oral typhoid vaccine*,1
Typhoid fever overview3
A potentially severe and occasionally life-threatening bacterial illness3
VIVOTIF is not indicated to treat the symptoms or complications of typhoid fever, including death.
Typhoid fever affects 21 million people and causes
222,000 deaths globally each year†,4
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Transmitted through the consumption of food and water contaminated with Salmonella typhi.
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Characterized by symptoms such as fever, headache, weakness, loss of appetite, vomiting, stomach pain, and constipation or diarrhea.
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At the onset of the illness, fatigue and a fever will appear and gradually worsen.
After 2–3 weeks of illness, there may be life-threatening complications in some untreated patients, including gastrointestinal perforation
and encephalopathy.Untreated typhoid fever can last for a month,
with reported case fatality ratios ranging
from 10% to 30%.
Travellers visiting friends and relatives in regions where typhoid is endemic are at increased risk, as they may be less careful with food and water precautions and may not seek pretravel health consultation or vaccination against typhoid fever.3
Identify your patients who
are at risk of becoming infected with typhoid fever
†According to the World Health Organization (WHO), as reported by the Canadian Immunization Guide.
Countries where your patients could be at risk of typhoid fever
Patients should be advised to always follow basic sanitation, food, and water precautions whether or not they have been immunized against typhoid.
Adapted from the Centers for Disease Control and Prevention, 2025.
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A major risk factor for travel-related typhoid fever is visiting friends and relatives5
Patients visiting loved ones in any of the areas indicated on the above map may be at increased risk of infection because they might be less careful with food and water than other travellers while abroad and might not seek pretravel health consultation.
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> 90%
of international travellers who contracted typhoid fever were visiting friends or family living abroad (based on a Quebec study).
-
7.0×
More likely for travellers visiting friends and relatives to be diagnosed with typhoid fever compared to tourist travellers
(in a study performed by the GeoSentinel network).
Although travellers visiting friends and relatives (VFR) appear to be at
increased risk for typhoid, the magnitude of incremental risk attributable
to VFR travel in addition to travel destination is unclear.
Taking preventive measures, such as safe food and water practices and frequent handwashing—especially before meals—are important in protecting against typhoid fever.3
Travelling can expose patients to diseases other than typhoid fever
Help protect your patients with VIVOTIF
VIVOTIF is indicated for immunization of adults and children
5 years and older against disease caused by Salmonella typhi.2
Complete course
7 DAYS before exposure
Immunization with VIVOTIF should be completed at least 1 week before exposure to S. typhi.
Booster at 7 YEARS
An optimal booster dose has not yet been established. However, it is recommended that a booster dose consisting of 4 capsules taken on alternate days be given every 7 years under conditions of repeated or continued exposure to typhoid fever.
Not all recipients of VIVOTIF will be fully protected against typhoid fever. Travellers should take all necessary precautions to avoid contact with or ingestion of potentially contaminated food or water.
The first and only
oral typhoid vaccine.‡,1
When is typhoid fever vaccination recommended?
Per both the Canadian Immunization Guide and the Protocole d’immunisation du Québec most Canadian travellers visiting South Asia (including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) should be offered typhoid fever vaccination.4,6
Find out more about the dosing and administration of VIVOTIF for your eligible patients
‡Comparative clinical significance unknown.
VIVOTIF:
Convenient oral dosing
Recommended dose
VIVOTIF capsules are taken approximately one hour before or two hours after a meal on
Days 1, 3, 5, and 7. The immunization schedule should be completed at least 1 week before exposure to S. typhi.
Remind your patients to stay the course
with the TAKE4 Text
Reminder Program!
Remind your patients to stay the course
with the TAKE4 Text Reminder Program!
This program offered by Bavarian Nordic provides travellers with reminders to take their 4-dose course of VIVOTIF prior to their trip. On the day of your patient’s first dose, they can text “TRAVEL” to
1-450-400-0015.
Important safety information2
Indication and clinical use:
VIVOTIF (Typhoid vaccine live oral attenuated Ty21a) is indicated for immunization of adults and children against disease caused by Salmonella typhi (new nomenclature: Salmonella enterica subspecies enterica serovar Typhi). Results from clinical studies indicate that adults and children 5 years and older may be protected against typhoid fever following the oral ingestion of 4 doses of VIVOTIF (enteric-coated capsules). Immunization (ingestion of all 4 capsules) should be completed at least 1 week prior to exposure to S. typhi.
Routine typhoid vaccination is not recommended in Canada but immunization should be considered in the following situations: 1) travel in endemic areas for extended periods, or off the usual tourist tracks; 2) ongoing household or intimate exposure to a typhoid carrier; 3) laboratory workers who frequently handle cultures of S. typhi. Not all recipients of VIVOTIF will be fully protected against typhoid fever. Travellers should take all necessary precautions to avoid contact with or ingestion of potentially contaminated food or water.
There is no evidence to support the use of typhoid vaccine to control common source outbreaks, disease following natural disasters, or in persons attending rural summer camps. VIVOTIF will not afford protection against enteric organisms other than S. typhi.
There are no studies reported using VIVOTIF as a booster for persons previously vaccinated with the parenteral vaccine.
An optimal booster dose has not yet been established. However, it is recommended that a booster dose consisting of 4 capsules taken on alternate days be given every 7 years under conditions of repeated or continued exposure to typhoid fever.
Typhoid fever continues to be an important disease in many parts of the world. Travellers entering such areas are at risk of contracting typhoid fever following the ingestion of contaminated food or water.
There are no data in geriatric patients. The efficacy of VIVOTIF (enteric-coated capsules) has not been established in geriatric patients or in children under 5 years of age. The capsule formulation is therefore not recommended for use in children under 5 years of age.
Contraindications:
- Patients who are hypersensitive to any component of the vaccine or the enteric-coated capsule.
- Safety of the vaccine has not been demonstrated in persons deficient in their ability to mount a humoral or cell-mediated immune response due to either a congenital or acquired immunodeficient state, including treatment with immunosuppressive or antimitotic drugs. The vaccine should not be administered to these persons regardless of benefits.
Relevant warnings and precautions:
- Administration during an acute febrile illness
- Administration during an acute gastrointestinal illness
- Concomitant intake of sulfonamides and antibiotics
- Alcohol consumption close to vaccination
- Antimalarial prophylaxis
- Unknown if VIVOTIF can cause fetal harm or affect reproduction.
VIVOTIF should be given to a pregnant woman only if clearly needed. - Unknown if VIVOTIF is excreted in human milk
- Not recommended for use in children under 5 years of age
For more information:
Consult the Vivotif Product Monograph for important information relating to adverse events, drug interactions, and dosing that has not been discussed in this piece. The Product Monograph is also available at 1-833-203-7933.
Explore other vaccines offered by Bavarian Nordic.
References: 1. Data on file. Bavarian Nordic Canada Inc. December 4, 2024. 2. VIVOTIF (Typhoid vaccine live oral attenuated Ty21a) Product Monograph. Bavarian Nordic Canada Inc. December 27, 2023. 3. Centers for Disease Control and Prevention. Typhoid and paratyphoid fever. Available from: https://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/typhoid-and-paratyphoid-fever.html. Accessed July 10, 2025. 4. Government of Canada. Typhoid vaccines: Canadian Immunization Guide. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-23-typhoid-vaccine.html. Accessed July 8, 2025. 5. Committee to Advise on Tropical Medicine and Travel. Statement on international travellers who intend to visit friends and relatives. Available from: https://www.canada.ca/en/public-health/services/catmat/statement-international-travellers-visit.html. Accessed December 20, 2024. 6. Gouvernement du Québec. Typh-O: vaccin oral contre la typhoïde. Available from: https://www.msss.gouv.qc.ca/professionnels/vaccination/piq-vaccins/typh-o-vaccin-oral-contre-la-typhoide/#indications. Accessed July 14, 2025.
