Abatacept and Typhoid Vaccine, Live: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 16, 2026 · Source data updated Jul 16, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abatacept
Typhoid Vaccine, Live
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Orencia (abatacept) calms down your immune system to help control conditions like rheumatoid arthritis. The oral typhoid vaccine (Vivotif) is a live vaccine, meaning it uses a weakened form of the germ to train your body to fight it.
When your immune system is quieted by abatacept, two things can happen. First, your body may not build as strong a response to the vaccine, so the shot may not protect you as well. Second, because the germ is alive, there is a possible (though not proven) chance it could cause a mild infection. The good news is your care team can plan the timing of your vaccines to keep you safe, so talk with your doctor or pharmacist before getting any live vaccine.
Interaction: Abatacept modulates the cellular immune response (T-cell costimulation blockade), which may blunt the immune response to the live attenuated oral typhoid vaccine (Ty21a) and theoretically permit uncontrolled replication of the attenuated organism.
- Direction: Reduced vaccine efficacy; possible risk of vaccine-derived infection.
- Mechanism: Altered/attenuated cellular immunity due to abatacept.
- Evidence: Probable; no direct vaccination data in abatacept patients.
- Onset: Unspecified.
- Management: Live vaccines are not recommended during or within 3 months following abatacept therapy. Coordinate immunization timing; ideally administer live vaccines before initiating abatacept per current guidance.
What happens
Secondary transmission of infection by the live vaccine; reduced effectiveness of immunization
Interaction Deep Dive
No information exists concerning how vaccination behaves in individuals undergoing abatacept therapy; nevertheless, giving live vaccines while abatacept is being administered, or within the 3 months after such treatment, is advised against. Because abatacept may modify the cellular immune response, there is potential for it to interfere with the host's defenses against infection. Consequently, the vaccine's effectiveness could be diminished by abatacept. No data address whether infection is secondarily transmitted from recipients of live vaccines to patients being treated with abatacept1.
Why it happens (mechanism)
Altered cellular immune response
How to manage this interaction
This is a manageable situation with the right timing. Keep taking your abatacept as prescribed, and do not skip doses on your own.
- Live vaccines, including the oral typhoid vaccine, are generally not given during abatacept treatment or within 3 months after stopping it.
- Before any travel or vaccination, let your prescriber and pharmacist know you are on Orencia so they can plan the best timing.
- Your care team may recommend completing needed live vaccines before you start abatacept, or may consider alternative protection options.
Always check with your pharmacist or doctor before receiving any vaccine while on this medication.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abatacept and Typhoid Vaccine, Live together?
Do not get the live oral typhoid vaccine while on abatacept or within 3 months of stopping it, because it may work poorly and carries a possible infection risk. Talk with your doctor or pharmacist to plan vaccine timing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abatacept and Typhoid Vaccine, Live interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abatacept and Typhoid Vaccine, Live interaction managed?
This is a manageable situation with the right timing. Keep taking your abatacept as prescribed, and do not skip doses on your own. Live vaccines, including the oral typhoid vaccine, are generally not given during abatacept treatment or within 3 months after stopping it. Before any travel or vaccination, let your prescriber and pharmacist know you are on Orencia so they can plan the best timing. Yo… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Abatacept or Typhoid Vaccine, Live need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Product Information: ORENCIA(R) IV powder, abatacept IV powder. Bristol-Myers Squibb, Princeton, NJ, 2008.
Keep reading about Abatacept
Keep reading about Typhoid Vaccine, Live
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