Vivotif
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.
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.
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What are the side effects of Vivotif?
Common Side Effects
- Stomach pain (6%)
- Nausea (6%)
- Headache (5%)
Other Side Effects
- Fever
- Diarrhea
- Vomiting
- Skin rash
Source: DailyMed
The following 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):
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.
Frequently asked questions about Vivotif
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What are the 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 forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 capsules | 1 dose pack | $112.36 | $112.36 |
Typical dosing 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?
Vivotif contraindications
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?
Prevention of typhoid fever in people ages 6 years or older
Prevention of typhoid fever in adults and children 2 years or older
Vivotif images
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References
Best studies we foundBarathan, 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.
Centers for Disease Control and Prevention. (2019). Typhoid vaccine VIS.
Centers for Disease Control and Prevention. (2023). Food and drink considerations when traveling.
Centers for Disease Control and Prevention. (2024). About typhoid fever and paratyphoid fever.
Centers for Disease Control and Prevention. (2024). Clinical guidance for typhoid fever and paratyphoid fever.
Centers for Disease Control and Prevention. (2024). Explaining how vaccines work.
Centers for Disease Control and Prevention. (2024). Preventing typhoid fever and paratyphoid fever.
Centers for Disease Control and Prevention. (2024). Symptoms of typhoid fever and paratyphoid fever.
Cryz, S. J., Jr (1998). Patient compliance in the use of Vivotif Berna(R) vaccine, typhoid vaccine, live oral Ty21a. Journal of Travel Medicine.
World Health Organization. (2020). How do vaccines work?
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