Salmonella enterica serovar Typhi strain CVD 908-htrA is a live attenuated strain which may be useful as an improved oral typhoid vaccine and as a vector for cloned genes of other pathogens. We conducted a phase 2 trial in which 80 healthy adults received one of two dosage levels of CVD 908-htrA in a double-blind, placebocontrolled, crossover study. There were no differences in the rates of side effects among volunteers who received high-dose vaccine (4.5 ؋ 10 8 CFU), lower-dose vaccine (5 ؋ 10 7 CFU), or placebo in the 21 days after vaccination, although recipients of high-dose vaccine (8%) had more frequent diarrhea than placebo recipients (0%) in the first 7 days. Seventy-seven percent and 46% of recipients of high-and lower-dose vaccines, respectively, briefly excreted vaccine organisms in their stools. All blood cultures were negative. Antibody-secreting cells producing antilipopolysaccharide (LPS) immunoglobulin A (IgA) were detected in 100 and 92% of recipients of high-and lower-dose vaccines, respectively. Almost half the volunteers developed serum anti-LPS IgG. Lymphocyte proliferation and gamma interferon production against serovar Typhi antigens occurred in a significant proportion of vaccinees. This phase 2 study supports the further development of CVD 908-htrA as a single-dose vaccine against typhoid fever and as a possible live vector for oral delivery of other vaccine antigens.Attenuated Salmonella enterica serovar Typhi oral vaccine Ty21a (7) and parenteral purified Vi polysaccharide vaccine (1, 13) have replaced parenteral killed whole-cell vaccine as the recommended prophylaxis against typhoid fever. However, both of these vaccines have disadvantages. The Vi vaccine is T-cell independent and so does not stimulate helper T cells that could enhance and broaden the immune response and elicit immunologic memory. Ty21a requires three or four doses for optimal immunogenicity.A single-dose, oral serovar Typhi vaccine strain is highly desirable. Moreover, such a strain would also be a promising vector for the delivery of heterologous cloned antigens (2,6,8,9,22,25). One strategy for attenuating salmonellae has been to introduce defined deletions into the genes encoding enzymes of the aromatic amino acid biosynthesis pathway, thereby rendering the bacteria auxotrophic for para-aminobenzoic acid (PABA) and dihydroxybenzoate (DHB) (10). These are substrates that the organism cannot scavenge in sufficient quantities in mammalian tissues to sustain growth. Such aro deletion mutants of S. enterica serovar Typhimurium are safe and immunogenic as live oral vaccines in mice and cattle (4,10,12,19). Analogous auxotrophic mutants of serovar Typhi have been prepared as typhoid vaccines and vaccine vectors for humans.In recent studies, vaccine strain CVD 908, a derivative of wild-type strain Ty2 harboring deletion mutations in aroC and in aroD, has been evaluated with adult volunteers. CVD 908 was well tolerated and highly immunogenic when given to volunteers in phase 1 studies after having been freshly harvested f...