Version July 2025
Chikungunya virus disease, prevention: IM: ~0.5 mL as a single dose. Note: There are currently no recommendations for a booster dose (Ref).
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.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.
>10%:
Gastrointestinal: Nausea (11%)
Hematologic & oncologic: Leukopenia (grade 1: 27%; grades 2/3: ≤4%), lymphocytopenia (grade 1: 19%; grades 2/3: ≤4%), neutropenia (grade 1: 28%; grades 2 to 4: ≤11%)
Local: Tenderness at injection site (11%)
Nervous system: Fatigue (29%), headache (32%)
Neuromuscular & skeletal: Arthralgia (17%), myalgia (24%)
Miscellaneous: Fever (14%)
1% to 10%:
Dermatologic: Skin rash (2%)
Gastrointestinal: Diarrhea (1%), vomiting (2%)
Local: Induration at injection site (1%), pain at injection site (6%)
Nervous system: Chills (2%)
Neuromuscular & skeletal: Back pain (1%)
<1%:
Cardiovascular: Atrial fibrillation
Endocrine & metabolic: Hyponatremia
Hematologic & oncologic: Lymphadenopathy
Frequency not defined:
Cardiovascular: Peripheral edema, syncope, tachycardia
Dermatologic: Erythematous rash, hyperhidrosis
Infection: Viremia
Nervous system: Asthenia, ataxia, dizziness, hypoesthesia, paresthesia, peripheral neuropathy, pain
Respiratory: Flu-like symptoms, tachypnea
Severe hypersensitivity reaction (eg, anaphylaxis) to chikungunya vaccine (live) or any component of the formulation; immunodeficiency or immunosuppression due to disease or medical therapy (including persons with hematologic and solid tumors, congenital immunodeficiency, or those severely immunocompromised due to HIV infection; those receiving chemotherapy or long-term immunosuppressive therapy).
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including injectable epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (Ref).
• Chikungunya-like adverse reactions: Severe and/or prolonged chikungunya-like adverse reactions (eg, severe myalgia, hypovolemic hyponatremia atrial fibrillation) have been reported.
• 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 (Ref).
• 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 (Ref).
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 vaccination in individuals with moderate or severe acute illness (with or without fever). The presence of a mild acute illness (with or without fever) should not delay vaccination (Ref).
• 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 (Ref).
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (Ref).
• 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 (Ref).
Special populations:
• Altered immunocompetence: Use is contraindicated in persons who are immunocompromised (eg, patients receiving chemotherapy); may have a reduced response to vaccination or may have an adverse event secondary to replication. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines (Ref). Live vaccines should be administered ≥4 weeks prior to planned immunosuppression and avoided within 2 weeks of immunosuppression when feasible; live vaccines should not be administered for at least 3 months after immunosuppressive therapy. Specific recommendations for use of vaccines in immunocompromised patients considering international travel as well as contacts of immunocompromised patients are available from the Infectious Diseases Society of America (Ref).
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (Ref). One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to vaccination decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Ref).
• 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 (Ref).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intramuscular:
Ixchiq: (1 ea) [contains albumin human, bovine serum albumin/cross-linking agent]
No
IM: Prior to using, the powder (antigen vial) must be reconstituted with the liquid (diluent). Administer by IM injection into 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, adults should be vaccinated while seated or lying down (Ref). US law requires that the date of administration, vaccine manufacturer, lot number of vaccine, vaccine information statement edition date and date it was provided, and administering person's name, title, and address be recorded.
For patients at risk of hemorrhage following IM injection, the Advisory Committee on Immunization Practices recommends that the vaccine 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 or smaller) 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).
Chikungunya virus disease, prevention: Prevention of disease caused by chikungunya virus (CHIKV) in persons ≥18 years of age who are at increased risk of exposure to CHIKV.
The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for the following persons ≥18 years of age at risk for exposure to CHIKV (CDC 2025):
• Persons traveling to a country or territory experiencing a chikungunya outbreak.
• Laboratory workers with potential for exposure to CHIKV.
The ACIP suggests considering vaccination for the following persons ≥18 years of age traveling to a country or territory not currently experiencing a chikungunya outbreak but with evidence of CHIKV transmission among humans within the last 5 years (CDC 2025):
• Persons who plan to stay for a cumulative period of ≥6 months.
• Persons >65 years of age (particularly those with underlying medical conditions) who are likely to have at least moderate exposure to mosquitos.
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 drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May decrease therapeutic effects 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 decrease therapeutic effects of Chikungunya Vaccine (Live). Anti-CD20 B-Cell Depleting Therapies may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Atidarsagene Autotemcel: May increase adverse/toxic effects of Vaccines. Atidarsagene Autotemcel may decrease therapeutic effects of Vaccines. Risk X: Avoid
Cladribine: May increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Cladribine may decrease therapeutic effects of Vaccines (Live). Risk X: Avoid
Corticosteroids (Systemic): May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Dimethyl Fumarate: May increase adverse/toxic effects of Vaccines (Live). Specifically, Dimethyl Fumarate may increase the risk of vaccinal infection. Dimethyl Fumarate may decrease therapeutic effects of Vaccines (Live). Management: Non-US labeling for dimethyl fumarate states that live attenuated vaccine administration is not recommended during treatment. US labeling states that safety and effectiveness of live vaccines administered with dimethyl fumarate has not been assessed. Risk C: Monitor
Dinutuximab Beta: May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Dinutuximab Beta may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Dupilumab: May increase adverse/toxic effects of Vaccines (Live). Risk X: Avoid
Elivaldogene Autotemcel: May increase adverse/toxic effects of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may decrease therapeutic effects 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
Etrasimod: May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Etrasimod may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Immune Globulins: May decrease therapeutic effects of Vaccines (Live). Management: Live organism vaccination should be withheld for as long as 6 to 11 months following immune globulin administration. Recommendations vary by product and immune globulin dose, see full monograph for details. Risk D: Consider Therapy Modification
Immunosuppressants (Cytotoxic Chemotherapy): May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Immunosuppressants (Miscellaneous Oncologic Agents): May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Immunosuppressants (Therapeutic Immunosuppressant Agents): May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Lebrikizumab: May increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Lebrikizumab may decrease therapeutic effects of Vaccines (Live). Risk X: Avoid
Leniolisib: May decrease therapeutic effects of Vaccines (Live). Risk C: Monitor
Methotrexate: May decrease therapeutic effects of Chikungunya Vaccine (Live). Methotrexate may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Nemolizumab: May increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Nemolizumab may decrease therapeutic effects of Vaccines (Live). Risk X: Avoid
Propacetamol: May decrease therapeutic effects 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
Rabies Immune Globulin (Human): May decrease therapeutic effects of Vaccines (Live). Management: Avoid administering the measles vaccine within 4 months after administration of rabies immune globulin. Avoid administering other live vaccines within 3 months after administration of rabies immune globulin. Risk D: Consider Therapy Modification
Teplizumab: May increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Teplizumab may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Tezepelumab: May increase adverse/toxic effects of Vaccines (Live). Risk X: Avoid
Thiotepa: May decrease therapeutic effects of Vaccines (Live). Thiotepa may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Tildrakizumab: May increase adverse/toxic effects of Vaccines (Live). The risk for contracting an infection from the vaccine may be increased. Tildrakizumab may decrease therapeutic effects of Vaccines (Live). Risk X: Avoid
Tralokinumab: May increase adverse/toxic effects of Vaccines (Live). Risk X: Avoid
Tuberculin Tests: Coadministration of Vaccines (Live) and Tuberculin Tests may alter diagnostic results. Management: It is preferable to administer live vaccines simultaneously with tuberculin tests. If a live vaccine has been recently administered, the tuberculin skin test should be administered 4 to 6 weeks following the administration of the vaccine. Risk D: Consider Therapy Modification
Vaccines (Live): May decrease therapeutic effects of Vaccines (Live). Management: Two or more injectable or nasally administered live vaccines not administered on the same day should be separated by at least 28 days (ie, 4 weeks). If not, the vaccine administered second should be repeated at least 4 week later. Risk C: Monitor
It is not known if the chikungunya vaccine can cross the placenta.
Outcome data following vaccination during pregnancy are limited (Maurer 2024).
Maternal-fetal virus transmission has occurred following infection with the chikungunya virus during outbreaks, particularly with maternal viremia at delivery. Newborns may appear healthy at birth but develop signs of infection within the first week of life (Ferreira 2024; Simon 2023). Viremia occurs following vaccination; monitor infants closely for 7 days after birth if maternal vaccination occurs within 14 days of delivery.
In general, vaccination with live, attenuated virus vaccines is contraindicated during pregnancy (ACIP [Kroger 2023]). If administration of the chikungunya vaccine is needed when exposure is not avoidable and risk of infection is high, avoid administration during the first trimester (until 14 weeks' gestation) and after 36 weeks' gestation. Vaccination should be deferred until after delivery when possible (CDC 2025).
Data collection to monitor pregnancy and infant outcomes following maternal vaccination is ongoing. Health care providers are encouraged to contact OXON Epidemiology to enroll patients exposed to Ixchiq during pregnancy in the registry (1-855-417-6214); patients may also enroll themselves.
It is not known if the chikungunya vaccine is present in breast milk.
When the risk of infection is high (eg, during an outbreak) and exposure cannot be avoided, the decision to breastfeed following vaccination should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of vaccination to the mother (CDC 2025).
Monitor for hypersensitivity and syncope for 15 minutes following administration (Ref). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
Induces anti-chikungunya virus neutralizing antibodies. The exact mechanism of protection has not been determined.
Onset: Seroresponse rates were ~99% and ~96% at 28 days and 180 days postvaccination, respectively.
