Table 1.
Characteristics of Live Attenuated Vaccines
| Cost [35] | Repeat administration [36] | Induction of innate immunity [21, 37] | Mucosal immunogenicity | Rare complication | Adverse events | Contraindication | Culture [38] | Combination vaccines in USA [36] | Route [36] | US tradename | Criteria |
|---|---|---|---|---|---|---|---|---|---|---|---|
| $21 per dose | Experienced but not performed in USA [39] | All live attenuated vaccines cause induction of the innate immune system as a first step to create immunity | With the intranasal measles vaccine [40] | Subacute sclerosing panencephalitis (0.7/million) [41] | Serum sickness like arthralgias; febrile seizures [41] | Allergy to neomycin, gelatin, immunocompro-mised, pregnancy [41] | Chicken embryo fibroblast | Mumps, measles, rubella with varicella | Subcutaneous | M-M-R II | MMR |
| $0.15 per dose | Yes | Yes [21] | VAPP (1/million) only with OPV2; cVDPV also rare | VAPP, fever, vomiting, diarrhea [42] | Allergy to vaccine component; in pregnancy, it should be used with caution [42] | Monkey kidney cells | bOPV (OPV1 and OPV3; not in use in USA) | Oral | Substituted by Ipol (IPV) in USA | OPV | |
| $2–3 per dose worldwide; intravesicular use around $160 in USA [43] | Experienced but not performed in USA [44] | Yes [45] | BCG osteitis [46] | Disseminated disease in immunosuppressed [46] | Immunosuppression, allergy to component of vaccine, active tuberculosis [46] | Surface pellicle on synthetic medium [47] | Not administered as a combination vaccine in USA | Percutaneous, intravesicular | BCG vaccine, TICE | BCG | |
| $18.88 per dose | Yes | Yes [21] | Guillain-Barré syndrome (controversial) [48] | Flu-like syndrome, wheezing, nasal congestion [48] | Immunosuppression, allergy to component of vaccine, pregnancy, CSF leak, concomitant aspirin, Reye’s syndrome [48] | Egg based | Not administered as a combination vaccine in USA | Intranasal | FluMist | Influenza | |
| $97.50 per dose, $71.88 per dose (pentavalent) | Yes | Yes [21] | Intussusception [49] | Cough, runny nose, fever, vomiting [49] | History of uncorrected congenital gastrointestinal malformation, intussusception, hypersensitivity to component of vaccine, severe combined immunodeficiency disease [49] | Virus from calf and human mixed | Not administered as a combination vaccine in USA | Oral | Rotarix, RotaTeq | Rotavirus | |
| $212–$240 per dose | Limited evidence [50] | Experienced [51] | Transmission of virus, anaphylaxis [52] | Headache and injection site reactions [52] | History of anaphylactic reaction to component of the vaccine, immune suppression [52] | Use human cell strains | Not administered as a combination vaccine in USA | Subcutaneous | Zostavax (discontinued in USA) | Shingles | |
| $109.26 per dose | Yes | No sufficient data | Reye syndrome in children following use of salicylates [53] | Fever, injection site reactions, rash [53] | History of severe allergic reaction to any component of the vaccine, immunosuppre-ssion, moderate or severe febrile illness, active untreated tuberculosis, pregnancy [53] | Use human cell strains | Mumps, measles, rubella with varicella | Subcutaneous | Varivax | Varicella |
Abbreviations: BCG, Bacillus Calmette-Guérin; CSF, cerebrospinal fluid; cVDPV, circulating vaccine-derived poliovirus; IPV, inactivated polio vaccine; MMR, measles, mumps, rubella; OPV, oral polio vaccine; VAPP, vaccine-associated paralytic poliomyelitis.