Ask the Experts: Typhoid

Results (4)

For routinely administered vaccines, there is no vaccine series that needs to be restarted because of an interval that is longer than recommended.

According to the CDC Yellow Book (www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/typhoid-and-paratyphoid-fever.html), the approach to missing a dose of oral typhoid vaccine (Vivotif by Bavarian Nordic, which may be given for international travel) is undefined. This vaccine is recommended to be given as a four-dose series of capsules taken by mouth every other day. No studies are available to define the impact of altering the dosing schedule for this vaccine, although some experts suggest that minor variations (such as taking a capsule one day late) may not affect the effectiveness of the vaccine.

Last reviewed: April 10, 2026

Two or more injectable or nasally administered live vaccines not administered on the same day should be separated by at least 4 weeks to minimize the potential risk for interference. If two such vaccines are separated by less than 4 weeks, the second vaccine administered should not be counted and the dose should be repeated at least 4 weeks later. Alternatively, one can perform serologic testing to check for immunity, but this option may be more costly, may not be practical if multiple antigens are involved (such as measles, mumps and rubella), and may provide results that are difficult to interpret.

In cases where the vaccine doses given less than 28 days apart are two doses of the same live vaccine in a series (e.g., 2 doses of MMR vaccine), not different vaccines, you do not need to repeat the second dose if it was inadvertently administered within the 4-day “grace period” before day 28. If given more than 4 days earlier than day 28, the second dose should be repeated after the recommended minimum interval from the invalid dose.

The oral vaccines Ty21a typhoid (Vivotif, Bavarian Nordic), cholera and rotavirus vaccines can be administered on the same day with or at any interval before or after other live vaccines (injectable or intranasal). However, ACIP recommends that oral cholera vaccine should be administered before oral Ty21a vaccine, and at least 8 hours should separate the oral cholera vaccine and the first dose of oral Ty21a in order to minimize the risk that the oral cholera vaccine buffer might interfere with the enteric coating of the oral Ty21a vaccine.

Last reviewed: April 10, 2026

In general, no. According to CDC’s webpage, “Timing and Spacing of Immunobiologics” (www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html),  concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. So, live oral cholera vaccine may be administered simultaneously with another vaccine, or at any interval before or after administration of another vaccine. There is one exception: CDC recommends (based upon expert opinion) that live oral cholera vaccine be administered at least 8 hours before the first dose of live oral Ty21a typhoid vaccine (Vivotif, Bavarian Nordic) in order to minimize the risk that the oral cholera vaccine buffer might interfere with the enteric coating of the oral Ty21a vaccine.

Last reviewed: April 10, 2026

According to CDC’s “General Best Practices for Immunization”, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. Therefore, live oral cholera vaccine may be administered simultaneously or at any interval before or after administration of most other vaccines.

One exception is when Ty21a oral typhoid vaccine (Vivotif, Bavarian Nordic) and oral cholera vaccine are both indicated. ACIP recommends that oral cholera vaccine should be administered before Ty21a vaccine, and at least 8 hours should separate the cholera vaccine and the first dose of Ty21a to avoid the potential for interference between the oral cholera vaccine buffer solution and the enteric-coated Ty21a vaccine dose.

Last reviewed: February 27, 2025

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