What are the different types of live vaccines (e.g. MMR (Measles, Mumps, and Rubella), varicella (chickenpox)) recommended for individuals without specific contraindications, such as severe immunodeficiency?

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Last updated: January 16, 2026 • View editorial policy

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Live Vaccines: Comprehensive List

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

Live Viral Vaccines

  • MMR (Measles, Mumps, Rubella): A combination vaccine protecting against three viral diseases, safe for immunocompetent individuals and certain HIV-infected patients with adequate CD4 counts (≥200 cells/mm³ in adults or ≥15% in children) 1, 2

  • Varicella (Chickenpox): Protects against varicella-zoster virus, can be administered to HIV-infected patients when adults have CD4 count ≥200 cells/mm³ and children aged 1-13 years have CD4 percentage ≥15% 1, 2

  • MMRV (Measles-Mumps-Rubella-Varicella): Combined vaccine containing all four antigens in a single formulation 1

  • Herpes Zoster (Shingles): Live attenuated vaccine (Zostavax) for prevention of shingles, distinct from the newer recombinant zoster vaccine (Shingrix) which is inactivated 1

  • Rotavirus: Oral vaccine for infants to prevent severe rotavirus gastroenteritis, contraindicated in severe combined immunodeficiency 1

  • Live Attenuated Influenza Vaccine (LAIV): Nasal spray formulation indicated only for healthy people aged 2-49 years, absolutely contraindicated in immunocompromised patients 1, 2

  • Yellow Fever: Required for travel to endemic areas, contraindicated in severely immunocompromised patients 1

  • Vaccinia (Smallpox): No longer routinely recommended for the general public 1

  • Oral Poliovirus Vaccine (OPV): No longer available or recommended in the United States due to risk of vaccine-associated paralytic poliomyelitis 1

Live Bacterial Vaccines

  • BCG (Bacille Calmette-Guérin): Tuberculosis vaccine, contraindicated in patients with severe T-cell immunodeficiencies and those with IFN-γ-IL-12 pathway defects who have predilection for BCG-induced infection 1

  • Oral Typhoid (Ty21a Salmonella typhi): Live bacterial vaccine for typhoid fever prevention, contraindicated in severe antibody deficiencies and T-cell defects 1

Critical Safety Considerations for Immunocompromised Patients

  • Absolute contraindications exist for patients with severe combined immunodeficiency (SCID), complete DiGeorge syndrome, and severe antibody deficiencies (X-linked agammaglobulinemia, common variable immunodeficiency) where all live vaccines must be avoided 1, 2

  • Patients with phagocytic function disorders (chronic granulomatous disease, leukocyte adhesion defects, myeloperoxidase deficiency) should avoid live bacterial vaccines but can receive live viral vaccines 1

  • Patients receiving high-dose corticosteroids (≥2 mg/kg/day or ≥20 mg/day prednisone for ≥2 weeks) must wait ≥3 months after discontinuation before receiving live vaccines 2

Household Contact Vaccination

  • Household members of immunocompromised patients should receive all age-appropriate vaccines including MMR, varicella, rotavirus (for infants), and zoster vaccines to create a protective barrier, with the critical exception that OPV should never be given to household contacts due to transmission risk 1, 2

  • Both inactivated influenza vaccine (IIV) and LAIV are acceptable for household contacts, as transmission of LAIV virus to immunocompromised individuals is extremely rare 1, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Vaccination in Immunocompromised Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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