Category	Example of Specific Immunodeficiency	Vaccine Contraindications	Effectiveness and Comments
Primarya
B lymphocyte (humoral)	Severe antibody deficiencies (eg, X-linked agammaglobulinemia and common variable immunodeficiency)	OPVb, smallpox, LAIV, yellow fever, and live-bacteria vaccinesc; consider measles vaccine; no data for varicella or rotavirus vaccines	Effectiveness of any vaccine dependent only on humoral response is doubtful; IGIV therapy interferes with measles and possibly varicella immune response.
	Less severe antibody deficiencies (eg, selective IgA deficiency and IgG subclass deficiencies)	OPVb; other live vaccinesd appear to be safe, but caution is urged	All vaccines probably effective. Immune response may be attenuated.
T lymphocyte (cell-mediated and humoral)	Complete defects (eg, severe combined immunodeficiency, complete DiGeorge syndrome)	All live vaccinesc,d	All vaccines ineffective.
	Partial defects (eg, most patients with DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia telangiectasia)	All live vaccinesc,d	Effectiveness of any vaccine depends on degree of immune suppression. Recommend inactivated vaccines.
Complement	Deficiency of early components (C1, C4, C2, C3)	None	All routine vaccines probably effective.
			Pneumococcal and meningococcal vaccines are recommended.
	Deficiency of late components (C5-C9), properdin, factor B	None	All routine vaccines probably effective.
			Meningococcal and pneumococcal vaccines are recommended.
Phagocytic function	Chronic granulomatous disease, leukocyte adhesion defects, myeloperoxidase deficiency	Live-bacteria vaccinesc	All inactivated vaccines safe and probably effective.
			Live-virus vaccines probably safe and effective.
Secondarya
	HIV/AIDS	OPV,b smallpox, BCG, LAIVd; withhold MMR and varicella in severely immunocompromised children	MMR, varicella, rotavirus, and all inactivated vaccines, including inactivated influenza, may be effective.e
	Malignant neoplasm, transplantation, autoimmune disease, immunosuppressive or radiation therapy	Live-virus and -bacteria, depending on immune statusc,d	Effectiveness of any vaccine depends on degree of immune suppression.

OPV indicates oral poliovirus; LAIV, live-attenuated influenza vaccine; IGIV, Immune Globulin Intravenous; Ig, immunoglobulin; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; BCG, bacille Calmette-Guérin; MMR, measles-mumps-rubella.