Comprehensive medication guide to Vivotif including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Coverage varies widely — many commercial plans do not cover Vivotif as it is classified as a travel medicine service. Some plans cover it with documented medical necessity. Medicare typically does not cover. Out-of-pocket cost without coverage: $111–$168 with discount cards.
Estimated Cash Pricing
$154–$168 retail for a 4-capsule pack (one full series); as low as $111–$117 with GoodRx or SingleCare discount cards. No generic available.
Medfinder Findability Score
72/100
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Vivotif is the brand name for typhoid vaccine live oral Ty21a — the only oral typhoid vaccine available in the United States. It is a live attenuated (weakened) bacterial vaccine approved by the FDA for the prevention of typhoid fever in adults and children ages 6 and older.
Vivotif is primarily recommended for travelers visiting typhoid-endemic regions (South Asia, sub-Saharan Africa, parts of Latin America and Southeast Asia), household contacts of documented typhoid carriers, and microbiology laboratory workers who frequently work with Salmonella typhi cultures. It is not a routine vaccine for the general US population.
Vivotif is currently marketed by Bavarian Nordic, which acquired the travel vaccine portfolio from Emergent BioSolutions in May 2023. Over 150 million doses have been administered globally since the vaccine's introduction.
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Vivotif contains live, attenuated Salmonella typhi Ty21a bacteria. Each enteric-coated capsule contains 2–10 × 10⁹ colony-forming units (CFUs). The enteric coating protects the bacteria from stomach acid, allowing them to reach the small intestine where they briefly colonize and stimulate an immune response.
The Ty21a strain has a genetic mutation that reduces its ability to synthesize complete lipopolysaccharide (LPS) — a key virulence factor. This allows brief replication sufficient to trigger both humoral immunity (antibodies, particularly mucosal IgA) and cell-mediated immunity (T cells), without causing disease. The bacteria then self-destruct from the accumulation of toxic LPS intermediates.
A complete 4-dose series taken on alternating days (Days 1, 3, 5, and 7) is required to build a maximal protective immune response. Efficacy has been shown to persist for at least 5 years. A booster series is recommended every 5 years for people with continued typhoid risk.
Ty21a 2–10 × 10⁹ CFU — enteric-coated oral capsule
One 4-capsule blister pack = complete primary immunization series or one booster dose
Vivotif is currently available — there is no active FDA or ASHP shortage as of 2026. A previous shortage from December 2020 was resolved in January 2023. However, Vivotif is a specialty travel vaccine that is not stocked at most general retail pharmacies. It is primarily distributed through travel medicine clinics, specialty vaccine networks, and select retail pharmacy locations.
Vivotif's findability score is 72/100 — generally available through the right channels but requires more effort to locate than a standard prescription. Demand spikes seasonally before summer travel and winter holidays, which can temporarily deplete stock at pharmacies that do carry it.
The best sources for Vivotif are travel medicine clinics and CVS MinuteClinic locations. To find which pharmacies near you have Vivotif in stock, medfinder calls local pharmacies on your behalf and texts you the results. Start your search at least 3–4 weeks before your trip to allow time for the 4-dose series plus one week before departure.
Vivotif is not a controlled substance, so any licensed prescriber with general prescribing authority can order it for eligible patients. No DEA registration or special certification is required. The most common prescribers include:
Travel medicine specialists (most experienced and most likely to stock the vaccine directly)
Primary care physicians (PCPs)
Infectious disease specialists
Nurse practitioners (NPs) and physician assistants (PAs) with prescribing authority
Pharmacists with vaccine prescriptive authority (varies by state — CVS MinuteClinic in some states)
Telehealth travel health services (such as Passport Health telehealth, and other pre-travel consultation platforms) can also prescribe Vivotif for eligible patients via virtual consultation. This is especially useful for patients in rural areas or those unable to see a provider before their trip. Note that the patient will still need to find a pharmacy with Vivotif in stock after obtaining the prescription.
No. Vivotif is not a controlled substance and is not scheduled by the DEA. Any licensed prescriber with general prescribing authority — including physicians, nurse practitioners, and physician assistants — can prescribe it without any DEA restrictions or special licensing.
Vivotif is a prescription-only vaccine, meaning it requires a valid prescription from a licensed healthcare provider before a pharmacy can dispense it. It cannot be purchased over the counter. There are no refill restrictions based on controlled substance scheduling — however, because Vivotif comes as a 4-capsule series for a single course of immunization, refills are generally not applicable in the traditional sense.
Side effects from Vivotif are generally mild and occur at a low rate. The most commonly reported adverse events from global postmarketing surveillance include:
Abdominal pain or cramping
Nausea (the only side effect statistically more frequent than placebo in clinical trials)
Diarrhea
Vomiting
Headache
Low-grade fever
Skin rash and urticaria (hives)
Anaphylaxis (extremely rare — one isolated nonfatal case reported in global postmarketing data from over 150 million doses)
Severe persistent diarrhea or vomiting (stop vaccine and contact prescriber)
Report any serious adverse events to your healthcare provider and to VAERS (vaers.hhs.gov).
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Typhim Vi
Injectable inactivated typhoid vaccine by Sanofi Pasteur. Single IM injection ≥2 weeks before travel. Approved for ages ≥2. Protects for 2 years. Safe for immunocompromised patients. Booster every 2 years.
Typbar TCV
WHO-recommended typhoid conjugate vaccine. Single dose, approved from age 6 months, 79–85% efficacy. Not currently licensed in the United States; available in many typhoid-endemic countries.
Prefer Vivotif? We can find it.
Antibiotics (fluoroquinolones, macrolides, penicillins, cephalosporins, clindamycin, chloramphenicol)
majorKill Ty21a vaccine bacteria, preventing immune response. Contraindicated. Complete antibiotic course and wait ≥3 days before starting Vivotif.
Sulfonamides (trimethoprim-sulfamethoxazole/Bactrim)
majorAntibacterial activity kills vaccine organisms. Contraindicated during Vivotif series.
Proguanil / Malarone (atovaquone/proguanil)
majorSignificantly decreases immune response to Vivotif. Complete Vivotif and wait ≥10 days before starting proguanil/Malarone.
Immunosuppressants (methotrexate, azathioprine, hydroxyurea, biologics, corticosteroids)
majorSuppress immune response to live vaccine; may also increase infection risk from live bacteria. Contraindicated. Use Typhim Vi instead.
Mefloquine (Lariam)
minorClinical studies support concurrent use with Vivotif without significant impairment of immunogenicity.
Chloroquine (Aralen)
minorClinical studies support concurrent use with Vivotif without significant impairment of immunogenicity.
Vivotif is a well-established, safe, and effective oral vaccine for typhoid fever prevention. With over 150 million doses administered globally and more than 30 years on the market, its safety record is excellent. For eligible patients — healthy adults and children ages 6 and older who are not on antibiotics or immunosuppressants — Vivotif offers the convenience of oral administration and 5 years of protection from a single 4-dose series.
The main practical challenge is finding it in stock at a local pharmacy. Vivotif is primarily stocked by travel medicine clinics and specialty vaccine networks rather than general retail pharmacies. Planning ahead — at least 3–4 weeks before travel — is essential, both to locate the vaccine and to allow time for the full 4-dose series plus one week of immune development before departure.
If you're struggling to find Vivotif near you, medfinder can take the work out of the search by calling pharmacies near you and texting you the results. Enter your medication, dosage, and location to get started.
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