Skip to main content

Unfortunately we don't fully support your browser. If you have the option to, please upgrade to a newer version or use Mozilla Firefox, Microsoft Edge, Google Chrome, or Safari 14 or newer. If you are unable to, and need support, please send us your feedback.

We'd appreciate your feedback.Tell us what you think!opens in new tab/window

Elsevier
Publish with us
Drug Monograph

Ebola Zaire Vaccine, Live

ERVEBO | Last revised on May 4, 2026

Read more

Indications/Dosage

  • Ebola virus (species Orthoebolavirus zairense) infection prophylaxis

General Dosing Information*

  • The duration of protection after vaccination is unknown.

  • The vaccine does not protect against other species of Orthoebolavirus or Orthomarburgvirus.

  • The effectiveness of the Ebola Zaire vaccine, live when administered concurrently with antiviral medication, immune globulin (IG), and/or blood or plasma transfusions is unknown.[64868]

  • In the United States, patients at the highest risk of potential occupational exposure to Ebola virus species Orthoebolavirus zairense should receive preexposure vaccination with Ebola Zaire vaccine. High risk patients include those responding to an outbreak of Ebola virus disease (EVD), working as health care personnel at federally designated Ebola treatment centers in the U.S., or laboratorians or other staff at biosafety level 4 facilities in the U.S.[66212]

For Ebola virus (species Orthoebolavirus zairense) infection prophylaxis*

Intramuscular dosage

Adults:

1 mL IM as a single dose.[64868] May administer a second dose at least 6 months after the first dose for those who are at a potential occupational risk for exposure to Ebola virus (species Zaire ebolavirus), including health care personnel at federally designated Ebola Treatment Centers or state-designated Special Pathogen Treatment Centers, laboratorians and support staff working at biosafety level 4 or Laboratory Response Network facilities, and responders expected to provide care for individuals with Ebola or be deployed to an outbreak area.[71642] [71643]

Children and Adolescents:

1 mL IM as a single dose.[64868]

Maximum Dosage Limits:*

•Adults

1 mL IM.

•Geriatric

1 mL IM.

•Adolescents

1 mL IM.

•Children

1 mL IM.

•Infants

Safety and efficacy have not been established.

•Neonates

Safety and efficacy have not been established.

Patients with Hepatic Impairment Dosing*

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Patients with Renal Impairment Dosing*

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

How Supplied

Ebola Zaire Vaccine, Live Suspension for injection

ERVEBO Vaccine Suspension for Injection (00006-4293) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.)

Description / Classification

Description

Ebola Zaire vaccine, live is a live, recombinant vaccine indicated for the prevention of disease caused by Orthoebolavirus zairense in adults and pediatric patients 1 year and older. Ebola virus disease (EVD) is contagious and transmitted through direct contact with blood, body fluids, and tissues of infected wild animals or people, as well as with surfaces and material, such as bedding and clothing contaminated with these fluids. Symptoms of EVD include fever, fatigue, muscle pain, headache, and sore throat. Symptom onset can be sudden, and the virus is often deadly. Cases of EVD are very low in the United States (US) and are usually the result of infections acquired while individuals are in other countries who then travel back to the U.S. Although Ebola is not common in the US, the US government is committed to fighting Ebola outbreaks in Africa; the approval of this vaccine helps to fight Ebola in close coordination with the US Department of Health and Human Services and the World Health Organization. The efficacy of the Ebola Zaire vaccine, live was tested in an open-label randomized cluster (ring) vaccination study during the 2014 Ebola outbreak in the Republic of Guinea. Patients were randomized to receive an "immediate" vaccination (n = 2,108) or a 21-day "delayed" vaccination (n = 1,429). Vaccine efficacy was 100%; no cases of confirmed EVD were observed in the immediate vaccination clusters, and 10 confirmed cases of EVD were observed in a total of 4 delayed vaccination clusters between Day 10 and Day 31 post-randomization. Ebola Zaire vaccine, live may not protect all vaccinated individuals and does not protect against viruses other than Orthoebolavirus zairense.[64868][64911]

Classification

  • General Anti-infectives Systemic

    • Vaccines

      • Pure Vaccines

        • Ebola Virus Vaccines

Administration Information

General Administration Information

For storage information, see the specific product information within the How Supplied section.

  • Verify immunization status in the state or local immunization information system in addition to the health care electronic record. If this vaccine has been previously given, question the patient, parent, or guardian about any symptoms or signs of an adverse reaction.[71206]

  • Advise individuals on the benefits and risks of the vaccine. Provide a copy of the Vaccine Information Statement (VIS).

  • Record manufacturer, lot number, administration date, and the name and address of the person administering the vaccine.

  • Ensure supportive care, including epinephrine 1 mg/mL injection, is readily accessible in the event of a clinically significant hypersensitivity reaction.

  • Complete a Vaccine Adverse Event Reporting System (VAERS) report if adverse events have been identified. The VAERS toll-free information line is 1-800-822-7967 and email address is [email protected].[65107]

Route-Specific Administration

  • Injectable Administration

    • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. The vaccine is a colorless to slightly brownish-yellow liquid with no particulates visible. If discoloration or visible particulate matter are present, discard the vaccine dose.[64868]

      • Do not mix with any other vaccine or product in the same syringe.

    • Intramuscular Administration

      • Preparation

        • Use the vaccine as supplied; no dilution or reconstitution is necessary.

        • Thaw vial at room temperature until no visible ice is present. Do NOT thaw the vial in a refrigerator.

        • Gently invert vial several times.

        • Use the vaccine immediately after thawing.

        • Withdraw a 1 mL dose from the vial using a sterile needle and sterile syringe. Discard unused portion.

        • Storage: If not used immediately after thawing, may store for up to 2 weeks refrigerated (2 to 8 degrees C [35.6 to 46.4 degrees F]) or up to 4 hours at room temperature (up to 25 degrees C [77 degrees F]) protected from light; do not refreeze.[64868]

        Intramuscular Injection

        • Inject intramuscularly.

        • Carefully observe patients for hypersensitivity or anaphylactic reactions after administration of the vaccine.[64868]

Adverse Reactions

Severe

  • anaphylactoid reactions

  • vasculitis

Moderate

  • erythema

  • oral ulceration

  • laboratory test interference

Mild

  • abdominal pain

  • anorexia

  • arthralgia

  • chills

  • diarrhea

  • dizziness

  • drowsiness

  • fatigue

  • fever

  • headache

  • inconsolable crying

  • injection site reaction

  • irritability

  • musculoskeletal pain

  • myalgia

  • nausea

  • vomiting

  • hyperhidrosis

  • paresthesias

  • pruritus

  • rash

  • vesicular rash

  • arthropathy

  • maculopapular rash

  • petechiae

  • purpura

  • viral shedding

Injection site reaction is 1 of the most common adverse reactions associated with the Ebola Zaire vaccine, live. Injection site pain (22% to 70%, adults; 26% to 52%, pediatrics), erythema/redness (1% to 12%, adults; 0.3% to 1%, pediatrics), swelling (2% to 17%, adults; 3% to 5%, pediatrics), and pruritus (3% to 7%, pediatrics) were reported during clinical trials. In 1 adult study, 29 patients (2.8%) reported injection-site pain of severe intensity.[64868]

Neurologic adverse reactions reported by patients who received the Ebola Zaire vaccine, live during clinical trials include headache (37% to 55%, adults; 4% to 59%, pediatrics), fatigue or drowsiness (19% to 26%, adults; 20% to 28%, pediatrics), dizziness (8% to 17%, pediatrics), and paresthesias (1.4%, adults). Irritability (1% to 11%) and crying (3% to 31%; screaming or inconsolable crying, 1% to 10%) were reported in pediatric patients during Ebola Zaire vaccine, live clinical trials. In individuals (age: 13 years and older) with HIV (n = 201), fatigue (2%) and headache (1.5%) were reported as a severe systemic reaction.[64868]

Arthralgia occurred in 7% to 40% of adult patients and 3% to 16% of pediatric patients who received the Ebola Zaire vaccine, live during blinded, placebo-controlled clinical trials. In an analysis across all adult studies, arthralgia was usually reported in the first few days after vaccination, was classified as mild to moderate intensity, and resolved within 1 week after onset. Severe arthralgia, defined as preventing daily activity, was reported in up to 3% of patients. Arthritis (including events of arthritis, joint effusion, joint swelling, osteoarthritis, monoarthritis, or polyarthritis) was reported in 0% to 24% of patients in blinded, placebo-controlled studies, with all but 1 study reporting arthritis in less than 5% of patients. Arthritis was usually reported within the first few weeks after vaccination, was of mild to moderate intensity, and resolved within several weeks after onset. In 1 study, 102 patients received the Ebola Zaire vaccine or a lower dose formulation. In this study, arthritis was reported in 24% of patients and severe arthritis, defined as preventing daily activity, was reported in 12% of patients. Joint effusion samples were obtained from 3 patients and all tested positive for vaccine virus RNA by RT-PCR. Of all 24 patients with arthritis, 6 patients reported recurrent or prolonged joint symptoms lasting up to 2 years after vaccination. Musculoskeletal pain or myalgia (30% to 33%, adults; 12% to 30%, pediatrics) and arthropathy (joint redness/warmth; 0.6%, adults) were also reported in patients treated with the Ebola Zaire vaccine, live during clinical trials. In individuals with HIV (n = 201), myalgia was reported as a severe systemic reaction in 1% of individuals (age: 13 and older).[64868]

Fever (34% to 39%, adults; 48% to 83%, pediatrics) was commonly reported during Ebola Zaire vaccine, live clinical trials. A fever of 38 degrees C or higher was reported in 6.4% to 7.5% of pediatric patients within 7 days after the first Ebola Zaire vaccine dose in clinical trials. Two serious adverse reactions of pyrexia were reported as vaccine-related in adult clinical trials. Decreases in lymphocytes (up to 85%) and neutrophils (up to 43%) were reported in clinical trials. No associated infections were reported. Hyperhidrosis/abnormal sweating (1% to 3%, adults; 1% to 5%, pediatrics) and chills (7% to 17%, adults; 5% to 19%, pediatrics) were also reported during Ebola Zaire vaccine, live clinical trials. In individuals 13 years and older living with HIV (n = 201), chills (2%), feeling hot (1.5%), hyperhidrosis (1.5%), and fever (1%) were reported as severe systemic reactions.[64868]

Vaccine-related anaphylactoid reactions were reported in 2 adult patients who received Ebola Zaire vaccine, live during clinical trials. Rash (petechiae, purpura, generalized rash, maculopapular rash, and vesicular rash) was reported in approximately 4% of adult patients who received Ebola Zaire vaccine, live during clinical trials. In an analysis across blinded, placebo-controlled adult studies, all but 1 study reported rash in less than 9% of patients. In 1 small study, rash occurred in 25% (n = 4) of Ebola Zaire vaccine, live patients. In the same study, cutaneous vasculitis was reported in 2 patients who received a lower dose formulation, but neither had evidence of systemic vasculitis. Vesicular fluid and skin biopsy samples taken from some patients with rash tested positive for vaccine virus RNA by RT-PCR. Vesicular lesions, which included events reported as vesicular rash and blisters, were reported in 1.5% of vaccine recipients.[64868]

Gastrointestinal adverse reactions reported during Ebola Zaire Vaccine, live clinical trials include nausea (8% to 10%, adults; 8%, pediatrics), vomiting (4%, adults; 4% to 17%, pediatrics), diarrhea (3% to 19%, pediatrics), abdominal pain (13%, adults; 2% to 21%, pediatrics), decreased appetite or anorexia (15%, adults; 21% to 27%, pediatrics), and mouth/oral ulceration (2%, adults; 2% to 6%, pediatrics). In individuals 13 years and older living with HIV (n = 201), nausea was reported as a severe systemic reaction in 0.5% of individuals.[64868]

Laboratory test interference may occur between Ebola Zaire vaccine, live and glycoprotein (GP)-based testing. After vaccination, individuals may test positive for anti-Ebola GP antibody and/or Ebola GP nucleic acid or antigens. GP-based testing may have limited diagnostic value during the period of vaccine viremia, in the presence of vaccine-derived Ebola GP, and after antibody response to the vaccine.[64868]

Viral shedding leading to transmission of vaccine virus is considered a theoretical risk for infection; viral RNA has been detected by RT-PCR in blood, saliva, urine, and vesicle fluid of individuals who received Ebola Zaire vaccine, live. Vaccination may not protect all individuals. Vaccinated individuals should continue to adhere to infection control practices to prevent Orthoebolavirus zairense infection and transmission.[64868]

Contraindications / Precautions

  • breast-feeding

  • immunosuppression

  • pregnancy

The coadministration of certain medications may lead to harm and require avoidance or therapy modification; review all drug interactions prior to concomitant use of other medications.

This medication is contraindicated in patients with a history of hypersensitivity to it or any of its components. It is also contraindicated in individuals with hypersensitivity to rice protein.[64868]

The safety and immunogenicity of the Ebola Zaire Vaccine, live was assessed in 201 individuals living with HIV who were receiving antiretroviral therapy and had an HIV viral load of less than 40 copies/mL and CD4+ cell count of 200 cells/mm3 or greater. The safety and effectiveness have not been assessed in other immunocompromised individuals. In individuals with significant immunosuppression, the effectiveness of the Ebola Zaire vaccine, live may be diminished. The risk of vaccination should be weighed against the risk of disease due to Zaire ebolavirus.[64868] Immunosuppressed persons may include individuals with acquired immunodeficiency syndrome (AIDS); symptomatic human immunodeficiency virus (HIV) infection; severe combined immunodeficiency (SCID); hypogammaglobulinemia; agammaglobulinemia; altered immune states due to diseases such as leukemia, lymphoma, or generalized neoplastic disease; or an immune system compromised by corticosteroid therapy with greater than physiologic doses, alkylating drugs, antimetabolites, chemotherapy, or radiation therapy. Corticosteroid therapy is usually not a contraindication to administering live-virus vaccines when administration is short-term (less than 14 days); a low-to-moderate dose (less than 2 mg/kg of body weight or 20 mg/day of prednisone or equivalent for persons who weigh more than 10 kg when administered for less than 2 weeks); long-term, alternate-day treatment with short-acting preparations; maintenance physiologic doses (replacement therapy); or when administered topically (skin, eyes), inhaled, or by local injection. Health care providers should wait at least 1 month after discontinuation of high-dose corticosteroid therapy given for 14 days or more before administering the Ebola Zaire vaccine, live. Individuals with leukemia, lymphoma, or other malignancies whose disease is in remission, who have restored immunocompetence, and whose chemotherapy has been discontinued for at least 3 months can receive live-virus vaccines.[65107]

Data are insufficient to advise a drug-associated risk of Ebola Zaire vaccine, live use during pregnancy. A person's risk of exposure to Orthoebolavirus zairense should be considered when deciding on vaccination. Fetal and neonatal outcomes are universally poor among pregnant people infected with Orthoebolavirus zairense; most pregnancies end in miscarriage or stillbirth. In pregnancies ending with live birth, neonates generally do not survive. In a developmental toxicity study performed in female rats prior to and during gestation, no vaccine-related fetal malformations or variations were observed.[64868]

There are no data on the presence of Ebola Zaire vaccine, live in human milk, its effects on the breast-fed child, or its effects on milk production. Consider the benefits of breast-feeding, the risk of potential vaccine exposure, and the risk of not vaccinating the lactating individual.[64868]

Mechanism Of Action

Immunization with the Ebola Zaire vaccine, live results in an immune response and protection from disease caused by Orthoebolavirus zairense. The relative contributions of innate, humoral, and cell-mediated immunity to protection from Orthoebolavirus zairense are unknown.[64868]

Pharmacokinetics

The Ebola Zaire vaccine, live is administered intramuscularly. In adult studies evaluating the occurrence of vaccine viremia (n = 186), vaccine virus RNA was detected by RT-PCR in the plasma of most patients 1 to 7 days after vaccination with 1 patient having a positive plasma RT-PCR result 14 days after vaccination. In adult and pediatric studies evaluating the occurrence of vaccine shedding (n = 359), vaccine virus RNA was detected by RT-PCR in the urine or saliva of some patients between Day 1 and Day 14 postvaccination. In 3 studies that assessed shedding at Day 28, no samples tested positive. In the pediatric study, 31.7% (19/60) of participants 1 to 17 years enrolled in a substudy shed vaccine virus in saliva after vaccination. Viral shedding was greatest on Day 7 and declined thereafter, with no shedding detected after Day 28. Vaccine virus RNA was detected by RT-PCR in vesicular fluid samples from some adult patients; 1 sample collected 20 days after vaccination tested positive for vaccine virus RNA by RT-PCR.[64868]

•Special Populations*

Pediatrics*

In pediatric patients 1 to 17 years, antibody geometric mean titers (GMT) to Ebola Zaire vaccine at day 28 after vaccination were noninferior to those seen in adult patients (GMT 1,748.8 vs. 1,234.4, respectively; GMT ratio, 1.42; 95% CI: 1.24 to 1.62).[64868]

Other*

HIV*

In clinical studies in individuals 13 through 70 years living with HIV (on antiretroviral therapy with an HIV viral load less than 40 copies/mL and a CD4+ count 200 cells/mm3 or greater), 81% had vaccine viremia, with most clearing viremia by Day 14, similar to previous studies. Among individuals who received 2 doses of Ebola Zaire vaccine, live, 56 days apart, vaccine viremia was detected in 1 individual on Day 28 after the first dose and in 2 individuals on Day 42 after the second dose. Shedding of vaccine virus in saliva was detected in 22.9% of individuals. Viral shedding was greatest on Day 7 and declined thereafter, with no shedding detected after Day 14. The geometric mean titer at Day 28 for Ebola Zaire vaccine, live was 1,223.1 (95% CI: 1,068 to 1,400.9) compared with 28.5 (95% CI: 21.6 to 37.7) for placebo, with a fold difference of 42.9 (95% CI: 31.49 to 58.43).[64868]

Pregnancy / Breast-Feeding

Pregnancy

Data are insufficient to advise a drug-associated risk of Ebola Zaire vaccine, live use during pregnancy. A person's risk of exposure to Orthoebolavirus zairense should be considered when deciding on vaccination. Fetal and neonatal outcomes are universally poor among pregnant people infected with Orthoebolavirus zairense; most pregnancies end in miscarriage or stillbirth. In pregnancies ending with live birth, neonates generally do not survive. In a developmental toxicity study performed in female rats prior to and during gestation, no vaccine-related fetal malformations or variations were observed.[64868]

Breast Feeding

There are no data on the presence of Ebola Zaire vaccine, live in human milk, its effects on the breast-fed child, or its effects on milk production. Consider the benefits of breast-feeding, the risk of potential vaccine exposure, and the risk of not vaccinating the lactating individual.[64868]

Interactions

  • azaTHIOprine

  • Betamethasone

  • Budesonide

  • Busulfan

  • Carmustine, BCNU

  • Chlorambucil

  • CISplatin

  • Cladribine

  • Corticotropin, ACTH

  • Cortisone

  • cycloSPORINE

  • Cytarabine, ARA-C

  • Dacarbazine, DTIC

  • dexAMETHasone

  • DOCEtaxel

  • Floxuridine

  • Fludarabine

  • Fluorouracil, 5-FU

  • Hydrocortisone

  • Hydroxyurea

  • Ifosfamide

  • Lomustine, CCNU

  • Melphalan

  • Mercaptopurine, 6-MP

  • Methotrexate

  • methylPREDNISolone

  • mitoXANTRONE

  • Mycophenolate

  • PACLitaxel

  • Pentostatin

  • prednisoLONE

  • predniSONE

  • Procarbazine

  • Streptozocin

  • Tacrolimus

  • Thioguanine, 6-TG

  • Thiotepa

  • Triamcinolone

  • vinCRIStine

  • Vinorelbine

  • Leflunomide

  • Sirolimus

  • Bexarotene

  • Temozolomide

  • Estramustine

  • Antithymocyte Globulin

  • Etanercept

  • riTUXimab

  • Basiliximab

  • inFLIXimab

  • Alemtuzumab

  • Interferon Alfa-2b

  • Interferon Alfa-n3

  • Everolimus

  • Natalizumab

  • Peginterferon Alfa-2a

  • Peginterferon Alfa-2b

  • Imatinib

  • PEMEtrexed

  • Adalimumab

  • Clofarabine

  • vinCRIStine Liposomal

  • Lenalidomide

  • Abatacept

  • Nelarabine

  • Certolizumab pegol

  • Budesonide; Formoterol

  • Temsirolimus

  • Ixabepilone

  • Rilonacept

  • Ustekinumab

  • Nilotinib

  • Golimumab

  • PRALAtrexate

  • Fingolimod

  • Belatacept

  • Obinutuzumab

  • Siltuximab

  • Blinatumomab

  • Deflazacort

  • riTUXimab; Hyaluronidase

  • Tisagenlecleucel

  • Axicabtagene Ciloleucel

  • Budesonide; Glycopyrrolate; Formoterol

  • Brexucabtagene Autoleucel

  • Lisocabtagene Maraleucel

  • Melphalan Flufenamide

  • Ponesimod

  • Idecabtagene Vicleucel

  • Anifrolumab

  • Ropeginterferon alfa-2b

  • Nanoparticle Albumin-Bound Sirolimus

  • Efgartigimod Alfa

  • Abrocitinib

  • Ciltacabtagene Autoleucel

  • Spesolimab

  • Ublituximab

  • Albuterol; Budesonide

  • Efgartigimod Alfa; Hyaluronidase

  • Ritlecitinib

  • Rozanolixizumab

  • Etrasimod

  • Bimekizumab

  • Vamorolone

  • Deuruxolitinib

  • Lebrikizumab

  • Nipocalimab

  • Brensocatib

  • Remibrutinib

  • Icotrokinra

  • Alkylating agents

  • Purine analogs

  • Antimetabolites

  • Alpha interferons

  • Folate analogs

  • Corticosteroids (systemic)

  • Neonatal Fc receptor (FcRn) blockers

  • Interferon Gamma-1b

  • Anakinra

  • Botulism Immune Globulin, BIG-IV

  • Vaccinia Immune Globulin, VIG

  • Belimumab

  • Tocilizumab

  • Ofatumumab

  • Canakinumab

  • Teriflunomide

  • Tofacitinib

  • Vedolizumab

  • Secukinumab

  • Ixekizumab

  • Venetoclax

  • Brodalumab

  • Dupilumab

  • Ocrelizumab

  • Sarilumab

  • Guselkumab

  • Tildrakizumab

  • Baricitinib

  • Emapalumab

  • Siponimod

  • Risankizumab

  • Upadacitinib

  • Ozanimod

  • Inebilizumab

  • Satralizumab

  • Atoltivimab; Maftivimab; Odesivimab

  • Ansuvimab

  • Voclosporin

  • Tezepelumab

  • Tralokinumab

  • Deucravacitinib

  • Ocrelizumab; Hyaluronidase

  • Sibeprenlimab

  • Ebolavirus monoclonal antibodies

  • Leniolisib

Abatacept: (Contraindicated) If possible, administer all needed vaccines before abatacept initiation. Live vaccines should not be given concurrently with abatacept or within 3 months of its discontinuation. The immune response of the immunocompromised patient to vaccines may be decreased and adjusted doses or boosters that are more frequent may be required. The immune response to an inactive vaccine may still be suboptimal. Live virus vaccines may induce the illness they are intended to prevent and are contraindicated for use during immunosuppressive treatment. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [31761] [43236]

Abrocitinib: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least four weeks before planned immunosuppression or wait until at least three months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67277]

Adalimumab: (Contraindicated) Do not administer live vaccines to adalimumab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving adalimumab. Before initiation of adalimumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Adalimumab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [27939] [43236]

Albuterol; Budesonide: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Alemtuzumab: (Contraindicated) Do not administer live vaccines to alemtuzumab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving alemtuzumab. At least 6 weeks before initiation of alemtuzumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Alemtuzumab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [58461]

Alkylating agents: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Alpha interferons: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Anakinra: (Major) Avoid concurrent use of live vaccines during treatment with anakinra due to potentially increased risk of infections; clinical safety of live vaccines during anakinra treatment has not been established. Live virus vaccines should generally not be administered to an immunosuppressed patient, as they may induce the illness they are intended to prevent. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. No data are available on the secondary transmission of infection from persons receiving live vaccines to patients receiving anakinra. The interval between live vaccinations and initiation of anakinra therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents. [27940] [43236]

Anifrolumab: (Contraindicated) Avoid administration of live vaccines with immunosuppressive drug therapy, such as anifrolumab, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [66846]

Ansuvimab: (Major) Avoid administration of the ebola Zaire vaccine, live with ebolavirus monoclonal antibodies (i.e., ansuvimab and atoltivimab; maftivimab; odesivimab), as use of these drugs together may reduce the effectiveness of the vaccine. Ebolavirus monoclonal antibodies have activity against Zaire ebolavirus. These antibodies, if given with the vaccine, may inhibit the replication of the vaccine virus. No vaccine-therapeutic interaction studies have been conducted. According to the Advisory Committee on Immunization Practices (ACIP), the length of time that an antibody-containing product may interfere with a live virus vaccine depends on the amount of antigen-specific antibody contained in the product; also, after an antibody-containing product is received, live vaccines should be delayed until the passive antibody has degraded. If the vaccine is administered too soon after an antibody-containing product, a repeat dose of the vaccine may be needed. [43236] [64868] [66032] [66201]

Antimetabolites: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Antithymocyte Globulin: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Atoltivimab; Maftivimab; Odesivimab: (Major) Avoid administration of the ebola Zaire vaccine, live with ebolavirus monoclonal antibodies (i.e., ansuvimab and atoltivimab; maftivimab; odesivimab), as use of these drugs together may reduce the effectiveness of the vaccine. Ebolavirus monoclonal antibodies have activity against Zaire ebolavirus. These antibodies, if given with the vaccine, may inhibit the replication of the vaccine virus. No vaccine-therapeutic interaction studies have been conducted. According to the Advisory Committee on Immunization Practices (ACIP), the length of time that an antibody-containing product may interfere with a live virus vaccine depends on the amount of antigen-specific antibody contained in the product; also, after an antibody-containing product is received, live vaccines should be delayed until the passive antibody has degraded. If the vaccine is administered too soon after an antibody-containing product, a repeat dose of the vaccine may be needed. [43236] [64868] [66032] [66201]

Axicabtagene Ciloleucel: (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during axicabtagene ciloleucel therapy, and prior to immune recovery following treatment with axicabtagene ciloleucel. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [62530] [65107]

azaTHIOprine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Baricitinib: (Major) Do not administer live virus vaccines to patients taking baricitinib, as no data are available on the secondary transmission of infection by live vaccines. Also, no data are available on the response to vaccination with any vaccine during baricitinib receipt. Before baricitinib initiation, review the vaccination status of patients, and update immunizations in agreement with current immunization guidelines. [63229]

Basiliximab: (Contraindicated) Do not administer live vaccines to basiliximab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving basiliximab. At least 2 weeks before initiation of basiliximab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Basiliximab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [41849] [43236]

Belatacept: (Contraindicated) Avoid the use of live vaccines such as the intranasal influenza vaccine; measles/mumps/rubella vaccines, MMR; Bacillus Calmette-Guerin Live, BCG; yellow fever vaccine; oral polio vaccine; varicella virus vaccine live; and TY21a typhoid vaccine during belatacept treatment. Further, inactive vaccine receipt may not illicit an acceptable response; belatacept may blunt the effectiveness of some immunizations. Consult the most current CDC guidances for vaccination recommendations. [44667]

Belimumab: (Major) Live vaccines should not be given for 30 days before or concurrently with belimumab, as clinical safety has not been established. Because of its mechanism of action, belimumab may interfere with the response to immunizations. No data are available on the secondary transmission of infection from persons receiving live vaccines. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236] [43658]

Betamethasone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Bexarotene: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Bimekizumab: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least four weeks before planned immunosuppression or wait until at least three months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [69656]

Blinatumomab: (Contraindicated) Do not administer live vaccines to blinatumomab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving blinatumomab. At least 2 weeks before initiation of blinatumomab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Blinatumomab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [58559]

Botulism Immune Globulin, BIG-IV: (Major) Vaccination with live vaccines should be deferred until 6 months after administration of botulism immune globulin as antibodies present in immune globulin preparations may interfere with the immune response to live virus vaccines. This interval may be shortened if exposure to measles is likely. If such vaccinations were given shortly before or after botulism immune globulin administration, revaccination may be necessary. [51716]

Brensocatib: (Contraindicated) Avoid administration of live vaccines with immunosuppressive agents, such as brensocatib, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [72561]

Brexucabtagene Autoleucel : (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during brexucabtagene autoleucel therapy, and prior to immune recovery following treatment with brexucabtagene autoleucel. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [65739]

Brodalumab: (Major) Avoid administration of live vaccines to brodalumab recipients. Before initiation of brodalumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live or inactive vaccines in patients receiving brodalumab therapy. [61762]

Budesonide: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Budesonide; Formoterol: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Budesonide; Glycopyrrolate; Formoterol: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Busulfan: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Canakinumab: (Major) Do not administer live vaccines to a patient who is receiving canakinumab; other vaccination schedules should be complete as recommended prior to initiating canakinumab treatment. No data are available regarding the risk of secondary transmission of infection by live vaccines, and the efficacy and safety of live vaccines have not been established in patients receiving canakinumab. The immune response to vaccines or toxoids may be decreased, as canakinumab may interfere with normal immune response to new antigens. Limited data are available on the effectiveness of vaccination with inactivated antigens in patients receiving canakinumab. Because interleukin-1 blockade may interfere with immune response to infections, it is recommended that prior to initiation of therapy with canakinumab, adult and pediatric patients receive any recommended vaccination (including pneumococcal vaccine and inactivated influenza vaccines). [41378] [43236]

Carmustine, BCNU: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Certolizumab pegol: (Contraindicated) Avoid use of live vaccines during or immediately prior to initiation of therapy with certolizumab. Update immunizations in agreement with current immunization guidelines prior to initiating certolizumab therapy. If immunization is necessary, refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [33930]

Chlorambucil: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Ciltacabtagene Autoleucel: (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during ciltacabtagene autoleucel therapy, and prior to immune recovery following treatment with ciltacabtagene autoleucel. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107]

CISplatin: (Contraindicated) Do not administer live vaccines to cisplatin recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving cisplatin. At least 2 weeks before initiation of cisplatin therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Cisplatin recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [28393] [43236]

Cladribine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Clofarabine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Corticosteroids (systemic): (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Corticotropin, ACTH: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Cortisone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

cycloSPORINE: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Cytarabine, ARA-C: (Contraindicated) Do not administer live vaccines to cytarabine recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving cytarabine. At least 2 weeks before initiation of cytarabine therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Cytarabine recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [48339]

Dacarbazine, DTIC: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Deflazacort: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Deucravacitinib: (Major) Avoid administration of live vaccines to deucravacitinib recipients. Before initiation of deucravacitinib therapy, consider completion of all age-appropriate vaccinations per current immunization guidelines. No data are available on the response to live vaccines in patients receiving deucravacitinib therapy. [67943]

Deuruxolitinib: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive drug therapy, such as deuruxolitinib, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least four weeks before planned immunosuppression or wait until at least three months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [70972]

dexAMETHasone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

DOCEtaxel: (Contraindicated) Do not administer live vaccines to docetaxel recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving docetaxel. At least 2 weeks before initiation of docetaxel therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Docetaxel recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [58408]

Dupilumab: (Major) Avoid administration of live vaccines to dupilumab recipients. Before initiation of dupilumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live vaccines in patients receiving dupilumab therapy. [61836]

Ebolavirus monoclonal antibodies: (Major) Avoid administration of the ebola Zaire vaccine, live with ebolavirus monoclonal antibodies (i.e., ansuvimab and atoltivimab; maftivimab; odesivimab), as use of these drugs together may reduce the effectiveness of the vaccine. Ebolavirus monoclonal antibodies have activity against Zaire ebolavirus. These antibodies, if given with the vaccine, may inhibit the replication of the vaccine virus. No vaccine-therapeutic interaction studies have been conducted. According to the Advisory Committee on Immunization Practices (ACIP), the length of time that an antibody-containing product may interfere with a live virus vaccine depends on the amount of antigen-specific antibody contained in the product; also, after an antibody-containing product is received, live vaccines should be delayed until the passive antibody has degraded. If the vaccine is administered too soon after an antibody-containing product, a repeat dose of the vaccine may be needed. [43236] [64868] [66032] [66201]

Efgartigimod Alfa: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive medications, such as neonatal Fc receptor (FcRn) blockers, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67194] [69130] [72165]

Efgartigimod Alfa; Hyaluronidase: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive medications, such as neonatal Fc receptor (FcRn) blockers, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67194] [69130] [72165]

Emapalumab: (Major) Do not administer live or live attenuated vaccines to patients receiving emapalumab and for at least 4 weeks after the last dose of emapalumab. The safety of immunization with live vaccines during or after emapalumab therapy has not been studied. [63767]

Estramustine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Etanercept: (Contraindicated) Etanercept has not been found to act as a general immunosuppressant; however, the patient's underlying disease state may result in the immunosuppression. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [28060] [29646] [43236]

Etrasimod: (Contraindicated) Avoid administration of live vaccines with immunosuppressive agents, such as etrasimod, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before etrasimod therapy or wait until at least 5 weeks after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [69114]

Everolimus: (Contraindicated) Do not administer live vaccines to everolimus recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving everolimus. Before initiation of everolimus therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Everolimus recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [49823] [49903]

Fingolimod: (Contraindicated) Do not administer live vaccines to a patient who is receiving fingolimod or has discontinued the drug in the last 2 months because of the risk of infection. No data are available regarding the risk of secondary transmission of infection by live vaccines, and the efficacy and safety of live vaccines have not been established in patients receiving fingolimod. Before fingolimod initiation, test patients without a history of chickenpox or without vaccination against varicella zoster virus (VZV) for antibodies to VZV. Consider VZV vaccination of antibody-negative patients before fingolimod initiation, and do not start fingolimod for 1 month to allow the full effect of vaccination to occur. In addition to the concerns with live virus vaccines, the immune response to inactive vaccines or toxoids may be decreased, as fingolimod may interfere with normal immune response to new antigens. No data are available on the effectiveness of vaccination with inactivated antigens in patients receiving fingolimod. Vaccination may be less effective during and for up to 2 months after fingolimod discontinuation. For example, as compared with the response of placebo recipients, the capacity to mount a skin delayed-type hypersensitivity reaction to Candida and to tetanus toxoid was decreased by approximately 30% among fingolimod 0.5 mg daily recipients. Further, in healthy patients, antigen-specific IgM titers were decreased by 25% in response to pneumococcal polysaccharide vaccine (PPV-23) immunization as compared with the response by placebo recipients. Similarly, IgG titers were decreased by 50% among fingolimod recipients as compared with placebo. [41823] [43236]

Floxuridine: (Contraindicated) Do not administer live vaccines to floxuridine recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving floxuridine. At least 2 weeks before initiation of floxuridine therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Floxuridine recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [48344]

Fludarabine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Fluorouracil, 5-FU: (Contraindicated) Do not administer live vaccines to fluorouracil recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving fluorouracil. At least 2 weeks before initiation of fluorouracil therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Fluorouracil recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [53824] [60092] [65107]

Folate analogs: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Golimumab: (Contraindicated) Do not administer live vaccines to golimumab recipients. Limited data are available on the response to live vaccination or on the risk of infection or infection transmission after the administration. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [35501] [43236]

Guselkumab: (Major) Avoid use of live vaccines in patients being treated with guselkumab; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving guselkumab. In addition, guselkumab may decrease the vaccine-induced immune response. Before initiation of guselkumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. [62120]

Hydrocortisone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Hydroxyurea: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Icotrokinra: (Contraindicated) Avoid administration of live vaccines with immunosuppressive drug therapy, such as icotrokinra, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [73304]

Idecabtagene Vicleucel: (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during idecabtagene vicleucel therapy, and prior to immune recovery following treatment with idecabtagene vicleucell. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107]

Ifosfamide: (Contraindicated) Do not administer live vaccines to ifosfamide recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving ifosfamide. Before initiation of ifosfamide therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Ifosfamide recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [51027]

Imatinib: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Inebilizumab: (Major) Administer all immunizations according to immunization guidelines at least 4 weeks before initiation of inebilizumab. Vaccination with live-attenuated or live vaccines is not recommended during treatment and until B-cell repletion. In a neonate or infant with in utero exposure to inebilizumab, do not administer live or live-attenuated vaccines before confirming recovery of B-cell counts in the infant. Depletion of B-cells in the exposed infant may increase the risks from live or live-attenuated vaccines. [43236] [60092] [65576]

inFLIXimab: (Contraindicated) Do not administer live vaccines to infliximab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving infliximab. Before initiation of infliximab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Infliximab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [27994] [43236]

Interferon Alfa-2b: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Interferon Alfa-n3: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Interferon Gamma-1b: (Major) Avoid the concomitant use of interferon gamma-1b with other immunological preparations such as live vaccines due to the risk of an unpredictable or amplified, immune response. [49610]

Ixabepilone: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Ixekizumab: (Major) Do not administer live vaccines to ixekizumab recipients. Before initiation of ixekizumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live or inactive vaccines in patients receiving Ixekizumab therapy. [60658]

Lebrikizumab: (Contraindicated) Avoid administration of live vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [71236]

Leflunomide: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236] [49634]

Lenalidomide: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Leniolisib: (Moderate) Patients receiving leniolisib may have a diminished response to live vaccines. Counsel patients receiving leniolisib about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107]

Lisocabtagene Maraleucel: (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during lisocabtagene maraleucel therapy, and prior to immune recovery following treatment with lisocabtagene maraleucel. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [66383]

Lomustine, CCNU: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Melphalan Flufenamide: (Contraindicated) Avoid administration of live virus vaccines in patients who are receiving melphalan. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period or altered immunocompetence. [41904] [44928] [60092] [65107]

Melphalan: (Contraindicated) Avoid administration of live virus vaccines in patients who are receiving melphalan. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period or altered immunocompetence. [41904] [44928] [60092] [65107]

Mercaptopurine, 6-MP: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Methotrexate: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

methylPREDNISolone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

mitoXANTRONE: (Contraindicated) Do not administer live vaccines to mitoxantrone recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving mitoxantrone. At least 2 weeks before initiation of mitoxantrone therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Mitoxantrone recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [48215]

Mycophenolate: (Contraindicated) Do not administer live vaccines to mycophenolate recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving mycophenolate. At least 2 weeks before initiation of mycophenolate therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Mycophenolate recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [27985] [43236]

Nanoparticle Albumin-Bound Sirolimus: (Contraindicated) Do not administer live vaccines to sirolimus recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving sirolimus. At least 2 weeks before initiation of sirolimus therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Sirolimus recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [28610] [43236]

Natalizumab: (Contraindicated) The immune response to vaccines or toxoids may be decreased in patients who receive natalizumab; however, no data are available. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [30470] [43236]

Nelarabine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [60092] [65107]

Neonatal Fc receptor (FcRn) blockers: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive medications, such as neonatal Fc receptor (FcRn) blockers, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67194] [69130] [72165]

Nilotinib: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Nipocalimab: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive medications, such as neonatal Fc receptor (FcRn) blockers, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67194] [69130] [72165]

Obinutuzumab: (Contraindicated) Do not administer live vaccines to obinutuzumab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving obinutuzumab. Before initiation of obinutuzumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Obinutuzumab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [56353]

Ocrelizumab: (Major) Due to the lack of clinical information related to the safety and efficacy of vaccine administration during ocrelizumab use, vaccination with live vaccines or live-attenuated vaccines is not recommended in patients taking ocrelizumab. Withhold vaccination with live or live-attenuated virus vaccines to patients during ocrelizumab treatment and until B-cell repletion. Administer all live or live-attenuated vaccinations according to current vaccination guidelines at least 4 weeks before initiation of ocrelizumab. Do not administer live or live-attenuated vaccines to infants born to mothers exposed to ocrelizumab during pregnancy before confirming B-cell count recovery as measured by CD19+ B-cells. ACIP recommends that patients receiving any vaccination during immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated a minimum of 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of, or in addition to, vaccination. [43236] [60092] [61838]

Ocrelizumab; Hyaluronidase: (Major) Due to the lack of clinical information related to the safety and efficacy of vaccine administration during ocrelizumab use, vaccination with live vaccines or live-attenuated vaccines is not recommended in patients taking ocrelizumab. Withhold vaccination with live or live-attenuated virus vaccines to patients during ocrelizumab treatment and until B-cell repletion. Administer all live or live-attenuated vaccinations according to current vaccination guidelines at least 4 weeks before initiation of ocrelizumab. Do not administer live or live-attenuated vaccines to infants born to mothers exposed to ocrelizumab during pregnancy before confirming B-cell count recovery as measured by CD19+ B-cells. ACIP recommends that patients receiving any vaccination during immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated a minimum of 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of, or in addition to, vaccination. [43236] [60092] [61838]

Ofatumumab: (Major) Administer all live and live-attenuated vaccines according to immunization guidelines at least 4 weeks before initiation of ofatumumab. Vaccination with live-attenuated or live vaccines is not recommended during treatment with ofatumumab; wait until B-cell recovery occurs after discontinuation of ofatumumab before administering these vaccines to a patient. [43236] [60092] [65850]

Ozanimod: (Major) Avoid the use of live vaccines and live attenuated vaccines during ozanimod treatment and for up to 3 months after discontinuation of ozanimod treatment. Live vaccinations may be less effective during ozanimod treatment and also may carry the risk of infection. [65169]

PACLitaxel: (Contraindicated) Do not administer live vaccines to paclitaxel recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving paclitaxel. At least 2 weeks before initiation of paclitaxel therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Paclitaxel recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [29200] [43236]

Peginterferon Alfa-2a: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Peginterferon Alfa-2b: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

PEMEtrexed: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Pentostatin: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Ponesimod: (Contraindicated) Avoid vaccines containing live virus (live attenuated vaccines) during treatment with ponesimod. If a live attenuated vaccine is required, administer at least 1 month (4 weeks) before initiation of ponesimod. The use of live attenuated vaccines may carry the risk of infection and should therefore be avoided during ponesimod treatment and for 1 to 2 weeks after discontinuation of ponesimod. During treatment, and for up to 1 to 2 weeks after discontinuation of ponesimod, vaccinations may also be less effective. [60092] [65107] [66527]

PRALAtrexate: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

prednisoLONE: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

predniSONE: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Procarbazine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Purine analogs: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Remibrutinib: (Contraindicated) Avoid administration of live vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [72734]

Rilonacept: (Contraindicated) Do not administer live vaccines to a patient who is receiving rilonacept. No data are available regarding the use of live vaccines during rilonacept treatment. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [33837] [43236]

Risankizumab: (Major) Avoid administration of live vaccines to risankizumab recipients. Before initiation of risankizumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live or inactive vaccines in patients receiving risankizumab therapy. [64073]

Ritlecitinib: (Contraindicated) Avoid administering live virus vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least four weeks before planned immunosuppression or wait until at least three months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [69127]

riTUXimab: (Contraindicated) Do not administer live vaccines to rituximab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving rituximab. At least 4 weeks before initiation of rituximab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Rituximab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [29025] [43236]

riTUXimab; Hyaluronidase: (Contraindicated) Do not administer live vaccines to rituximab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving rituximab. At least 4 weeks before initiation of rituximab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Rituximab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [29025] [43236]

Ropeginterferon alfa-2b: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient, including those receiving Interferon therapy. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Rozanolixizumab: (Contraindicated) Avoid administration of live virus vaccines with immunosuppressive medications, such as neonatal Fc receptor (FcRn) blockers, and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least 4 weeks before planned immunosuppression or wait until at least 3 months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [67194] [69130] [72165]

Sarilumab: (Major) Avoid concurrent use of live vaccines during treatment with sarilumab due to potentially increased risk of infections; clinical safety of live vaccines during sarilumab treatment has not been established. No data are available on the secondary transmission of infection from persons receiving live vaccines to patients receiving sarilumab. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents. [51778] [61976]

Satralizumab: (Major) Administer all live vaccines according to immunization guidelines at least 4 weeks before initiation of satralizumab. Vaccination with live-attenuated or live vaccines is not recommended during treatment with satralizumab. [43236] [60092] [65841]

Secukinumab: (Major) Do not administer live vaccines to secukinumab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving secukinumab. Before initiation of secukinumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Secukinumab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. Similar antibody responses were seen when healthy individuals who received a single 150 mg dose of secukinumab 2 weeks before vaccination with a non-US approved group C meningococcal polysaccharide conjugate vaccine and a non-US approved inactivated seasonal influenza vaccine. The efficacy of meningococcal and influenza vaccines has not been evaluated in patients undergoing treatment with secukinumab. [58739]

Sibeprenlimab: (Major) Do not administer live virus vaccines within 30 days prior to initiation of sibeprenlimab or during treatment as safety has not been established. Sibeprenlimab may interfere with immune responses to vaccines and increase the risk of infection from live vaccines. [72946]

Siltuximab: (Contraindicated) Do not administer live vaccines to siltuximab recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving siltuximab. Before initiation of siltuximab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Siltuximab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [57062]

Siponimod: (Major) Avoid the use of live vaccines during treatment with siponomid and for 4 weeks after stopping treatment due to the risk of secondary infection. Additionally, vaccines may be less effective if administered during siponimod treatment and for 4 weeks after siponimod treatment discontinuation. [64031]

Sirolimus: (Contraindicated) Do not administer live vaccines to sirolimus recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving sirolimus. At least 2 weeks before initiation of sirolimus therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Sirolimus recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [28610] [43236]

Spesolimab: (Contraindicated) Avoid administration of live vaccines during and for at least 16 weeks after spesolimab treatment. Before initiation of spesolimab therapy, consider completion of all age-appropriate vaccinations per current immunization guidelines. No data are available on the response to live vaccines in patients receiving spesolimab therapy. [60092] [65107] [67922]

Streptozocin: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Tacrolimus: (Contraindicated) Do not administer live vaccines to tacrolimus recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving tacrolimus. At least 2 weeks before initiation of tacrolimus therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Tacrolimus recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [60497]

Temozolomide: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Temsirolimus: (Contraindicated) The use of live vaccines should be avoided during treatment with temsirolimus. Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [33280] [43236]

Teriflunomide: (Major) Due to the lack of clinical information related to the safety and efficacy of vaccine administration during teriflunomide use, concomitant vaccination with live vaccines is not recommended. The long half-life of teriflunomide should be considered when contemplating administration of a live vaccine after stopping the medication if the teriflunomide drug elimination procedure has not been performed. [51794]

Tezepelumab: (Major) Avoid administration of live vaccines to tezepelumab recipients. Before initiation of tezepelumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available regarding the response to live vaccines in patients receiving tezepelumab therapy. [67195]

Thioguanine, 6-TG: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Thiotepa: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236]

Tildrakizumab: (Major) Avoid administration of live vaccines to tildrakizumab recipients. Before initiation of tildrakizumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live or inactive vaccines in patients receiving tildrakizumab therapy. [62970]

Tisagenlecleucel: (Contraindicated) Avoid administration of live virus vaccines in the six weeks prior to the start of lymphodepleting chemotherapy, during tisagenlecleucel therapy, and prior to immune recovery following treatment with tisagenlecleucel. Patients with altered immunocompetence, including those receiving or those that have recently received immunosuppressive drug therapy, may be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [62282] [65107]

Tocilizumab: (Major) Avoid concurrent use of live vaccines during treatment with tocilizumab due to potentially increased risk of infections; clinical safety of live vaccines during tocilizumab treatment has not been established. No data are available on the secondary transmission of infection from persons receiving live vaccines to patients receiving tocilizumab. The interval between live vaccinations and initiation of tocilizumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents. [38283] [51778]

Tofacitinib: (Major) Do not administer live virus vaccines to patients taking tofacitinib, as no data are available on the secondary transmission of infection by live vaccines. Also, no data are available on the response to vaccination with any vaccine during tofacitinib receipt. Before tofacitinib initiation, review the vaccination status of patients, and update immunizations in agreement with current immunization guidelines. [52315]

Tralokinumab: (Major) Avoid administration of live vaccines to tralokinumab recipients. Before initiation of tralokinumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. No data are available on the response to live vaccines in patients receiving tralokinumab therapy. [67217]

Triamcinolone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Ublituximab: (Contraindicated) Avoid administration of live vaccines with immunosuppressive drug therapy and prior to immune recovery following treatment with immunosuppressive drug therapy. When feasible, administer indicated live virus vaccines at least four weeks before planned immunosuppression or wait until at least three months after discontinuation. The time to restoration of immune competence may be longer in some patients. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccines may be less effective if administered during a period of altered immunocompetence. [60092] [65107] [68398]

Upadacitinib: (Major) Avoid use of live vaccines during or immediately prior to upadacitinib therapy initiation. Before initiating upadacitinib, it is recommended that patients be brought up to date with all immunizations, including varicella zoster or prophylactic herpes zoster vaccinations, in agreement with current vaccination guidelines. [60092] [64572] [65107]

Ustekinumab: (Contraindicated) If possible, administer all recommended vaccines before ustekinumab initiation. Ustekinumab recipients may receive inactive vaccines, but the elicited immune response may be insufficient to prevent disease. Do not administer live vaccines to a ustekinumab recipient. Furthermore, do not administer BCG live vaccines for either 1 year before or 1 year after ustekinumab receipt, due to the infectious risk for Mycobacteria. No data are available on the response to live vaccination or on the risk of infection or infection transmission after the administration of other live vaccines to ustekinumab recipients. Cautious administration of ustekinumab to household contacts of ustekinumab recipients may be warranted due to the potential risk for shedding from the household contact and transmission to the patient. Practitioners should also refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [36889] [43236]

Vaccinia Immune Globulin, VIG: (Major) Defer vaccination with live attenuated virus vaccines until approximately 3 months after administration of vaccinia immune globulin (VIG). Inform the immunizing physician of recent therapy with the immune globulin so that appropriate measures can be taken. The efficacy of live attenuated virus vaccines may be impaired by vaccinia immune globulin (VIG) administration; revaccination may be necessary. The passive transfer of antibodies from the immune globulin may impair the efficacy of live attenuated virus vaccines. [48345]

Vamorolone: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107]

Vedolizumab: (Major) Avoid administering live vaccines to vedolizumab recipients unless the benefits outweigh the risks; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving vedolizumab. Before initiation of vedolizumab therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Vedolizumab recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [57235]

Venetoclax: (Major) Avoid live vaccines to venetoclax recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving venetoclax. Before initiation of venetoclax therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Venetoclax recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [60706]

vinCRIStine Liposomal: (Contraindicated) Do not administer live vaccines to vincristine recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving vincristine. At least 2 weeks before initiation of vincristine therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Vincristine recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [56085]

vinCRIStine: (Contraindicated) Do not administer live vaccines to vincristine recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving vincristine. At least 2 weeks before initiation of vincristine therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Vincristine recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [56085]

Vinorelbine: (Contraindicated) Do not administer live vaccines to vinorelbine recipients; no data are available regarding the risk of secondary transmission of infection by live vaccines in patients receiving vinorelbine. Before initiation of vinorelbine therapy, consider completion of all age appropriate vaccinations per current immunization guidelines. Vinorelbine recipients may receive inactivated vaccines, but the immune response to vaccines or toxoids may be decreased. [43236] [56871]

Voclosporin: (Major) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. [43236] [66336]

Monitoring Parameters

  • laboratory monitoring not necessary

US Drug Names

  • ERVEBO

References

Reference 1

27939 - Humira (adalimumab) injection package insert. North Chicago, IL: AbbVie Inc.; 2025 Dec.

Reference 2

27940 - Kineret (anakinra) package insert. Stockholm, Sweden: Swedish Orphan Biovitrum AB; 2025 Oct.

Reference 3

27985 - CellCept (mycophenolate mofetil) package insert. South San Francisco, CA: Genentech USA, Inc.; 2025 May.

Reference 4

27994 - Remicade (infliximab) package insert. Horsham, PA: Janssen Biotech, Inc.; 2025 Feb.

Reference 5

28060 - Enbrel (etanercept injection) package insert. Thousand Oaks, CA: Amgen; 2026 Jan.

Reference 6

28393 - Platinol (cisplatin) for injection package insert. Paramus, NJ: WG Critical Care, LLC; 2022 March.

Reference 7

28610 - Rapamune (sirolimus) package insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc.; 2022 Aug.

Reference 8

29025 - Rituxan (rituximab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2021 Dec.

Reference 9

29200 - Taxol (paclitaxel) package insert. Princeton, NJ: Bristol-Meyers Squibb; 2011 Apr.

Reference 10

29646 - Moreland LW, Bucy RP, Weinblatt ME, et al. Immune function in patients with rheumatoid arthritis treated with etanercept. Clin Immunol 2002;103:13-21.

Reference 11

30470 - Tysabri (natalizumab) package insert. Cambridge, MA: Biogen Inc.; 2025 Mar.

Reference 12

31761 - Orencia (abatacept) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2025 Nov.

Reference 13

33280 - Torisel (temsirolimus injection) package insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc.; 2011 Jun.

Reference 14

33837 - Arcalyst (rilonacept) package insert. Tarrytown, NY: Regeneron Pharmaceuticals, Inc.; 2021 Mar.

Reference 15

33930 - Cimzia (certolizumab pegol) subcutaneous injection package insert. Smyrna, GA: UCB Inc.; 2025 Sept.

Reference 16

35501 - Simponi (golimumab) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2025 Oct.

Reference 17

36889 - Stelara (ustekinumab) injection package insert. Horsham, PA: Janssen Biotech Inc.; 2026 April.

Reference 18

38283 - Actemra (tocilizumab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2025 Dec.

Reference 19

41378 - Ilaris (canakinumab) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2024 Nov.

Reference 20

41823 - Gilenya (fingolimod) oral capsule package insert. East Hanover, New Jersey: Novartis Pharmaceuticals Corporation; 2025 Aug.

Reference 21

41849 - Simulect (basiliximab) package insert. East Hanover, New Jersey: Novartis Pharmaceuticals Corporation; 2020 August

Reference 22

41904 - Alkeran (melphalan) injection package insert. Weston, FL: ApoPharma USA Inc.; 2018 Nov.

Reference 23

43236 - National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(2):1-64.

Reference 24

43658 - Benlysta (belimumab) injection package insert. Philadelphia, PA: GlaxoSmithKline LLC; 2025 June.

Reference 25

44667 - Nulojix (belatacept) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2021 Jul.

Reference 26

44928 - Alkeran (melphalan) tablets package insert. Weston, FL: ApoPharma USA Inc.; 2017 May.

Reference 27

48215 - Mitoxantrone injection package insert. Irvine, CA: Teva Parenteral Medicines, Inc.; 2011 Sep.

Reference 28

48339 - Cytarabine injection package insert. Bedford, OH: Bedford Laboratories; 2008 Sep.

Reference 29

48344 - Fdur (floxuridine) package insert. Paramus, NJ: Mayne Pharma (USA), Inc.; 2007 Nov.

Reference 30

48345 - CNJ-016 (vaccinia immune globulin intravenous, human) package insert. Winnipeg, Canada: Emergent BioSolutions Canada, Inc.; 2018 Nov.

Reference 31

49610 - Actimmune (interferon gamma-1b) injection solution package insert. Dublin, Ireland: Horizon Therapeutics Ireland DAC; 2024 Dec.

Reference 32

49634 - Arava (leflunomide) package insert. Bridgewater, NJ:. Sanofi-Aventis U.S. LLC; 2024 Jun.

Reference 33

49823 - Afinitor (everolimus) tablets package insert. East Hanover, NJ:Novartis Pharmaceuticals Corporation; 2026 June.

Reference 34

49903 - Zortress (everolimus) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2024 Feb.

Reference 35

51027 - Ifex (ifosfamide) injection package insert. Deerfield, IL: Baxter Healthcare Corp; 2024 Dec.

Reference 36

51716 - BabyBIG (botulism immune globulin intravenous human, BIG-IV) package insert. Westlake Village, CA: Baxalta Inc.; 2021 Jun.

Reference 37

51778 - Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of vaccines and immune globulins in persons with altered immunocompetence. MMWR 1993;42:1-18

Reference 38

51794 - Aubagio (teriflunomide) tablets package insert. Cambridge, MA: Genzyme Corporation; 2026 Feb.

Reference 39

52315 - Xeljanz and Xeljanz XR (tofacitinib) package insert. New York, NY: Pfizer Inc.; 2026 March.

Reference 40

53824 - Fluorouracil injection package insert. New York, NY: Pfizer Labs; 2012 Aug.

Reference 41

56085 - Vincristine sulfate injection package insert. Sellersville, PA: Teva Pharmaceuticals USA; 2013 Mar.

Reference 42

56353 - Gazyva (obinutuzumab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2025 Dec.

Reference 43

56871 - Navelbine (vinorelbine) injection package insert. Parsippany, NJ: Pierre Fabre Pharmaceuticals Inc; 2020 Jan.

Reference 44

57062 - Sylvant (siltuximab) injection package insert. Hertfordshire, U.K.: EUSA Pharma (UK), Ltd.; 2019 Dec.

Reference 45

57235 - Entyvio (vedolizumab) injection package insert. Cambridge, MA: Takeda Pharmaceuticals U.S.A, Inc.; 2026 Feb.

Reference 46

58408 - Docetaxel injection package insert. Princeton, NJ: Sandoz, Inc.; 2021 Jan.

Reference 47

58461 - Lemtrada (alemtuzumab) injection package insert. Cambridge, MA: Genzyme Corporation; 2024 May.

Reference 48

58559 - Blincyto (blinatumomab) injection package insert. Thousand Oaks, CA Amgen Inc.; 2025 Apr.

Reference 49

58739 - Cosentyx (secukinumab) injection package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2026 April.

Reference 50

60092 - Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014; 58: e44-100.

Reference 51

60497 - Envarsus XR (tacrolimus) extended-release tablets. Cary, NC: Veloxis Pharmaceuticals, Inc.; 2024 Apr.

Reference 52

60658 - Taltz (ixekizumab) injection package insert. Indianapolis, IN: Eli Lilly and Company; 2024 Aug.

Reference 53

60706 - Venclexta (venetoclax) tablets package insert. South San Francisco, CA: Genentech, Inc.; 2026 May.

Reference 54

61762 - Siliq (brodalumab) injection. Bridgewater, NJ: Bausch Health US, LLC; 2026 Feb.

Reference 55

61836 - Dupixent (dupilumab) injection package insert. Tarrytown, NY: Regeneron Pharmaceuticals, Inc.; 2026 April.

Reference 56

61838 - Ocrevus (ocrelizumab) injection package insert. South San Francisco, CA: Genentech, Inc.; 2026 May.

Reference 57

61976 - Kevzara (sarilumab) package insert. Bridgewater, NJ: Sanofi-Aventis US. LLC; 2024 Jun.

Reference 58

62120 - Tremfya (guselkumab) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2026 May.

Reference 59

62282 - Kymriah (tisagenlecleucel) suspension for IV infusion package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2025 Jun.

Reference 60

62530 - Yescarta (axicabtagene ciloleucel) suspension for injection package insert. Santa Monica, CA: Kite Pharma, Inc.; 2026 Feb.

Reference 61

62970 - Tildrakizumab-asmn (Ilumya) injection package insert. Cranbury, NJ: Sun Pharmaceutical Industries, Inc.; 2025 Dec.

Reference 62

63229 - Olumiant (baricitinib) tablets package insert. Indianapolis, IN: Lilly USA, LLC; 2022 Jun.

Reference 63

63767 - Gamifant (emapalumab) package insert. Stockholm, Sweden: Swedish Orphan Biovitrum AB (publ); 2025 Jun.

Reference 64

64031 - Mayzent (siponimod) oral tablets package insert. East Hanover, NJ: Novartis Pharmaceutical Corporation; 2025 Aug.

Reference 65

64073 - Skyrizi (risankizumab-rzaa) injection package insert. North Chicago, IL: AbbVie Inc.; 2026 March.

Reference 66

64572 - Rinvoq + Rinvoq LQ (upadacitinib) package insert. North Chicago, IL: Abbvie Inc.; 2025 Oct.

Reference 67

64868 - Ervebo (Ebola Zaire Vaccine, live) package insert. Rahway, NJ: Merck Sharp & Dohme LLC; 2026 April.

Reference 68

64911 - US Food and Drug Administration (FDA). FDA News Release: First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response. Retrieved Dec 23, 2019. Available on the World Wide Web at: https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-ebola-virus-disease-marking-critical-milestone-public-health?utm_campaign=121919_PR_First%20FDA-approved%20vaccine%20for%20the%20prevention%20of%20Eboopens in new tab/window

Reference 69

65107 - Kroger A, Bahta L, Hunter P. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Accessed April 25, 2024. Available at https://www.cdc.gov/vaccines/hcp/imz-best-practices/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html.opens in new tab/window

Reference 70

65169 - Ozanimod (Zeposia) capsules package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2024 Aug.

Reference 71

65576 - Uplizna (inebilizumab-cdon) injection package insert. Dublin, Ireland: Horizon Therapeutics Ireland DAC.; 2025 Dec.

Reference 72

65739 - Tecartus (brexucabtagene autoleucel) injection package insert. Santa Monica, CA: Kite Pharma, Inc.; 2026 Apr.

Reference 73

65841 - Enspryng (satralizumab-mwge) injection package insert. South San Francisco, CA: Genentech, Inc.; 2022 Mar.

Reference 74

65850 - Kesimpta (ofatumumab) injection package insert. East Hanover, NJ: Novartis Pharmaceutical Corporation; 2026 Apr.

Reference 75

66032 - Inmazeb (atoltivimab, maftivimab, odesivimab) for Injection package insert. Tarrytown, NY: Regeneron Pharmaceutical Inc; 2024 Oct.

Reference 76

66201 - Ebanga (ansuvimab-zykl) package insert. Baltimore, MD: Emergent Manufacturing Operations Baltimore LLC; 2026 Feb.

Reference 77

66212 - Centers for Disease Control and Prevention (CDC). Use of Ebola vaccine: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR 2021;70(1):1-12.

Reference 78

66336 - Lupkynis (voclosporin) capsules package insert. Rockville, MD: Aurinia Pharma U.S., Inc.; 2025 Oct.

Reference 79

66383 - Breyanzi (lisocabtagene maraleucel) injection package insert. Bothell, WA: Juno Therapeutics, Inc.; 2025 Dec.

Reference 80

66527 - Ponvory (ponesimod) tablet package insert. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2024 Jun.

Reference 81

66846 - Saphnelo (anifrolumab-fnia) injection package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2026 April.

Reference 82

67194 - Vyvgart (efgartigimod alfa-facb) package insert. Boston, MA: Argenx US, Inc.; 2026 May.

Reference 83

67195 - Tezspire (tezepelumab) injection package insert. Thousands Oak, CA: Amgen Inc.; 2025 Oct.

Reference 84

67217 - Adbry (tralokinumab-ldrm) injection package insert. Madison, NJ; LEO Pharma Inc.; 2025 Dec.

Reference 85

67277 - Cibinqo (abrocitinib) package insert. New York, NY: Pfizer; 2023 Dec.

Reference 86

67922 - Spevigo (spesolimab-sbzo) package insert. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2025 Oct.

Reference 87

67943 - Sotyktu (deucravacitinib) tablets package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2026 March.

Reference 88

68398 - Briumvi (ublituximab-xiiy) injection package insert. Morrisville, NC: TG Therapeutics, Inc.; 2026 Jan.

Reference 89

69114 - Velsipity (etrasimod) oral tablet package insert. New York, NY: Pfizer, Inc.; 2025 Aug.

Reference 90

69127 - Litfulo (ritlecitinib) package insert. New York, NY: Pfizer Inc.; 2023 Jun

Reference 91

69130 - Rystiggo (rozanolixizumab-noli) injection package insert. Smyrna, GA: UCB, Inc.; 2025 Dec.

Reference 92

69656 - Bimzelx (bimekizumab-bkzx) solution for injection package insert. Smyrna, GA: UCB, Inc.; 2024 Nov.

Reference 93

70972 - Leqselvi (deuruxolitinib) tablet package insert. Whippany, NJ: Sun Pharmaceutical Industries, Inc.; 2024 July.

Reference 94

71206 - Institute for Safe Medication Practices (ISMP). Vaccine registry not checked before administration. 2024 July; 23(7):2-3.

Reference 95

71236 - Ebglyss (lebrikizumab-lbkz) injection package insert. Indianapolis, IN: Eli Lilly and Company; 2026 Jun.

Reference 96

71642 - Centers for Disease Control and Prevention (CDC). Requesting Ebola vaccine doses. May 1, 2024. Accessed December 13, 2024. Available on the World Wide Web at https://www.cdc.gov/ebola/hcp/vaccines/ebola-vaccine-request.html.opens in new tab/window

Reference 97

71643 - Centers for Disease Control and Prevention (CDC). Expanded access investigational new drug (IND) protocol: Ervebo (Ebola Zaire Vaccine, Live) booster dose for domestic pre-exposure prophylaxis (PrEP) Vaccination of Adults (greater than or equal to 18 years of age) at potential occupation risk for exposure to Zaire ebolavirus. Accessed December 13, 2024. Available on the World Wide Web at https://www.cdc.gov/ebola/media/pdfs/2024/08/Protocol-7298_v4.1_06.20.2024_clean_v2.pdf.opens in new tab/window

Reference 98

72165 - Imaavy (nipocalimab-aahu) injection package insert. Horsham, PA: Janssen Biotech, Inc.; 2025 Apr.

Reference 99

72561 - Brinsupri (brensocatib) tablets package insert. Bridgewater, NJ: Insmed Incorporated; 2025 Aug.

Reference 100

72734 - Rhapsido (remibrutinib) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation: 2025 Sep.

Reference 101

72946 - Voyxact (sibeprenlimab-szsi) package insert. Rockville, MD: Ostuka America Pharmaceutical, Inc.; 2025 Nov.

Reference 102

73304 - Icotyde (icotrokinra) tablets package insert. Horsham, PA: Janssen Biotech, Inc.; 2026 March.