Vivotif Berna

Generic Name: typhoid vaccine (live), oral (TYE foid vax EEN)

What is typhoid vaccine?

Typhoid (also called “typhoid fever”) is a serious disease caused by Salmonella typhi bacteria. Typhoid can be fatal if left untreated.

Typhoid can cause high fever, muscle aches, severe headache, weakness, confusion or agitation, loss of appetite, stomach pain, diarrhea or constipation, and rose-colored spots on the skin.

Untreated typhoid infection may lead to kidney failure, or intestinal bleeding caused by perforation (forming of a hole), which can be fatal. If the infection spreads to the gallbladder, the infected person may become a chronic carrier of the bacteria that causes typhoid. A carrier may have no symptoms but is capable of spreading the infection to others.

Typhoid is spread through contact with the stool (bowel movements) of a person infected with the bacteria. This usually occurs by eating food or drinking water that has become contaminated with feces from an infected person. Once in the digestive tract, typhoid infection can spread to the blood and other parts of the body.

Typhoid fever is most common in non-industrialized parts of the world, especially Asia, Africa, and Central or South America. People who travel to those regions are at risk of coming into contact with the disease.

The typhoid vaccine is used to help prevent this disease in adults and children who are at least 6 years old. Although not part of a routine immunization schedule in the U.S., typhoid vaccine is recommended for people who travel to areas where the disease is common.

This vaccine works by exposing you to a small amount of the bacteria, which causes your body to develop immunity to the disease.

Typhoid vaccine will not treat an active infection that has already developed in the body, and will not prevent any disease caused by bacteria other than Salmonella typhi.

Like any vaccine, the typhoid vaccine may not provide protection from disease in every person.

What is the most important information I should know about typhoid vaccine?

You should not receive this vaccine if you have ever had an allergic reaction to typhoid vaccine in the past, or if you have fever with any type of infection or illness, or a weak immune system caused by disease or by using certain medicines such as chemotherapy. Typhoid vaccine should not be used in a person who is a typhoid carrier.

Before you receive this vaccine, tell the doctor if you have any illness with vomiting or diarrhea, if you are taking an antibiotic or sulfa drug (Azulfidine, Bactrim, Cotrim, Gantrisin, Septra, SMX-TMP, Sulfazine), or if you plan to start taking an anti-malaria medication within 10 days after receiving typhoid vaccine.

You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, the doctor may ask you to wait until you get better before you can receive the vaccine.

The typhoid oral vaccine is given in a series of 4 capsules that are taken 1 per day on alternating days (days 1, 3, 5, and 7). On this alternating-day schedule, you will take 1 capsule every 48 hours for 7 days. You must take each capsule according to the recommended schedule for this vaccine to be effective.

You should complete all doses at least 1 week before your scheduled travel or possible exposure to typhoid.

You must keep typhoid vaccine capsules cold when not in use. Once you receive the capsules from your doctor or pharmacy, take them directly home and place them in the refrigerator. Keep each capsule in the foil blister pack in the refrigerator until you are ready to take it. Do not allow the capsules to freeze.

Like any vaccine, the typhoid vaccine may not provide protection from disease in every person.

In addition to receiving typhoid vaccine, take precautions while traveling such as avoiding raw fruits or vegetables that cannot be peeled, drinks that contain ice, flavored ices that may have been made with contaminated water, unbottled or unboiled water, or any food or beverage purchased from a street vendor.

What should I discuss with my healthcare provider before receiving typhoid vaccine?

Typhoid vaccine should not be used in a person who is a typhoid carrier. You should not receive this vaccine if you have ever had an allergic reaction to typhoid vaccine in the past, or if you have:

fever with any type of infection or illness;

a weak immune system caused by disease such as HIV/AIDS or cancer; or

a weak immune system caused by using certain medicines such as chemotherapy.

You may not be able to receive this vaccine if you have:

stomach flu or any illness with vomiting or diarrhea;

if you are taking an antibiotic, especially a sulfa drug such as sulfasalazine (Azulfidine, Sulfazine), sulfamethoxazole (Bactrim, Cotrim, Septra, SMX-TMP), or sulfisoxazole (Gantrisin); or

if you plan to start taking an anti-malaria medication within 10 days after receiving a typhoid oral vaccine.

You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, the doctor may ask you to wait until you get better before you can receive the vaccine.

Vaccines may be harmful to an unborn baby and generally should not be given to a pregnant woman. However, not vaccinating the mother could be more harmful to the baby if the mother becomes infected with a disease that this vaccine could prevent. Your doctor will decide whether you should receive this vaccine, especially if you have a high risk of infection with typhoid. It is not known whether typhoid vaccine passes into breast milk, or if it could harm a nursing baby. Do not receive this vaccine without telling your doctor if you are breast-feeding a baby.

How is typhoid vaccine given?

Typhoid vaccine is recommended for adults and children in the following situations:

people who travel to countries where typhoid fever is common;

people who will have long-term exposure to food or water that may be contaminated with typhoid;

people who live with someone who is a typhoid carrier; and

laboratory workers who may come into contact with Salmonella typhi in a work setting.

The typhoid oral vaccine is given in a series of 4 capsules that are taken 1 per day on alternating days (days 1, 3, 5, and 7). On this alternating-day schedule, you will take 1 capsule every 48 hours for 7 days. You must take each capsule according to the recommended schedule for this vaccine to be effective.

You should complete all doses at least 1 week before your scheduled travel or possible exposure to typhoid.

You must keep typhoid vaccine capsules cold when not in use. Once you receive the capsules from your doctor or pharmacy, take them directly home and place them in the refrigerator. Keep each capsule in the foil blister pack in the refrigerator until you are ready to take it. Do not allow the capsules to freeze. Take the capsule on an empty stomach, at least 1 hour before a meal.

Swallow the capsule as quickly as possible after placing it in your mouth. Take with a full glass of cold or lukewarm water or other beverage. Do not use warm or hot drinks such as coffee, tea, or warm milk. The liquid you use to help swallow the typhoid vaccine capsule should not be warmer than your body temperature (98.6 degrees F).

Do not crush, chew, or break a typhoid vaccine capsule. Swallow the pill whole. The enteric-coated pill has a special coating to release the vaccine slowly into your body. Breaking the pill could damage this coating.

The complete series of 4 vaccine capsules should provide protection against typhoid for up to 5 years. Another series of 4 capsules is then recommended every 5 years during possible exposure to typhoid. Your individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by the Centers for Disease Control and Prevention (CDC).

Be sure you receive all recommended doses of this vaccine. If you do not receive the full series of capsules every 5 years during continued exposure, you may not be fully protected against the disease.

Wash your hands often to help prevent typhoid when you are in an area where contamination is possible.

What happens if I miss a dose?

Contact your doctor if you forget to take a capsule on the scheduled day. You may need to start over to make sure you are fully protected against the disease.

Be sure to receive another series of 4 capsules every 5 years during continued exposure to typhoid.

What happens if I overdose?

An overdose of this vaccine is unlikely to occur when taken as directed.

What should I avoid before or after getting typhoid vaccine?

In addition to receiving typhoid vaccine, take precautions while traveling to further prevent coming into contact with bacteria that cause typhoid fever:

Avoid eating leafy vegetables such as spinach or lettuce, which are harder to wash properly.

Avoid eating raw fruits or vegetables that cannot be peeled, or that have been peeled by another person.

Avoid drinks that contain ice, or frozen treats and flavored ices that may have been made with contaminated water.

Avoid eating foods you have not cooked or prepared yourself. Use clean surfaces and utensils when preparing food.

Drink only bottled water (carbonated is best) or water that has been boiled for at least 1 minute.

Avoid any food or beverage purchased from a street vendor.

Typhoid vaccine side effects

You should not receive a booster dose if you had a life-threatening allergic reaction after taking a typhoid vaccine capsule.

Becoming infected with typhoid is much more dangerous to your health than receiving the vaccine to protect against it. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects include:

low fever;

headache;

nausea, vomiting, diarrhea, stomach pain; or

mild skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect typhoid vaccine?

Before receiving this vaccine, tell the doctor about all other vaccines you have recently received.

You should not take an anti-malaria medication called proguanil (Malarone) for at least 10 days after you have received your last dose of typhoid vaccine. Proguanil may make typhoid vaccine less effective.

There may be other drugs that can affect this vaccine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.