What are the live vaccines, including MMR (Measles, Mumps, and Rubella) vaccine, Varicella (chickenpox) vaccine, OPV (Oral Poliovirus Vaccine), and Rotavirus vaccine?

Live Vaccines: Complete List

The live vaccines currently available include MMR (measles, mumps, rubella), varicella, rotavirus, live attenuated influenza vaccine (LAIV), yellow fever, herpes zoster (shingles), BCG (Bacille Calmette-Guérin), oral typhoid (Ty21a Salmonella typhi), and historically oral poliovirus vaccine (OPV, no longer used in the United States). 1, 2

Live Viral Vaccines

• MMR (Measles, Mumps, Rubella): A combination vaccine containing live attenuated strains of all three viruses, administered subcutaneously at 0.5 mL per dose 2, 3

• Varicella (Chickenpox): Live attenuated varicella-zoster virus vaccine for prevention of primary varicella infection 1, 2

• MMRV: Combined measles, mumps, rubella, and varicella vaccine available as an alternative to separate MMR and varicella vaccines 4, 5

• Rotavirus: Oral vaccine for prevention of severe diarrheal disease in infants, containing live reassortant rotaviruses 1, 2, 6

• LAIV (Live Attenuated Influenza Vaccine): Nasal spray influenza vaccine indicated for healthy people aged 2-49 years 1, 2

• Yellow Fever: Live attenuated vaccine for prevention of yellow fever in travelers to endemic areas 1, 2

• Herpes Zoster (Shingles): Live zoster vaccine (ZVL) for prevention of shingles in older adults 1, 2

• Vaccinia (Smallpox): Live vaccine for smallpox, not routinely recommended for the general public 1

• OPV (Oral Poliovirus Vaccine): Live oral polio vaccine no longer available or recommended in the United States 1

Live Bacterial Vaccines

• BCG (Bacille Calmette-Guérin): Live bacterial vaccine for tuberculosis prevention in high-risk populations 1, 2

• Ty21a Salmonella Typhi: Oral typhoid vaccine for prevention of typhoid fever in travelers to endemic areas 1, 2

Critical Contraindications

All live vaccines are contraindicated in patients with severe combined immunodeficiency (SCID), complete DiGeorge syndrome, and during pregnancy. 1, 2

• Patients with severe T-cell deficiencies (SCID, complete DiGeorge syndrome) should avoid all live viral and bacterial vaccines prior to immune reconstitution 1

• Patients with severe antibody deficiencies (X-linked agammaglobulinemia, common variable immunodeficiency) should avoid OPV, yellow fever, LAIV, and live bacterial vaccines 1

• HIV/AIDS patients with severe immunosuppression should avoid OPV, smallpox, BCG, and LAIV; withhold MMR, varicella, and rotavirus if CD4+ T-lymphocyte count is <200/mm³ or <15% 1

• Live vaccines are generally contraindicated during pregnancy due to theoretical fetal risk 1, 2

Administration Timing

When administering multiple live vaccines, they must either be given on the same day or separated by at least 4 weeks (28 days). 2

• 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 2

• Immune globulin administration may impair live vaccine efficacy; defer vaccination with live virus vaccines until approximately 3-6 months after immune globulin administration 1, 7

Special Populations

• Patients with phagocytic function defects (chronic granulomatous disease) should avoid live bacterial vaccines but can usually receive live viral vaccines 1, 2

• Patients with complement deficiencies can typically receive all routine vaccines including live vaccines 2

• Patients with partial T-cell deficiencies may receive selected live vaccines if CD4+ T-cell count is >500 cells/mm³ (>1000 cells/mm³ for children 1-6 years, >1500 cells/mm³ for infants <1 year) 1