Vivotif Shortage: What Providers and Prescribers Need to Know in 2026

For clinicians managing pre-travel health, Vivotif (typhoid vaccine live oral Ty21a) is a first-line option for typhoid prophylaxis in eligible patients. After a documented supply disruption from late 2020 through early 2023, Vivotif is currently commercially available — but its specialty distribution channel means patients may still struggle to find it. This guide provides a clinical summary of current Vivotif availability, contraindication review, interaction management, and patient counseling points for travel medicine providers in 2026.

Shortage Status: Current and Historical

The ASHP Drug Information Service documented a Vivotif shortage beginning December 9, 2020. The shortage was resolved January 23, 2023, when Emergent Travel Health confirmed availability through wholesalers. Bavarian Nordic completed acquisition of the Emergent travel vaccine portfolio in May 2023 and has since reported Vivotif revenue growth of 30% in Q3 2025 year-over-year, with the vaccine capturing approximately 20% of the US typhoid vaccine market.

There is no active FDA or ASHP shortage as of 2026. However, because Vivotif is distributed through specialty vaccine channels rather than general pharmaceutical wholesalers, patient-level access remains inconsistent. Patients presenting to primary care or urgent care facilities may not find Vivotif locally and should be directed to travel medicine clinics or guided to call ahead.

Key Contraindications to Review Before Prescribing

Because Vivotif is a live attenuated bacterial vaccine, the contraindication profile is important to review at every pre-travel consultation:

Immunocompromised patients: Vivotif is contraindicated in patients with congenital or acquired immune deficiency, including those on immunosuppressive therapy (corticosteroids, DMARDs, biologics, chemotherapy, radiation). Risk of uncontrolled replication of vaccine organisms.

Active febrile illness: Defer vaccination until the patient is afebrile.

Active GI illness: Do not administer during acute diarrheal illness or vomiting — defer until resolved.

Concurrent antibiotics/sulfonamides: Antibacterial agents active against S. typhi may prevent adequate replication of the vaccine strain and ablate the immune response. Defer Vivotif until at least 3 days after completion of antibiotics.

Age: Not indicated for children under 6 years. Use Typhim Vi for children ages 2–5.

Pregnancy: Use only if clearly needed; reproductive toxicity studies have not been conducted. Consider Typhim Vi as a safer alternative in pregnancy.

Drug Interaction Review

The interaction profile of Vivotif is primarily driven by its nature as a live bacterium:

Proguanil (Malarone): A study of 30 individuals demonstrated that concurrent proguanil administration (200 mg/day) significantly decreased the immune response to Vivotif. Recommendation: complete Vivotif at least 10 days before initiating proguanil.

Mefloquine and chloroquine: Clinical studies indicate these can be co-administered with Vivotif without significant impairment of immunogenicity.

Immunosuppressants: Belimumab, certolizumab, baricitinib, brodalumab, hydroxyurea, methotrexate, and other immunosuppressive agents significantly impair the immune response to live vaccines and are contraindicated. Reference current CDC guidance for timing relative to biologics.

When to Choose Typhim Vi Instead

Typhim Vi (Vi polysaccharide, inactivated) is the appropriate substitute in the following clinical scenarios:

Immunocompromised patient (any cause)

Child under age 6

Patient on concurrent antibiotic therapy that cannot be held

Pregnancy (preferred inactivated option)

Patient requires vaccination within 10 days of departure (Typhim Vi can be given up to 2 weeks before)

Note that Typhim Vi provides protection for only 2 years vs. 5 years for Vivotif, and must be boosted every 2 years for continued risk.

Efficacy Summary

According to 2015 CDC ACIP recommendations: in a systematic review and meta-analysis, the estimated 2.5–3.0 year cumulative efficacy was approximately 48% for Vivotif (Ty21a) and 55% for Typhim Vi. Neither vaccine is 100% effective. Counsel patients to practice safe food and water precautions regardless of vaccination status.

Patient Counseling Points

Complete the full 4-dose series before travel — a partial series provides inadequate protection

Keep capsules refrigerated between doses — do not leave out at room temperature

Swallow capsules whole ~1 hour before a meal with a cold/lukewarm drink — do not crush or chew

Vaccine organisms can be transiently shed in stool, though secondary transmission has not been documented

Booster every 5 years for continued typhoid risk

Providers can refer patients to medfinder for providers to help them find Vivotif in stock locally. You can also share our patient guide to finding Vivotif.