What happens if you take Vivotif with food?

The manufacturer doesn't specify what happens when you take Vivotif with food. But it's thought that doing so might affect [how well this vaccine works](https://pubmed.ncbi.nlm.nih.gov/9772310/) to protect you against typhoid fever. For the best results, swallow Vivotif whole one hour before a meal.

Is Vivotif a live vaccine?

Yes, Vivotif is a [live-attenuated vaccine](https://www.goodrx.com/health-topic/vaccines/how-vaccines-work#types-of-vaccines). This means that the vaccine is made using live, but weakened forms of the bacteria *S. typhi*. Live vaccines might not be appropriate for people with [weakened immune systems](https://www.cdc.gov/vaccines/hcp/current-vis/typhoid.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html) because the bacteria in the vaccine might [make them sick](https://www.cdc.gov/vaccines/basics/explaining-how-vaccines-work.html). So make sure your healthcare team knows about all of your medical conditions and medications you're taking before receiving Vivotif.

Who should receive Vivotif?

Vivotif isn't recommended as routine vaccination in the United States and isn't for everyone. This vaccine is only recommended for people who are at high risk of coming into contact with *S. typhi*. These people include __travelers__ going to areas where there's a known risk of being exposed to *S. typhi*. Check if vaccination is recommended for [your destination](https://wwwnc.cdc.gov/travel/destinations/list). Additionally, Vivotif is recommended for people who are __in close contact__ with someone (e.g., someone you live with) who is carrying the *S. typhi* bacteria inside their body and people who __work with *S. typhi* often__ (e.g., in a lab for research). If any of these apply to you, talk to your healthcare professional (HCP) about taking Vivotif.

Vivotif

typhoid vaccine live oral

Used for Typhoid

Vivotif is a prescription live-attenuated vaccine that's used to prevent typhoid fever in people ages 6 years and older. It comes as a capsule that's taken by mouth on an empty stomach every other day for 4 doses total. Vivotif isn't a routine vaccine for everyone; it's only recommended for certain people who are traveling to a place where typhoid is common or for people who are at high risk of coming into contact with Salmonella typhi, the bacteria that causes typhoid fever. Side effects of this vaccine include stomach pain, nausea, and headache.

Reviewed by:

Robert Chad Hakim, PharmD, BCCCP

Allison Gourley, PharmD

Last reviewed on January 6, 2025

What is Vivotif?

What is Vivotif used for?

Prevention of typhoid fever in people ages 6 years or older

How Vivotif works

Vivotif is a vaccine that protects you from Salmonella typhi (S. typhi), a bacteria that causes typhoid fever. It's a live-attenuated vaccine that's made from a weakened version of the bacteria. The vaccine helps your body's immune system make antibodies against the weakened bacteria. These antibodies will then attack the bacteria if it ever infects your body.

Are you looking for information on Typhim Vi (typhoid vaccine) injection instead?

Drug facts

Common BrandsVivotif

Drug ClassVaccine

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

Side effects of Vivotif

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Stomach pain (6%)
Nausea (6%)
Headache (5%)

Less Common Side Effects

Fever
Diarrhea
Vomiting
Skin rash

Source: DailyMed

The following Vivotif side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

Diarrhea
Fever
Headache
Nausea
Stomach pain
Vomiting

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Avg retail price

$157.88(Save 26.22%)

GoodRx discount

$116.49

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Pros and cons of Vivotif

Pros

A first-choice option for preventing typhoid fever
Can provide protection for up to 5 years (compared to Typhim Vi (typhoid vaccine) injection)
Taken by mouth
Can be given to children as young as 6 years old

Cons

Need to take 4 doses for a full course
Capsules need to be refrigerated
Need to take it an hour before a meal with a cold or luke-warm drink
Might not be a good option for people who have weakened immune systems

Pharmacist tips for Vivotif

Store Vivotif in the refrigerator at all times (but don't freeze it) and take it right away when it's time for your dose. If Vivotif was left out of the refrigerator and warmed up, don't take it and contact your prescriber or pharmacist for a replacement.
Set an alarm or mark the days you need to take Vivotif on your calendar. This can help you remember to take the vaccine, since you'll need to take it every other day until you finish all the capsules.
For best protection against typhoid fever, take all 4 doses of Vivotif at least 1 week before potential exposure.
Don't chew Vivotif capsules. Swallow the capsule whole about 1 hour before a meal with a cold or lukewarm drink. A drink that's hot or steaming can cause the vaccine to not work as well.
If you continue to be at risk for typhoid over an extended period of time, let your healthcare team know. Depending on your risk, they might recommend that you get a Vivotif booster every 5 years.
Practice safe eating and drinking habits even after you've received Vivotif. This vaccine can help prevent typhoid fever, but it's not always effective. Get medical help right away if you have symptoms of typhoid fever include fever, weakness, stomach pain, and loss of appetite.
It's not known if Vivotif causes harm to unborn babies when given to people who are pregnant. It should be given while pregnant if it's absolutely needed. Discuss with your obstetrician-gynecologist (OB-GYN) about the risks and benefits of the medication before taking Vivotif.

Common questions about Vivotif

Vivotif should be stored in the refrigerator at all times. The only time it should be taken out of the refrigerator is right before you're about to take a dose; you shouldn't wait for it to warm up before taking the dose. If you've accidentally left Vivotif out of the refrigerator, ask your pharmacy or prescriber if it's possible to get a replacement.

The manufacturer doesn't specify what happens when you take Vivotif with food. But it's thought that doing so might affect how well this vaccine works to protect you against typhoid fever. For the best results, swallow Vivotif whole one hour before a meal.

You can drink coffee after taking Vivotif, but only if the coffee is cold or lukewarm (no warmer than body temperature). Drinks that are too warm or hot can damage the contents of the vaccine and affect how well the vaccine works.

Yes, you can only get Vivotif with a prescription from a healthcare professional (HCP). This vaccine should be available at most local pharmacies. But your pharmacist might need to order it first and it can take a few days for the vaccine to arrive. If you have a prescription for Vivotif, call your local pharmacy to check.

Yes, Vivotif is a live-attenuated vaccine. This means that the vaccine is made using live, but weakened forms of the bacteria S. typhi. Live vaccines might not be appropriate for people with weakened immune systems because the bacteria in the vaccine might make them sick. So make sure your healthcare team knows about all of your medical conditions and medications you're taking before receiving Vivotif.

Vivotif isn't recommended as routine vaccination in the United States and isn't for everyone. This vaccine is only recommended for people who are at high risk of coming into contact with S. typhi. These people include travelers going to areas where there's a known risk of being exposed to S. typhi. Check if vaccination is recommended for your destination. Additionally, Vivotif is recommended for people who are in close contact with someone (e.g., someone you live with) who is carrying the S. typhi bacteria inside their body and people who work with S. typhi often (e.g., in a lab for research). If any of these apply to you, talk to your healthcare professional (HCP) about taking Vivotif.

Vivotif and Typhim Vi are both vaccines that help protect you from typhoid fever. Some of the differences between the two are related to the type of vaccine, timing, and how each of the vaccines are given. Vivotif is a live-attenuated vaccine that's taken by mouth every other day for a total of 4 doses, starting at least 1 week before potential exposure. You'll need a booster every 5 years if you continue to be at risk for typhoid fever. Typhim Vi is an inactivated vaccine that's injected into the muscle once at least 2 weeks before potential exposure. You'll need a dose every 2 years if you continue to be at risk.

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Risks and warnings for Vivotif

Vivotif can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Maintain necessary precautions

Just like all vaccines, receiving Vivotif doesn't guarantee that you won't get infected with S. typhi. For the best protection against typhoid fever, you should receive a full course of Vivotif as well as take all necessary precautions to avoid getting sick from unclean food and drinks. Some examples include avoiding raw foods, street food, bushmeat (local wild game, typically animals not eaten in the United States), tap water, fountain drinks, ice, and freshly squeezed juice.

Interactions with other medications

Risk factors: Taking sulfa medications, antibiotics, and certain antimalarial medications with Vivotif | Taking Malarone (atovaquone / proguanil) within 10 days of completing Vivotif treatment

Vivotif can interact with several other medications, including some sulfa medications, antibiotics, and certain antimalarial medications (e.g., mefloquine, chloroquine, proguanil in Malarone (atovaquone / proguanil)). These medications can lower how well Vivotif works for you. Make sure to tell your prescriber about all the medications you're taking before starting Vivotif. Don't start any new medications while taking Vivotif without talking to a member of your care team first.

Not recommended for people with weakened immune systems

Risk factors: Conditions that lower the immune system | Taking medications that lower the immune system

Live-attenuated vaccines, like Vivotif, aren't recommended for people with weakened immune systems. They might be at higher risk of accidental infection from uncontrolled growth of the weakened bacteria contained in the vaccine. And there's a possibility that the vaccine won't work as well. People with weakened immune systems include those with certain conditions (e.g., human immunodeficiency virus (HIV), cancer). If you have a weakened immune system, ask your care team what options are right for you.

Vivotif dosage

The average cost for 1 dose pack of 4 capsules of Vivotif is $116.49 with a free GoodRx coupon. This is 26.22% off the average retail price of $157.88.

Dose pack

Dosage	Quantity	Price as low as	Price per unit
4 capsules	1 dose pack	$116.49	$116.49

Typical dosage for Vivotif

Each capsule of Vivotif contains 2–10x10⁹ colony-forming units (CFUs) of live attenuated strain Salmonella typhi Ty21a.

Adults and children ages 6 years and older: The typical dose is 1 capsule by mouth once every other day for a total of 4 doses. Take each capsule an hour before a meal with a cold or lukewarm (no warmer than body temperature) drink. The 4-dose series should be completed at least a week before potential exposure to S. typhi.

How much does Vivotif cost?

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Vivotif (brand)

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Vivotif contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Vivotif will not be safe for you to take.

Acute (sudden, short-term) febrile illness (e.g., rapid onset of fever, muscle pain, joint pain, headache, chills)
Have medical conditions or take medications that weaken the immune system

What are alternatives to Vivotif?

There are a number of medications that your doctor can prescribe in place of Vivotif. Compare a few possible alternatives below.

Vivotif

Used for:

Prevention of typhoid fever in people ages 6 years or older

$116.49Lowest GoodRx priceView prices

Typhim Vi

Used for:

Prevention of typhoid fever in adults and children 2 years or older

$117.00Lowest GoodRx priceView prices

News about Vivotif

Travel Vaccines: How to Get Vaccinated for Yellow Fever, Malaria, and More

If you’re planning an international trip, you may need to update your vaccinations. Learn where to get travel vaccines, such as for yellow fever, and how to save on the cost.

Vivotif images

This medicine is Pink And White Dose Pack.pink and white - Vivotif Typhoid Oral Vaccine

References

Best studies we found

Barathan, M. (2024). From fever to action: Diagnosis, treatment, and prevention of acute undifferentiated febrile illnesses. Pathogens and Disease.

Bavarian Nordic A/S. (2024). Vivotif- salmonella typhi ty21a capsule, coated package insert]. DailyMed.

Centers for Disease Control and Prevention. (n.d.). Destinations.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

Vivotif