Typhoid vaccine oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral vaccine containing Salmonella enterica serovar Typhi Ty21a
Drugs List
Therapeutic Indications
Uses
Vaccination against typhoid fever
Active oral immunisation against typhoid fever.
For comprehensive information or advice on this product or the immunisation programme in the UK, the following website should be accessed.
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Dosage
Adults
One capsule to be taken on day 1. The second capsule should be taken on day 3 and the third capsule on day 5.
The vaccine schedule should be completed at least 1 week before the risk of exposure to typhoid fever.
Revaccination
In patients who remain at risk of exposure to typhoid fever, revaccination comprises the ingestion of three capsules on days 1, 3 and 5.
Children
Children aged 5 years and above
One capsule to be taken on day 1. The second capsule should be taken on day 3 and the third capsule on day 5.
The vaccine schedule should be completed at least 1 week before the risk of exposure to typhoid fever.
Revaccination
In patients who remain at risk of exposure to typhoid fever, revaccination comprises the ingestion of three capsules on days 1, 3 and 5.
Additional Dosage Information
The vaccine contains live Salmonella and a course of treatment should not be started until 3 days after completion of any antibacterial therapy; it is also preferred that antibacterial therapy is not started until 3 days after completion of the vaccine course of treatment.
If concurrent malaria prophylaxis is required, there should be an interval of at least 3 days between completion of the course of vaccine and the first dose of malaria prophylaxis, except that the fixed dose combination of proguanil and atovaquone may be used concurrently, as may mefloquine, provided that for mefloquine the dose is taken at least 12 hours after the vaccine dose.
Contraindications
Children under 5 years
Febrile disorder
Immunosuppression
Breastfeeding
Galactosaemia
Gastrointestinal disorder
Hereditary fructose intolerance
Immunodeficiency syndromes
Pregnancy
Precautions and Warnings
Glucose-galactose malabsorption syndrome
Lactose intolerance
Live vaccine must not be given during/within 6 months of chemotherapy
Live vaccine must not be given during/within 6 months of radiotherapy
Postpone immunisation if there is active or suspected infection
Advise ability to drive/operate machinery may be affected by side effects
Previous/Concurrent medicine consider washout period: See prescribing info
Vaccine may not be effective in 100% of patients
Contains lactose
Preparation contains sucrose
Follow national immunisation guidelines
Advise patient on timing of malaria prophylaxis if required concurrently
Unless the immunisation schedule of 3 vaccine capsules is completed, an optimal immune response may not be achieved.
Even after three doses, not all recipients of typhoid oral vaccine will be fully protected against typhoid fever. Therefore, travellers should take all necessary precautions to avoid contact with or ingestion of potentially contaminated food or water.
Protection against typhoid fever commences approximately 7 to 10 days after ingesting the third dose of vaccine.
Under conditions of repeated or continuous exposure to S. typhi protection persists for at least 3 years. In the case of travel from a non-endemic area to an area where typhoid fever is endemic, a booster consisting of three doses is recommended every 3 years.
Pregnancy and Lactation
Pregnancy
Typhoid oral vaccine is contraindicated during pregnancy.
The manufacturer states that typhoid oral vaccine should not be administered during pregnancy unless it is clearly needed when there is an increased risk of infection. At the time of writing there is limited published information regarding the use of the live oral typhoid vaccine during pregnancy. Potential risks are unknown. The Green book suggests that this vaccine should only be considered if there is no alternative vaccine.
Lactation
Typhoid oral vaccine is contraindicated during breastfeeding.
The manufacturer does not recommend using typhoid oral vaccine during breastfeeding. It is not known if typhoid oral vaccine is excreted in human milk. There is also no data available regarding the extent the inactive ingredient dibutyl phthalate (DBP) may be excreted with breast milk. Effects on exposed infants are unknown.
Side Effects
Abdominal distension
Abdominal pain
Anaphylactic reaction
Arthralgia
Asthenia
Back pain
Chills
Decreased appetite
Dermatitis
Diarrhoea
Dizziness
Fatigue
Fever
Flatulence
Headache
Hypersensitivity reactions
Influenza-like symptoms
Malaise
Myalgia
Nausea
Paraesthesia
Pruritus
Rash
Shock
Urticaria
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Vivotif Gastro-resistant capsules, hard. PaxVax Ltd. Revised July 2018.
Immunisation against infectious disease - The Green Book.
Available at https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Last accessed: 21 January 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 21 January 2020
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