING INTERVAL: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.