Safety of live attenuated vaccines in immunocompromised individuals and pregnant women: a systematic literature review

ABSTRACT Background Live-attenuated vaccines (LAVs) are typically contraindicated for immunocompromised patients and pregnant women, although the potential benefits of vaccination with LAV in these populations should not be overlooked. This systematic literature review was conducted to evaluate the safety of LAVs in immunocompromised patients and pregnant women. Research design and methods The searches were conducted across PubMed, Embase, and Cochrane databases. We included studies reporting on safety outcomes of LAV use in immunocompromised patients and pregnant women. A narrative synthesis was employed to present the primary findings. Results A total of 96 studies were included, reporting outcomes on 18 LAVs, mostly for varicella-zoster, measles-mumps-rubella, and influenza vaccines. Comparative studies revealed minor differences in adverse events (AEs) between immunocompromised LAV recipients and placebo recipients, and between immunocompromised and healthy vaccinated individuals. Severe AEs and fatalities were infrequent, primarily noted in oncology patients in case studies. Twelve studies addressed LAV safety in pregnant women, with no instances of vertical transmission reported, and no conclusive link found between LAVs and serious AEs. Conclusions LAVs appeared generally safe and well-tolerated for immunocompromised patients and pregnant women. However, evidence is still limited, and more research is needed to address data gaps and support evidence-based decision-making.

• Publication year

  2025

• Venue

  Expert Review of Vaccines

• Publication date

  2025-11-12

• Fields of study

  Medicine

• Identifiers
  DOI 10.1080/14760584.2025.2589213PMID 41220274
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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