OST. Gain a healthy respect for the risks of typhoid, before you. The only oral vaccine for protection against typhoid fever 1,2

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1 Gain a healthy respect for the risks of typhoid, before you ET OST (Typhoid Vaccine Live Oral Attenuated Ty21a) 1

2 Typhoid fever affects about 21.5 million people each year in the developing world 3 Are you prepared? Typhoid fever is a life-threatening illness. 3 You can get it by eating food or drinking water contaminated with unseen Salmonella Typhi bacteria. Typhoid fever is more common in areas where sanitation is likely to be poor, so when travelling to Asia, Africa or Latin America, you can be at risk. 3 YEA ARS AR R E OF ECT O PROT ION C * Not all vaccinated persons will be fully protected against typhoid fever even after a full course of Vivotif Typhoid fever areas at risk 4 CUBA CHINA MEXICO Incidence rate > 100 per 100,000 per year per 100,000 per year < 10 per 100,000 per year Based on data pulled in 2004 DOMINICAN REPUBLIC INDIA THAILAND If you are travelling to the areas at risk, you should learn how you can protect yourself from typhoid fever. 3

3 Signs and symptoms After Salmonella Typhi bacteria has been ingested, they multiply and spread to your bloodstream. A sustained fever, as high as 40 C (104 F), is one of many ways the body can react.3 Possible Symptoms of TYPHOID FEVER3 Sustained fever Stomach pains Headache Loss of appetite Weakness Rash The only way to confirm an illness is through stool or blood sample testing.3 If you suspect you or a loved one has typhoid fever, consult a healthcare professional immediately.3 What can you do? Typhoid fever can be prevented.3 Protect yourself two ways:3 1 Avoid risky food and drinks Boil it, cook it, peel it or leave it Only eat food that has been well cooked and is still hot when served. Avoid uncooked foods, especially shellfish or raw fruits and vegetables5 2 Drink and use ice only from purified water that has been boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers. Carbonated drinks, are usually safe5 Avoid food from street vendors Get vaccinated with a vaccine like orally taken Vivotif 1 Ask your healthcare professional about Vivotif Vivotif is an oral vaccine that protects against typhoid fever.1 The vaccine is made up of a strain of Salmonella Typhi bacteria that is no longer harmful. This strain is called S. Typhi Vaccine Strain Ty21a. By stimulating protective immunity to the typhoid fever bacteria it provides 7 years of protection.1* 4 capsules for 7 years of protection Swallow the capsule with cold or lukewarm water 1 hour before or 2 hours after a meal 1 Complete the course of Vivotif at least 1 week before you leave for your trip1 *As with all vaccines, not all vaccinated persons will be fully protected against typhoid fever.1 Travellers should take all necessary precautions to avoid contact with or ingestion of potentially contaminated food or water.3

4 Gain a healthy respect for the risks of typhoid fever, before you GET LOST Ask your healthcare professional about protecting yourself from typhoid fever. 3 How to store it Keep Vivotif out of the reach and sight of children. Vivotif is not stable when exposed to room temperature. Vivotif should be stored at refrigerated temperatures between 2 C and 8 C (35.6 F and 46.4 F). Vaccine capsules should be stored between doses in the refrigerator. The vaccine may be out of refrigeration during a reasonable transit time home from the clinic. If the capsules are left outside of refrigeration at room temperature 25 C (77 F) 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. Each blister of vaccine shows an expiration date. This expiration date is valid only if the product has been maintained between 2 C and 8 C (35.6 F and 46.4 F). The product should be stored in a dry place and protected from light. Vivotif is a vaccine for adults and children 5 years of age and older intended to help prevent typhoid fever caused by Salmonella Typhi. This protection lasts for 7 years. Vivotif does not treat typhoid fever once it develops and does not protect against other intestinal organisms. Immunization should be completed at least one week prior to exposure/ departure. Not everyone who gets vaccinated will be fully protected, therefore, precautions necessary to avoid possibly contaminated food or water should still be taken. Allergic reactions and side effects such as stomach pain, nausea, vomiting, diarrhea, fever, flu-like illness, headache and rash may occur. 1 Before you use Vivotif, talk to your doctor or pharmacist if you have fever or an illness in your gut, if you are or think you might be pregnant, or if you are breast-feeding. 1 Ask your healthcare professional if Vivotif is right for you 3 Side effects and what to do about them The following side effects were reported most commonly (that is in less than one in ten persons but more than in one in hundred persons) in clinical studies: 1 Stomach pain, feeling or being sick (nausea and vomiting), diarrhea, fever, fl u-like illness, headache and rash. Side effects that have been reported very rarely (that is in less than one in ten thousand persons) during normal use include: 1 Skin irritation, rashes, red or lumpy raised rashes, itching and hives. Severe allergic reactions with drops of blood pressure and loss of consciousness. Weakness, generally feeling unwell, shivering, tiredness, pins and needles, dizziness, joint and muscle pain. These symptoms disappear spontaneously within a few days. This is not a complete list of side effects. For any unexpected effects while taking Vivotif, contact your doctor or pharmacist. 1 Vivotif coverage The cost of Vivotif may be covered by your private insurance. Contact your insurance provider and give the DIN (drug identification number) below to find out: Vivotif DIN:

5 References: 1. Valneva, Vivotif Product Monograph, January 23, Canadian Immunization Guide Typhoid Vaccine. Available at: ca/publicat/cig-gci/p04-typh-eng.php#approve. Last modifi ed: January Typhoid Fever. Centers for Disease Control and Prevention website. cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/. Accessed June 16, Crump JA, et al., The global burden of typhoid fever. Bull World Health Organ 2004;82: Todar, K. Salmonella and Salmonellosis. Todar s Online Textbook of Bacteriology. Accessed September 6, VALNEVA Canada Inc. All trademarks used under license. VALNEVA Canada Inc , Saint-Charles Blvd. Kirkland (Montreal), Quebec H9H 5B9

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