Version May 2024
Note: According to Advisory Committee on Immunization Practices (ACIP), doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (Ref).
Tick-borne encephalitis, prevention:
Primary immunization: IM: 0.5 mL per dose administered as a 3-dose series with the second dose given 14 days to 3 months after the first dose, and the third dose given 5 to 12 months after the second dose. Note: Complete the series ≥1 week prior to potential exposure to tick-borne encephalitis virus.
Booster immunization (for persons with continuous exposure or possible re-exposure to tick-borne encephalitis virus): IM: 0.5 mL as a single dose administered ≥3 years following completion of the primary series.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Tick-borne encephalitis vaccine: Pediatric drug information")
Note: According to Advisory Committee on Immunization Practices (ACIP), doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (Ref).
Tick-borne encephalitis, prevention:
Primary immunization: Note: Complete the series ≥1 week prior to potential exposure to tick-borne encephalitis virus (TBEV).
Children and Adolescents <16 years: IM: 0.25 mL per dose administered as a 3-dose series with second dose given 1 to 3 months after the first dose, and the third dose given 5 to 12 months after the second dose.
Adolescents ≥16 years: IM: 0.5 mL per dose administered as a 3-dose series with the second dose given 14 days to 3 months after the first dose, and the third dose given 5 to 12 months after the second dose.
Booster immunization (for persons with continuous exposure or possible re-exposure to TBEV):
Children ≥4 years and Adolescents <16 years: IM: 0.25 mL as a single dose administered ≥3 years following completion of the primary series.
Adolescents ≥16 years: IM: 0.5 mL as a single dose administered ≥3 years following completion of the primary series.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Local: Pain at injection site (8% to 14%), tenderness at injection site (13% to 30%)
Nervous system: Headache (3% to 11%)
1% to 10%:
Gastrointestinal: Anorexia (1% to 3%), nausea (≤3%), vomiting (≤2%)
Local: Erythema at injection site (2% to 4%), induration at injection site (1% to 3%), swelling at injection site (1% to 3%)
Nervous system: Fatigue (2% to 7%), malaise (2% to 5%), restlessness (4% to 9%), sleep disorder (≤3%)
Neuromuscular & skeletal: Arthralgia (≤1%), myalgia (2% to 5%)
Miscellaneous: Fever (more common in children)
<1%:
Dermatologic: Ecchymoses (injection site), injection site pruritus, urticaria
Gastrointestinal: Abdominal pain, diarrhea, dyspepsia
Hematologic & oncologic: Lymphadenitis (axillary/inguinal)
Hypersensitivity: Hypersensitivity reaction
Local: Hematoma at injection site, warm sensation at injection site
Nervous system: Abnormal sensory symptoms, dizziness, drowsiness, vertigo
Postmarketing:
Cardiovascular: Edema, tachycardia
Dermatologic: Dermatitis, erythema of skin, erythematous rash, hyperhidrosis, maculopapular rash, pruritus, skin rash, vesicular eruption
Hypersensitivity: Anaphylaxis
Immunologic: Exacerbation of autoimmune disease
Infection: Herpes zoster infection (triggered in pre-exposed individuals)
Local: Inflammation at injection site, injection site nodule
Nervous system: Abnormal gait, acute disseminated encephalomyelitis, aseptic meningitis, Bell’s palsy, chills, demyelinating disease, encephalitis, facial paresis, Guillain-Barre syndrome, hemiparesis, hemiplegia, meningism, motor dysfunction, neuralgia, neuritis, paralysis, paresis, polyneuropathy, seizure, transverse myelitis
Neuromuscular & skeletal: Asthenia, back pain, joint swelling, limb pain, muscle rigidity, myelitis, neck pain, neck stiffness
Ophthalmic: Eye pain, optic neuritis, photophobia, visual impairment
Otic: Tinnitus
Respiratory: Dyspnea, flu-like symptoms
Miscellaneous: Febrile seizure
Severe hypersensitivity (eg, anaphylaxis) to tick-borne encephalitis vaccine or any component of the formulation.
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2023]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Postpone administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]).
• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2023]).
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2023]).
• Vaccines: In order to maximize vaccination rates, the Advisory Committee on Immunization Practices recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or nonlive) for which a person is eligible at a single visit, unless contraindications exist (ACIP [Kroger 2023]).
Special populations:
• Altered immunocompetence: Postpone vaccination during periods of severe immunosuppression (eg, patients receiving chemotherapy/radiation therapy or other immunosuppressive therapy [including high-dose corticosteroids]) if appropriate; may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines (ACIP [Kroger 2023]; IDSA [Rubin 2014]). Nonlive vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; nonlive vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2023]; IDSA [Rubin 2014]).
Dosage form specific issues:
• Albumin: Formulation contains albumin, which may carry a remote risk of viral transmission, including a theoretical risk of Creutzfeldt-Jakob disease transmission.
• Gelatin: Product may contain gelatin.
• Neomycin: Product may contain neomycin.
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate use: Specific recommendations for use of vaccines in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions are available from the Infectious Diseases Society of America (IDSA [Rubin 2014]).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval (ACIP [Kroger 2023]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension Prefilled Syringe, Intramuscular:
Ticovac: 2.4 mcg/0.5 mL (0.5 mL) [contains albumin human, chicken protein, formaldehyde solution, neomycin, protamine sulfate]
Suspension Prefilled Syringe, Intramuscular [preservative free]:
Ticovac: 1.2 mcg/0.25 mL (0.25 mL) [contains albumin human, chicken protein, formaldehyde solution, neomycin, protamine sulfate]
No
Suspension Prefilled Syringe (Ticovac Intramuscular)
1.2MCG/0.25ML (per 0.25 mL): $347.32
2.4 mcg/0.5 mL (per 0.5 mL): $347.32
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IM: Allow vaccine to come to room temperature prior to administration. Shake well. Do not use if a homogenous off-white, opalescent suspension does not form. Administer IM in the deltoid muscle (Ref). Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Ref). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, patients should be vaccinated while seated or lying down (Ref). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23-gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for ≥2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (Ref).
Parenteral: IM: Allow vaccine to come to room temperature prior to administration. Shake well. Do not use if a homogenous off-white, opalescent suspension does not form. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, patients should be vaccinated while seated or lying down (Ref).
Administer IM; preferred muscle for injection is based on age:
Children <3 years: IM injection in anterolateral thigh preferred; deltoid muscle can be used if muscle mass is adequate (Ref).
Children ≥3 years and Adolescents: IM injection in the deltoid muscle. Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Ref).
US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23-gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (Ref).
In the United States, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to the patient/caregiver before administering each dose of this vaccine; the VIS edition date and date it was provided to the patient/caregiver should be recorded as required by US law.
Tick-borne encephalitis prevention: Active immunization to prevent tick-borne encephalitis in persons ≥1 year of age.
Ticovac (Tick-Borne Encephalitis Vaccine) may be confused with Tenivac (Tetanus and Diphtheria Toxoids).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification
Cladribine: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Corticosteroids (Systemic): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination
Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 3 after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Methotrexate: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to methotrexate initiation, if possible. If patients are vaccinated less than 14 days prior to or during methotrexate therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification
Teplizumab: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccination with inactivated or non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted.
It is not known if the components of this vaccine are present in breast milk.
According to the manufacturer, the decision to breastfeed following immunization should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
Monitor for hypersensitivity and syncope for 15 minutes following administration (ACIP [Kroger 2023]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
Promotes active immunization by inducing tick-borne encephalitis virus-neutralizing antibodies.
Onset: Immune response was elicited by 3 weeks after the third dose; ~90% of individuals ≥16 years of age were seropositive by 7 days after the third dose.
Duration: ~82% to 100% of vaccinated individuals remained seropositive at 3 years after the primary series.
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