Typhoid vaccine is used to help prevent this disease in adults and children who are at least 6 years old. Although not part of a routine immunization schedule in the U.S., typhoid vaccine is recommended for:

• people who travel to area where typhoid fever is common (especially Asia, Africa, and Central or South America);

• people who live with someone who is a typhoid carrier; and

• laboratory workers who may come into contact with Salmonella typhi in a work setting.

This vaccine works by exposing you to a small amount of the bacteria, which causes your body to develop immunity to the disease.

Typhoid vaccine will not treat an active infection that has already developed in the body, and will not prevent any disease caused by bacteria other than Salmonella typhi.

Like any vaccine, the typhoid vaccine may not provide protection from disease in every person.

Tell your doctor if you use other medicines or have other medical conditions or allergies.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Take each capsule according to the recommended schedule or this vaccine may not be effective. Plan ahead so that you complete all doses at least 1 week before you enter a typhoid risk area. The timing of this vaccination is very important for it to be effective.

Take the capsule every other day on an empty stomach for 7 days (total of 4 capsules), at least 1 hour before eating. You will need to skip a day between capsules. Follow all instructions on the medicine package.

Take Vivotif Berna with a full glass of cool or lukewarm water. Avoid very hot or cold water, which could cause the capsule to dissolve too quickly.

Swallow the capsule as quickly as possible after placing it in your mouth.

Swallow the capsule whole and do not crush, chew, break, or open it.

You must keep typhoid vaccine capsules cold. When you receive the capsules, place them in a refrigerator as soon as possible. Keep each capsule in the foil blister pack in the refrigerator until you are ready to take it. Do not allow the capsules to freeze.

This vaccine should be effective for up to 5 years. You may need to take another series of 4 capsules every 5 years if you continue to be exposed to typhoid. Follow your doctor's instructions or the schedule recommended by the Centers for Disease Control and Prevention (CDC).

You should not receive this vaccine if you have ever had an allergic reaction to typhoid vaccine in the past, or if you have:

• a fever with any type of infection or illness; or

• weak immune system caused by disease or by using certain medicine.

If you have any of these other conditions, your vaccine may need to be postponed or not given at all:

• stomach flu or any illness with vomiting or diarrhea;

• if you are taking an antibiotic, especially a sulfa drug; or

• if you plan to start taking anti-malaria medicine within 10 days after receiving a typhoid oral vaccine.

You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.

Tell your doctor if you are pregnant or breastfeeding.

Call your doctor if you forget to take a capsule on the scheduled day. You may need to start over to make sure you are fully protected against the disease.

Be sure to receive another series of 4 capsules every 5 years during continued exposure to typhoid.

An overdose of this vaccine is unlikely to occur when taken as directed.

Avoid eating anything for at least 1 hour after you take a capsule.

In addition to using this vaccine, take precautions while traveling to further prevent coming into contact with bacteria that cause typhoid fever:

• Avoid eating leafy vegetables such as spinach or lettuce, which are harder to wash properly.

• Avoid eating raw fruits or vegetables that cannot be peeled, or that have been peeled by another person.

• Avoid drinks that contain ice, or frozen treats and flavored ices that may have been made with contaminated water.

• Avoid eating foods you have not cooked or prepared yourself. Use clean surfaces and utensils when preparing food.

• Drink only bottled water (carbonated is best) or water that has been boiled for at least 1 minute.

• Avoid any food or beverage purchased from a street vendor.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Becoming infected with typhoid fever is much more dangerous to your health than receiving this vaccine. However, like any medicine, this vaccine can cause side effects but the risk of serious side effects is extremely low.

Common side effects include:

• fever;

• headache;

• nausea, vomiting, diarrhea, stomach pain; or

• skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.

Before using this vaccine, tell your doctor about all other vaccines you have recently received.

You should not take an anti-malaria medicine that contains proguanil (such as Malarone) for at least 10 days after you have received your last dose of typhoid vaccine. Proguanil may make typhoid vaccine less effective.

Other drugs may affect typhoid vaccine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.