Live oral attenuated typhoid vaccine (Ty21a) Pregnancy: SPC 4.6: animal reproduction studies have not been conducted and it is not known whether Vivotif causes foetal harm or affects reproductive capacity. 'Vivotif should not be administered during pregnancy unless clearly needed, like in cases of increased risk of infection.' Breast-feeding: no data in nursing mothers; S. Typhi Ty21a is not absorbed systemically so is not expected to be excreted in human milk, but 'Vivotif should not be administered during breast-feeding unless clearly needed, like in cases of increased risk of infection.'

Typhoid vaccine (live)

Brand names: Vivotif

A live attenuated oral vaccine against Salmonella enterica serotype Typhi, used to provide active immunisation against typhoid fever, mainly for travellers to endemic areas.

Adult dose

Dose: Active immunisation against typhoid fever (live attenuated oral Ty21a vaccine): one gastro-resistant capsule taken on each of Days 1, 3 and 5. A complete vaccination course is three capsules.

Route: Oral. SPC 4.2 verbatim: 'One capsule of Vivotif is taken with cold or lukewarm water (temperature not more than 37ºC) on an empty stomach and at least one hour before the next meal. The vaccine capsule should not be chewed and should be swallowed as soon as possible after placing in the mouth.'

Frequency: One capsule on Day 1, Day 3 and Day 5 (three doses in total). Revaccination is recommended at three years following the most recent vaccination, for all individuals, and comprises the same three-capsule Days 1, 3 and 5 course.

VERBATIM (SPC 4.2): 'One capsule of Vivotif is taken on each of Days 1, 3 and 5. Complete vaccination comprises the ingestion of three capsules as described above. The optimal immune response may not be achieved unless the entire vaccination schedule is completed. Protection against typhoid fever commences approximately seven to ten days after ingesting the third dose of vaccine. The entire vaccination schedule should be completed at least one week prior to travel to an endemic area.' || REVACCINATION (SPC 4.2): 'Revaccination is recommended at three years following the most recent vaccination for all individuals. Revaccination comprises the ingestion of three capsules on Days 1, 3, and 5, as for the original vaccination schedule.' || ANTIBACTERIALS (SPC 4.5): 'Vaccination with Vivotif should be postponed during and for at least three days before and after antibiotic or antibacterial sulfonamide treatment, due to possible inhibition of the growth of the vaccine organisms and potential attenuation of the immune response. A longer interval should be considered for long-acting antibiotics (e.g., azithromycin).' || MALARIA PROPHYLAXIS (SPC 4.5): 'If malaria prophylaxis is needed, it is recommended to complete the vaccination with Vivotif prior to malaria prophylaxis. In this case, an interval of at least three days should be kept between the last dose of Vivotif and the start of malaria prophylaxis.' || CO-ADMINISTRATION (SPC 4.5): 'Vivotif may be administered concomitantly with yellow fever vaccine, CVD 103-HgR cholera vaccine and oral polio vaccine. No data are available regarding interaction between Vivotif and other live attenuated vaccines.' || EFFICACY CAVEAT (SPC 4.4): 'Vivotif does not provide 100% protection against typhoid fever. Vaccinees should adhere to hygiene advice and exercise caution regarding food and water consumed in typhoid-affected areas.' || EXCIPIENTS (SPC 4.4): 'The capsules contain lactose and sucrose. Patients with rare hereditary problems of galactose intolerance, congenital lactase deficiency, glucose-galactose malabsorption, fructose intolerance, or sucrose-isomaltase insufficiency should not take this vaccine.' || No maxDose is entered: SPC 4.2 defines a fixed three-capsule course and states no dose ceiling for this indication.

Paediatric dose

Dose: One gastro-resistant capsule on each of Days 1, 3 and 5 — SPC 4.2: 'The posology in children is the same as in adults.' This is a fixed capsule course and is NOT weight-based; do not compute a per-kilogram dose.

Route: Oral, swallowed whole (not chewed) with cold or lukewarm water not more than 37°C, on an empty stomach and at least one hour before the next meal.

Frequency: Days 1, 3 and 5 (three capsules), as for adults. Revaccination at three years.

AGE LIMIT, SPC 4.2 verbatim: 'Safety and efficacy in children under five years of age have not been established.' SPC 4.8: 'Frequency, type and severity of adverse reactions in children are expected to be the same as in adults.' Verify all under-18 use against a children's formulary before administering.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
Allergic reaction to previous ingestion of the product
Congenital or acquired immune deficiency (including patients receiving immunosuppressive or antimitotic drugs)
Acute febrile illness or acute gastrointestinal illness — vaccination should be postponed until after recovery

Side effects

Common — headache
Common — abdominal pain, nausea, vomiting, diarrhoea
Common — rash
Common — pyrexia
Post-marketing, frequency not known — hypersensitivity, anaphylactic reaction including shock
Post-marketing, frequency not known — decreased appetite
Post-marketing, frequency not known — paraesthesia, dizziness
Post-marketing, frequency not known — flatulence, abdominal distension
Post-marketing, frequency not known — dermatitis, pruritus, urticaria
Post-marketing, frequency not known — arthralgia, myalgia, back pain
Post-marketing, frequency not known — asthenia, malaise, fatigue, chills, influenza-like illness

Clinical monograph

How it works

The attenuated Ty21a strain replicates transiently in the gut to stimulate a protective mucosal and systemic immune response without causing disease.

Prescribing in practice

As a live vaccine it is contraindicated in significant immunosuppression and in pregnancy unless the risk of typhoid exposure clearly outweighs the theoretical risk.
The oral capsules must be taken apart from food and swallowed whole with a cool drink, and the full course completed to achieve protection.
Concurrent antibacterials, antimalarials such as proguanil, and certain other agents can inactivate the vaccine, so administration timing should follow current prescribing references.

Monitoring

No routine laboratory monitoring is required; observe for tolerability and ensure the full schedule is completed and a booster taken at the recommended interval for continued exposure.

Counselling the patient

Complete the entire course and keep the capsules refrigerated as directed.
Protection is not absolute, so maintain strict food and water hygiene while travelling.
Tell the team if you are taking antibiotics or are or might be pregnant before starting.

Evidence & guidelines

Use is supported by UK immunisation guidance (the Green Book) and travel health recommendations for endemic regions.

Reference: UKHSA Green Book Ch.33; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways