Vaccines What You Need to Know About Live Virus Vaccines By Pat Bass, MD Pat Bass, MD LinkedIn Twitter Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians. Learn about our editorial process Updated on May 30, 2021 Medically reviewed by Anju Goel, MD, MPH Medically reviewed by Anju Goel, MD, MPH LinkedIn Anju Goel, MD, MPH, is a board-certified physician who specializes in public health, communicable disease, diabetes, and health policy. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Vaccine Types List of Live Vaccines Advantages Disadvantages A live virus vaccine contains a live, weakened (attenuated) virus that helps your body develop an immune response without you developing symptoms of the disease it is intended to prevent. The weakened virus "teaches" your immune system to recognize the disease-causing pathogen and launch a pathogen-specific attack if it encounters it again. Many vaccines of this type give you lifelong immunity with only one or two doses. TEK IMAGE / SCIENCE PHOTO LIBRARY / Getty Images How Live Vaccines Differ Live attenuated vaccines have been among the most successful preventive interventions in medical history. Due to global vaccination programs, smallpox was declared eradicated in 1980, while polio and measles have been declared eliminated in some parts of the world. Live viral vaccines are just one type of vaccine. There are other types that do not involve live viruses or bacteria. These include: Inactivated vaccines: Also referred to as "killed" or "inactivated whole-cell" vaccines, these involve a dead virus or bacterium that the immune system still regards as harmful, triggering a pathogen-specific immune response. The annual flu shot is one such example of this, as are the rabies (spread through saliva of animals) and hepatitis A (liver infection) vaccines. Toxoid vaccines: These vaccines do not produce immunity to the actual infection. Rather, they contain a chemically altered toxin made by the bacterium or virus that the immune system responds to, preventing the harmful effects of the infection. The tetanus vaccine (prevents painful muscle contractions) is one such example of this type. Subunit vaccines: These vaccines involve a protein or part of a virus or bacterium that triggers a pathogen-specific immune response. Hepatitis B (liver infection), human papillomavirus (HPV, a sexually transmitted infection that produces warts), and pertussis (whooping cough, a respiratory infection) are among the diseases prevented by these types of vaccines. Conjugate vaccines: This type of vaccine targets bacteria that have an outer coating made up of sugar molecules (polysaccharides). This coating is designed to disguise the bacteria and prevent an immune response. These vaccines are effective in young children who have an immature immune system. Haemophilus influenzae type B (Hib) vaccine (prevents a severe infection) is one such example. History of Vaccines and Vaccinations Types of Live Viral Vaccines Live attenuated viral vaccines are typically delivered by injection, although some are available as a nasal spray or taken by mouth. These include: Chickenpox (varicella) vaccines FluMist (intranasal flu nasal spray) Measles, mumps, and rubella (MMR) vaccines Japanese encephalitis vaccine Oral polio vaccine (no longer used in the United States) Rotavirus vaccines Smallpox vaccine (discontinued worldwide due to the eradication of smallpox) Yellow fever vaccine There are also live attenuated vaccines used to prevent bacterial infections like cholera (bacterial disease of the small intestine), typhoid (spreads through contaminated food), and tuberculosis (serious lung infection). Top 20 Vaccines You Should Know About Advantages There are benefits of using live attenuated vaccines that other vaccines may not deliver. By and large, live vaccines are more durable, meaning that the body will retain its immune "memory" of a pathogen longer than it will with killed or subunit vaccines. Because of this, booster shots are not needed as often or at all with certain live vaccines. The live attenuated hepatitis A vaccine, for example, may protect you for 20 years or more. Moreover, your immune system's response to live vaccines is typically equivalent to that of a natural infection without the associated harms. Most live vaccines can give you a lifetime of protection. The need for multiple shots and booster shots—and people not returning to get them—is one of the reasons why immunization rates are often lower from inactivated vaccines compared to live ones. Live virus vaccines are also being increasingly used by researchers as "viral vectors" for gene therapy. Because the weakened viruses are still "programmed" to attack specific cells, they can latch onto and implant a cell with modified DNA to potentially treat inheritable genetic disorders. Additional research on using vaccines in this way is needed. Immunization Schedule for Children in the U.S. Disadvantages and Considerations One downside of live vaccines is that they require refrigeration, which can limit the ability to use them in resource-limited areas. If these vaccines are not kept at the correct temperature, they can become inactive. If this happens, immunization may not be effective. Also, some live virus vaccines come as a powder and require reconstitution (restoring from a dry state) with a specific diluent (fluid) before they can be administered. Administrator error can also undermine the effectiveness of the vaccine. Vaccine Side Effects and Adverse Events Although small, there is the risk that the weakened live virus could end up causing the illness it was meant to prevent. This is especially the case in people who are severely immunocompromised. In the absence of a normal immune response, the weakened virus has the potential to replicate and, in rare cases, reverse to its natural virulent state. As a general rule, live attenuated vaccines should not be given to severely immunocompromised people, including: People on daily high-dose steroids (strong anti-inflammatory medicines) People undergoing chemotherapy (medicines to kill cancer cells) Organ transplant recipients People with advanced human immunodeficiency virus (HIV) infection Those who are pregnant Even so, there are times when the benefits of vaccination in these individuals outweigh the risks. In such cases, expert consultation is needed to determine whether the use of a live attenuated vaccine is appropriate. The Safety and Science of Vaccine Ingredients A Word From Verywell Vaccines are one of the true public health success stories. Tetanus, diphtheria, mumps, and polio are examples of diseases that were once common but are now rarely seen in the United States. Even if eradication is not achieved, vaccines can significantly reduce the incidence and severity of many dread infections. With that said, the recent anti-vaccination movement threatens to reverse many of those gains with diseases like measles. This highly contagious viral disease was declared eliminated in the United States in 2000, but now is reemerging in regional outbreaks not only in America but abroad. How to Talk to a Vaccine Skeptic Vaccines Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. 14 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Centers for Disease Control and Prevention. 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Centers for Disease Control and Prevention. Vaccine recommendations and guidelines of the ACIP: Altered immunocompetence. Centers for Disease Control and Prevention. Contraindications and precautions. Hopkins Tanne J. Measles cases and deaths are increasing worldwide, warn health agencies. BMJ. 2020 Nov;371:m4450. doi:10.1136/bmj.m4450 By Pat Bass, MD Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit