Dosing and uses of Vivotif (typhoid vaccine live)
Adult dosage forms and strengths
enteric-coated capsule
- 2-6 x 10^9 colony-forming units of viable Salmonella typhi Ty21a and 5-50 x 10^9 bacterial cells of nonviable S typhi Ty21a
- Available as pack of 4 capsules
Typhoid Fever Prophylaxis
Indicated for selective immunization against typhoid fever for people traveling to endemic areas
1 capsule PO every other day x 4 doses (days 0, 2, 4, and 6); swallow with cool water on an empty stomach (see Administration)
Booster: Repeat same regimen every 5 yr
Dosing Considerations
Current vaccination schedules available at https://www.cdc.gov/vaccines/default.htm
Pediatric dosage forms and strengths
enteric-coated capsule
- 2-6 x 10^9 colony-forming units of viable Salmonella typhi Ty21a and 5-50 x 10^9 bacterial cells of nonviable S typhi Ty21a
- Available as pack of 4 capsules
Typhoid Fever Prophylaxis
Indicated for selective immunization against typhoid fever for people traveling to endemic areas
<6 years: Safety and efficacy not established
≥6 years: 1 capsule PO every other day x 4 doses (days 0, 2, 4, and 6); swallow with cool water on an empty stomach (see Administration)
Booster: Repeat same regimen every 5 yr
Dosing Considerations
Current vaccination schedules available at https://www.cdc.gov/vaccines/default.htm
Vivotif (typhoid vaccine live) adverse (side) effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
1-10%
Abdominal pain (6.4%)
Nausea (5.8%)
Headache (4.8%)
Fever (3.3%)
Diarrhea (2.9%)
Vomiting (1.5%)
Skin rash (1%)
Warnings
Contraindications
Hypersensitivity; acute febrile illness; immunosuppression (inability to mount humoral/cell-mediated immune response)
Cautions
Complete vaccination 1 week before exposure to endemic area (eg, Africa, Southeast Asia, Central and South America, Near East, Middle East, and Indian subcontinent)
Postpone vaccine with GI illness
Coadministration of sulfonamides or antibiotics (eg, mefloquine, chloroquine, proguanil) may inactivate vaccine
Efficacy: oral 60-70%; parenteral 70-96%
May administer with Hib, DTP, OPV, IPV, MMR, influenza, and hepatitis B vaccines at same time
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether distributed in breast milk, caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Vivotif (typhoid vaccine live)
Mechanism of action
Live attenuated oral vaccine; conveys active immunity via stimulation of production of endogenously produced antibodies
Pharmacokinetics
Duration: Not established; onset of protection from disease is relatively slow, but duration is long lasting (years)
Administration
Instructions
Swallow capsule at least 1 hr before a meaL
Each enteric-coated capsule should be taken with cool water no warmer than 98.6°F (37.0°C)
Storage
Not stable when exposed to ambient temperatures; therefore, should be shipped and stored between 2-8°C (35.6-46.4°F)
Expiration date is valid only if the product has been maintained at 2-8°C (35.6-46.4°F)
