Typhoid vaccine (oral) belongs to the group of medications called vaccines. It is used to protect adults and children over 5 years old against typhoid fever that is caused by bacteria called Salmonella enterica serovar Typhi (S. typhi).

The vaccine is made up of S. typhi that is no longer harmful. The vaccine works by activating the immune system to produce antibodies that will attack S. typhi bacteria should they later get into the body. Although this is not a routine vaccine in Canada, it is recommended if you are travelling to an area where there is a risk of getting typhoid fever, if you have close contact with someone who carries typhoid, or if you work in a laboratory and handle S. typhi. The protection granted by this vaccine lasts 7 years.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual dose of this medication is one capsule taken every other day (e.g., day 1, 3, 5, and 7) for a total of 4 capsules. Take each capsule with at least 4 ounces (120 mL) of cool or lukewarm water (not warmer than 37°C or 98.6°F) approximately 1 hour before or 2 hours after a meal. The capsules should be swallowed whole (do not chew) as soon as possible after placing it in your mouth. All 4 capsules should be taken at least one week before being exposed to typhoid fever.

Although optimal booster doses have not been determined, it is recommended that a booster dose of 4 capsules taken on alternate days every 7 years be given if you have repeated or continued exposure to typhoid fever.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose and it has been less than 24 to 28 hours from when you should have taken the dose, take the capsule as soon as you remember. Then skip a day and take the next dose and continue on the every-other-day dosing schedule. Do not take a double dose to make up for a missed one. If it has been longer than 48 hours from when you should have taken the capsule or you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication in the refrigerator at temperatures between 2°C and 8°C (35.6°F and 46.4°F). The vaccine may be left out of the refrigerator during a reasonable transit time home from the clinic or pharmacy. If the capsules are left outside of the refrigerator at room temperature 77°F (25°C) for up to 12 hours on a one-time only occasion, the product quality will not be affected and the capsules can still be taken.  Do not allow the capsules to freeze, protect them from light and moisture, and keep them out of the reach of children.

Each enteric-coated capsule contains one dose of lyophilized bacteria for oral administration. Nonmedicinal ingredients: sucrose, amino acid mixture, ascorbic acid, lactose, magnesium stearate, hydroxypropyl cellulose-phthalate, dibutyl phthalate, diethyl phthalate, ethylene glycol, gelatine type B, titanium dioxide, erythrosine FD&C Red No. 3, yellow iron oxide, red iron oxide, and titanium dioxide.

Do not take this medication if you:

• are allergic to typhoid vaccine or any ingredients of this medication
• have a suppressed immune system (e.g., have immune system problems or are taking medications that suppress the immune system)
• currently have an infection in your digestive tract (such as diarrhea) with fever

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• diarrhea
• fever
• flu-like illness (e.g., general feeling of unwell, shivering, pins and needles)
• headache
• nausea
• skin rash
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• dizziness
• generally feeling unwell
• joint and muscle pain
• pins and needles sensation
• shivering
• weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a severe allergic reaction (e.g., hives, difficulty breathing, swelling of the face, mouth, throat or tongue)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Illness with fever: If you have an acute illness with a fever, you should not take this medication until the illness has resolved.

Protection: Not everyone who takes this vaccine will be fully protected against typhoid fever. If you are travelling to high-risk areas, take all necessary precautions to avoid contact with or ingestion of potentially contaminated food or water.

Vomiting and diarrhea: If you have an acute stomach or intestinal illness associated with vomiting or diarrhea, you should not take this medication until the illness has resolved, as this illness will affect how well the vaccine is absorbed by the body.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if typhoid vaccine (oral) passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children under 5 years of age.

There may be an interaction between typhoid vaccine (oral) and any of the following:

• acetaminophen
• alcohol
• antibiotics (e.g., amoxicillin, erythromycin, clarithromycin, ciprofloxacin, tetracycline)
• anti-cancer medications (e.g., asparaginase, cisplatin, doxorubicin, methotrexate, vincristine)
• azathioprine
• cholera vaccine
• corticosteroids (e.g., prednisone, dexamethasone)
• cyclosporine
• etanercept
• fingolimod
• hydroxychloroquine
• hydroxyurea
• imiquimod
• immune globulins
• leflunomide
• mercaptopurine
• monoclonal antibodies (e.g., adalimumab, belimumab, daclizumab, golimumab, infliximab)
• mycophenolate
• sirolimus
• tacrolimus
• tofacitinib
• other vaccines

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.