Live Vaccines: Types and Considerations

Types of Live Vaccines and Administration

The Centers for Disease Control and Prevention recommends live vaccines, such as MMR (Measles, Mumps, Rubella), which provides protection against three different viral diseases in the general population 1, 2
The American Academy of Pediatrics recommends Varicella (Chickenpox) vaccine to prevent primary varicella infection in children 2
The Centers for Disease Control and Prevention recommends Zoster vaccine live (ZVL) for prevention of herpes zoster (shingles) in older adults, with a strength of evidence rated as high 2, 3
The World Health Organization recommends Rotavirus vaccine, an oral vaccine for prevention of severe diarrheal disease in infants, with a strength of evidence rated as high 2, 4
The Centers for Disease Control and Prevention recommends Yellow fever vaccine for prevention of yellow fever in travelers to endemic areas, with a strength of evidence rated as high 2, 5
The American Academy of Pediatrics recommends LAIV (Live Attenuated Influenza Vaccine), a nasal spray influenza vaccine, for children and adults, with a strength of evidence rated as moderate 2, 5
The Centers for Disease Control and Prevention recommends BCG (Bacille Calmette-Guérin) for tuberculosis prevention in high-risk populations, with a strength of evidence rated as high 2, 5
The World Health Organization recommends Ty21a Salmonella Typhi, an oral typhoid vaccine, for prevention of typhoid fever in travelers to endemic areas, with a strength of evidence rated as moderate 2, 5

The American College of Obstetricians and Gynecologists recommends that live vaccines are generally contraindicated during pregnancy due to theoretical risk to the fetus, with a strength of evidence rated as high 6
The Infectious Diseases Society of America recommends that live vaccines are typically contraindicated in patients with severe combined immunodeficiency (SCID), complete DiGeorge syndrome, HIV/AIDS with severe immunosuppression, active malignancy on immunosuppressive therapy, with a strength of evidence rated as high 2, 5, 6
The American Academy of Allergy, Asthma, and Immunology recommends that patients with B-cell (humoral) deficiencies may have uncertain responses to vaccines that depend primarily on antibody response, with a strength of evidence rated as moderate 2, 5
The American Academy of Pediatrics recommends that patients with T-cell deficiencies should generally avoid all live vaccines, with a strength of evidence rated as high 2, 5
The Infectious Diseases Society of America recommends that patients with complement deficiencies can typically receive all routine vaccines including live vaccines, with a strength of evidence rated as high 2, 5
The American Academy of Allergy, Asthma, and Immunology recommends that patients with phagocytic function defects (e.g., chronic granulomatous disease) should avoid live bacterial vaccines but can usually receive live viral vaccines, with a strength of evidence rated as moderate 2, 5

The Centers for Disease Control and Prevention recommends that when administering multiple live vaccines, they should either be given on the same day or separated by at least 4 weeks, with a strength of evidence rated as high 7
The American Academy of Pediatrics recommends that if two live parenteral vaccines are administered less than 4 weeks apart, the second vaccine dose should be repeated after waiting at least 4 weeks from the invalid dose, with a strength of evidence rated as moderate 7
The Centers for Disease Control and Prevention recommends that simultaneous administration of indicated vaccines increases the likelihood of complete vaccination and provides timely protection, with a strength of evidence rated as high 7

The American Academy of Allergy, Asthma, and Immunology recommends that patients with severe T cell deficiencies should not receive any live viral or bacterial vaccines prior to immune reconstitution 8, 9
Patients with chronic granulomatous disease and IFN-γ-IL-12 pathway defects should not receive BCG or Salmonella Ty21a due to predilection for these infections 10
Close contacts of immunocompromised patients should not receive oral polio vaccine due to viral shedding risk, but may receive other live vaccines like MMR and varicella as shedding is unlikely 10

Oral poliovirus vaccine (OPV) contains three attenuated strains, though it carries a small risk of vaccine-associated paralysis (2 per 1,000,000) and is no longer used in many countries 10
Smallpox vaccine is a live vaccine used in specific circumstances 9