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The information contained herein is based upon published fact and is designed for advisory purposes. It is not intended to replace the expertise and decision of the attending physician.

Administration of VIVIOTIF®

VIVOTIF® and Travel Related Medications
Does the excretion of attenuated Ty21a organisms pose a threat to individuals who are immunocompromised?

Will Prilosec® (or other protein pump inhibitors) affect Vivotif®?

Since Vivotif® also stimulates immunity in the intestinal tract, can the oral vaccine be used in a patient who has had part of the intestine removed?



Can the parenteral Vi typhoid vaccine be administered following an incomplete regimen of the oral Ty21a vaccine?

    To date, there are no studies on:

      • the use of the injectable Vi vaccine being given to a person who has taken the oral vaccine, or

      • the use of the oral Ty21a vaccine being given to a person who has received the injectable vaccine.
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Does an interruption in the dosing schedule effect efficacy?

In general, only limited data is available on the effect of a slight change in schedule. To achieve optimum protection, all four doses should be taken according to the recommended schedule. However, a delay of 24-48 hours in taking one dose should not be expected to markedly affect efficacy.

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If a patient has to restart the vaccination schedule, how long do they have to wait before taking the vaccine again?

No waiting times is required. There are no safety concerns as that 5-fold higher doses have been given without problems.

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Can alcohol be consumed during vaccine administration?

    Alcohol should not be consumed within two (2) hours of taking the VIVOTIF® vaccine. Alcohol will break the enteric-coated capsule, resulting in the capsule dissolving in the stomach rather than the intestinal tract. In addition, tests have confirmed that alcohol will kill the live, attenuated bacteria in the vaccine.
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If someone has trouble swallowing capsules, can the capsule be opened and the contents sprinkled or dissolved in liquid?

    The vaccine is a live, attenuated bacterial vaccine in an enteric capsule. Therefore, the capsule should NEVER be opened and the contents administered in food or liquids.
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If a patient is taking antibiotics, can he or she take Vivotif®?

Vivotif® can be taken 3 days AFTER THE END of antibiotic therapy. This guideline is based on the half-lives of the antibiotics and the expected local concentrations within the gastrointestinal lumen.

Antibiotic therapy can be started 3 DAYS AFTER THE LAST VIVOTIF CAPSULE.

These guidelines apply regardless of the short-term or long-term antibiotic therapy

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Can Malarone™ (Atovaquone/Proguanil) be used with VIVOTIF®?

    Malarone™ is a combination of Proguanil and Atovaquone. The FDA approved package insert for Vivotif® states that a 10-day period should be observed between the use of Proguanil and Vivotif®. While the original testing was done with Proguanil alone, until the FDA reviews data with the combination product (ie, Malarone™) the 10-day separation of between Vivotif® and Proguanil applies.

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Can mefloquine (Larium®) be used with VIVOTIF®?

    Clinical results indicate that Larium® can be administered together with the oral typhoid fever vaccine with no effect on immunogenicity.

    Larium® is the registered trademark of Roche Laboratories for mefloquine hydrochloride.
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Can chloroquine (Aralen®) be used with VIVOTIF®?

    Clinical results indicate that chloroquine can be administered together with the oral typhoid fever vaccine with no effect on immunogenicity.
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Can proguanil be used with VIVOTIF®?

    While not approved for use in the US, Proguanil should not be administered together with the oral Ty21a vaccine. Chemoprophylaxis with proguanil should not be started sooner than 10 days after the LAST DOSE of VIVOTIF®.
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What is the recommended administration time interval between VIVOTIF® and Yellow Fever Vaccine?

    The concomitant administration of either oral polio or Yellow Fever vaccine does not suppress the immune response elicited by the oral Ty21a vaccine. There is no evidence that the simultaneous administration interferes with the efficacy of VIVOTIF®.
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Does the excretion of attenuated Ty21a organisms pose a threat to individuals who are immunocompromised?

    There is no data nor evidence that the amount of Ty21a organisms excreted in fecal matter poses a risk for an immunocompromised individual.
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Will Prilosec® (or other protein pump inhibitors) affect Vivotif®?

In the lab, it has been shown that the capsules are not affected for up to 2 hours at stomach pH of 3 and 5. The stomach acidity is likely around that pH if people are treated with protein pump inhibitors. The conclusion is that the experiments show that there is no evidence for damage to the capsule at the above stated pH for at least 2 hours. Thus vaccination can take place while being treated with proton pump inhibitors.

TO AVOID ANY POTENTIAL DIRECT EFFECT OF THE MEDICATION ON VIVOTIF, IT IS RECOMMENDED TO SPACE INTAKE OF THE TWO MEDICATIONS BY 12 HOURS (ONE IN AM, ONE IN PM)

Prilosec® is the registered trademark for Omeprazole.

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Since Vivotif® also stimulates immunity in the intestinal tract, can the oral vaccine be used in a patient who has had part of the intestine removed?

    The efficacy of VIVOTIF® (Typhoid Vaccine Live Oral Ty21a) is based on the growth of Ty21a in the small intestine. This growth-induced immune response then induces both local and systemic immunity. If all of the intestine has been removed, no priming of the host may be expected. If the small intestine or the duodenum is still functioning, the priming of the host is still possible.

    Therefore, after removal of the full intestine, VIVOTIF® is contraindicated, as no priming may occur. If the small intestine or part is still available, VIVOTIF® may be used as priming of the host is still possible.
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