Can Vivotif and MMR Be Given at the Same Time?
Yes, Vivotif (Ty21a oral typhoid vaccine) and MMR vaccine can be administered simultaneously or at any interval before or after each other without concern for interference. 1
Key Principle for Oral Live Typhoid Vaccine
The Ty21a oral typhoid vaccine (Vivotif) is specifically exempt from the standard 4-week spacing rule that applies to parenteral (injected) live vaccines. 1, 2
- Ty21a typhoid vaccine and parenteral live vaccines (including MMR, varicella, and yellow fever) can be administered simultaneously or at any interval before or after each other, if indicated. 1
- This flexibility exists because the oral route of administration for Ty21a does not interfere with the immune response to parenteral live vaccines. 1
Standard Live Vaccine Spacing Rules (For Context)
While Vivotif is exempt, understanding the general rule helps clarify why this exception matters:
- Parenteral live vaccines (like MMR) must either be given on the same day or separated by at least 4 weeks to avoid immune interference. 3, 2, 4
- If two parenteral live vaccines are given less than 4 weeks apart (but not simultaneously), the second dose should not be counted as valid and must be repeated. 1, 2
Clinical Application
For your patient needing both Vivotif and MMR:
- Administer both vaccines on the same day if convenient. 1
- Alternatively, give them at any interval apart (days, weeks, or months) based on clinical scheduling needs. 1, 2
- No waiting period is required between these two vaccines in either direction. 1
Supporting Evidence from Recent Studies
A 2022 study in Nepal demonstrated non-interference when Vi-DT typhoid conjugate vaccine was given concomitantly with MMR vaccine in 9-15 month old infants, showing comparable seroconversion rates and no safety concerns. 5 While this study used the injectable Vi-DT conjugate vaccine rather than oral Ty21a, it further supports the principle that typhoid vaccines do not interfere with MMR immunogenicity.
Common Pitfall to Avoid
Do not mistakenly apply the 4-week spacing rule to Vivotif. 1 The oral Ty21a typhoid vaccine is specifically exempted from this requirement, unlike other live vaccines such as varicella, yellow fever, or intranasal influenza vaccine. 1, 2