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Vaccination for people who are immunocompromised

Inborn errors of immunity, including primary immunodeficiency

Inborn errors of immunity (IEI), including primary immunodeficiencies, are inherited conditions that impair immune system function.

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Overview

  • Inborn errors of immunity (IEI), including primary immunodeficiencies, are inherited conditions that impair immune system function.
  • Different types of IEI affect a person’s susceptibility to infections, vaccine responses and contraindications to live vaccines.
  • People with IEI can generally receive non-live vaccines safely, but their immune response to the vaccine may be suboptimal.
  • People with IEI often need extra vaccines and regular boosters of some non-live vaccines, depending on the type of IEI.
  • Live vaccines are contraindicated for many — but not all — people with IEI.

For more details about the immunosuppressive potential of various medications and medical conditions, see:

Introduction

Inborn errors of immunity (IEI), including primary immunodeficiencies are inherited conditions that may impair cellular, humoral or both components of the immune system.

IEI disorders can have various clinical presentations, and may present in childhood or adulthood. People with IEI disorders often have increased susceptibility to infections, as well as a predisposition to autoinflammatory diseases or cancers.

Different types of IEI affect a person’s susceptibility to infections, their immune response to vaccinations and which vaccines they can safely receive.

There are more than 400 known IEI disorders.1 These can be grouped as:

  • antibody (B-cell) deficiencies
  • T-cell deficiencies
  • combined T- and B-cell deficiencies
  • phagocytic and neutrophil disorders
  • defects of innate immunity
  • complement deficiencies

Assessing the type and degree of immunodeficiency

Specialist clinicians should first assess the type and degree of immunodeficiency to help determine the safety and effectiveness of vaccines for people with inborn errors of immunity (IEI). Alongside clinical history and genetic testing, some laboratory tests can help with this assessment. Specialised tests may be used to evaluate the type and degree of immunodeficiency and require interpretation by clinicians with expertise in this area. These tests may include the following:

  • cellular immunity assessment — lymphocyte counts (complete blood count with differential; and subset analysis of B- and T-lymphocytes, including CD4+ and CD8+ lymphocytes), or tests that measure T-cell proliferation or function in response to specific or non-specific stimuli (such as lymphocyte proliferation assays)
  • humoral immunity assessment — immunoglobulin and immunoglobulin subclass levels, or specific antibody levels in response to vaccines (such as tetanus and diphtheria)
  • phagocyte function assessment — dihydrorhodamine reduction (DHR) test, or nitroblue tetrazolium (NBT) test
  • complement deficiency assessment — total haemolytic complement assay (CH50), and analysis of the alternate pathway (AH50)

Measuring antibody levels in response to vaccines to assess IEI

Serological testing to assess immune responses after immunisation is not recommended, except in certain circumstances. This is because it often fails to produce clinically relevant information.

However, serological testing after vaccination with the following vaccines may occasionally be used by specialists in immunology or infectious diseases to assess IEI disorders. This may include evaluating responses to:

  • polysaccharide vaccines — an adequate response to polysaccharide vaccines (such as 23-valent pneumococcal polysaccharide vaccine) requires functional B-cells.
  • protein vaccines — an antibody-mediated response to protein antigens (such as antigens in tetanus- and diphtheria-containing vaccines) requires intact T- and B-cell function. An impaired response suggests a more severe form of immunodeficiency.
  • conjugate vaccines — responses to protein or polysaccharide antigens can be assessed using Haemophilus influenzae type b vaccines (Hib-PRP) and pneumococcal conjugate vaccines.

Seek specialist advice to guide the investigation and interpretation of these tests. Only IgG titres should be used to evaluate these vaccine responses, and the assessment may vary depending on the person’s age and clinical history.2

Principles of non-live vaccine administration for people with inborn errors of immunity

People with IEI can safely receive all non-live vaccines. This includes inactivated vaccines, conjugate vaccines, recombinant vaccines and viral vector vaccines.

See:

The immune response to non-live vaccines may be suboptimal depending on the degree of immunodeficiency. People with severe immunodeficiencies, such as those with severe antibody deficiencies, may not have a response to vaccination. Others may have adequate responses but require ongoing booster doses due to their continuous susceptibility to infections.

All people with IEI should receive seasonal influenza vaccine each year.

For young children with IEI that may require corrective therapy such as stem cell transplant in early childhood, vaccination could be deferred until after completion of definitive treatment (e.g. transplantation).3,4

Principles of live vaccine administration for people with inborn errors of immunity

Immunisation with live vaccines is contraindicated for many — but not all — people with inborn errors of immunity (IEI).

Live vaccines are generally contraindicated in people with:

  • antibody (B-cell) deficiencies
  • T-cell deficiencies
  • combined T- and B-cell deficiencies
  • defects of innate immunity
  • phagocytic and neutrophil disorders

Exceptions include:

  • people with less severe or partial antibody deficiencies (selective IgA deficiency, IgG subclass deficiency) can receive MMR and monovalent varicella vaccines, if they have known intact T-cell immunity and some ability to produce antibodies
  • people with partial T-cell or other combined deficiencies (such as incomplete DiGeorge syndrome, Wiskott–Aldrich syndrome) can receive MMR and monovalent varicella vaccines, if they have a total CD4+ lymphocyte count of >500 cells/μL and normal mitogen response
  • people with chronic granulomatous disease can receive live viral vaccines, but not live bacterial vaccines
  • people with defects in interferon (IFN)-gamma/interleukin (IL)-12 axis can receive live viral vaccines, but not live bacterial vaccines

People with complement deficiency can safely receive live vaccines.

Infants with suspected immunodeficiency (such as infants with a family history of inherited immunodeficiency) should not receive live vaccines (including BCG, rotavirus, MMR or varicella vaccines) until they have been reviewed by a specialist.

See:

Live vaccines for people receiving immunoglobulin therapy

People with IEIs may receive immunoglobulin (Ig) replacement therapy in the form of intravenous immunoglobulin (IVIg) or subcutaneous immunoglobulin (SCIg) to maintain IgG levels and reduce the risk of recurrent infections. Ig therapy may interfere with the response to live vaccines. People who are receiving regular Ig therapy should wait at least 3 months before receiving MMR, monovalent varicella or MMRV vaccines.

See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination.

Antibody (B-cell) immunodeficiencies: recommendations for vaccination

B-cell immunodeficiencies are defects of humoral immunity. These conditions make people susceptible to diseases caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. Deficiencies can be severe or less severe (partial).

Severe deficiencies

Examples of severe defects include X-linked agammaglobulinaemia (XLA) and common variable immunodeficiency (CVID). 
People with these conditions:

  • are contraindicated to receive live vaccines
  • can safely receive non-live vaccines but are unlikely to respond adequately
  • may need extra vaccines or extra doses of some non-live vaccines
  • can be protected against infections with immunoglobulin therapy

For more details, see:

Less severe deficiencies

Examples of less severe, or partial, antibody defects include selective IgA deficiency, specific polysaccharide antibody deficiency (SPAD) and IgG subclass deficiency.

People with these conditions:

  • are generally contraindicated to receive live vaccines — exceptions are MMR and monovalent varicella vaccines
  • are likely to mount an immune response to vaccination, but it may be suboptimal depending on the type of antibody immunodeficiency and the vaccine received
  • can safely receive non-live vaccines according to routine schedules
  • may need extra vaccines or extra doses of some non-live vaccines
  • can consider yellow fever vaccination in consultation with a specialist if risk cannot be avoided (see Travellers who are immunocompromised, Yellow fever)

For more details, see:

T-cell or combined (T- and B-cell) immunodeficiencies: recommendations for vaccination

People with T-cell or combined T- and B-cell immunodeficiencies are susceptible to many viruses and bacteria. Defects can be severe or less severe (partial).

Severe deficiencies

Examples of severe T-cell or combined T- and B-cell defects include complete DiGeorge syndrome and severe combined immunodeficiency disease (SCID).

People with these conditions:

  • are contraindicated to receive live vaccines
  • can safely receive non-live vaccines, but immunological responses are likely to be impaired
  • may need extra vaccines or extra doses of some non-live vaccines
  • for individuals with complete DiGeorge or SCID who may require corrective therapy such as stem cell and thymus transplant in early childhood, all vaccination could be deferred until after transplantation – this does not include passive immunisation with an RSV-specific monoclonal antibody (see Haematopoietic stem cell transplant: recommendations for vaccination)
  • can be protected against infections with immunoglobulin therapy.

For more details, see:

Less severe deficiencies

Examples of less severe, or partial, T-cell or combined T- and B-cell defects include incomplete DiGeorge syndrome, Wiskott–Aldrich syndrome, ataxia telangiectasia, hyper-IgM syndrome, hyper-IgE syndrome and X-linked lymphoproliferative disease.

People with these conditions:

  • are generally contraindicated to receive live vaccines — except MMR and monovalent varicella vaccines, which may be given to people with less severe T-cell or combined deficiencies, who have a total CD4+ count of >500 cells/μL and normal mitogen response
  • can safely receive non-live vaccines according to routine schedules
  • may need extra or extra doses of some non-live vaccines

For more details, see:

Phagocytic and neutrophil disorders: recommendations for vaccination

Phagocytic and neutrophil disorders include chronic granulomatous disease, myeloperoxidase deficiency, leucocyte adhesion and migration defects, Chédiak–Higashi syndrome, and congenital or cyclic neutropenia. People with these conditions have an increased risk of bacterial infections.

People with these conditions:

  • are contraindicated to receive live bacterial vaccines (such as BCG and oral typhoid vaccines)
  • are contraindicated to receive live viral vaccines — except for people with chronic granulomatous disease, who can safely receive live viral vaccines, including MMR and varicella vaccines
  • can safely receive non-live vaccines according to routine schedules, and these vaccines are likely to be effective
  • may need extra vaccines or extra doses of some non-live vaccines

For more details, see:

Defects of innate immunity: recommendations for vaccination

Defects of innate immunity include those relating to cytokine generation or cellular activation. These include impairments in the interferon (IFN)-gamma/interleukin (IL)-12 axis and IFN-alpha/beta receptor subunit 1 (IFNAR1). Some defects increase susceptibility to pyogenic bacterial infections, while others increase susceptibility to viral infections. Defects in the IFN-gamma/IL-12 axis increase susceptibility to intracellular bacteria (eg Salmonella or mycobacteria).

IFNAR1 deficiency is a rare condition affecting people of Western Polynesian heritage, including Tongan, Samoan and Niuean. It is associated with severe illness and death from certain viral infections and also potentially from some live attenuated viral vaccines, including the measles, mumps and rubella (MMR) vaccine, the yellow fever vaccine and potentially varicella vaccine, though disseminated varicella post vaccination has not been seen.5,6 Currently, diagnosis of IFNAR1 deficiency before vaccination is challenging and there is no established treatment.

Healthcare providers need to be aware that children of Western Polynesian heritage who present for medical attention and are very unwell in the 1-2 weeks following an MMRV or varicella vaccine may need further investigation by an immunologist to assess for an immune deficiency. Any suspected adverse event following immunisation should be reported. Family members of people who have had a severe reaction to a live viral vaccine, or are related to someone with known IFNAR1 deficiency, should see an immunologist before having the live vaccines. Children who have safely received a first dose of MMRV or varicella vaccine are highly unlikely to have IFNAR1 deficiency.5

People with these conditions:

  • are generally contraindicated to receive live vaccines, and should only receive live vaccines after specialist advice is sought, according to their increased susceptibility to certain pathogens. For example:
    • People with defects that are associated with invasive bacterial or mycobacterial infections, such as defects in the IFN-gamma/IL-12 production axis, should not receive live bacterial vaccines but may receive live viral vaccines.
    • People with defects that are associated with severe viral infections, such as defects in type 1 IFN signalling and production, should not receive live viral vaccines.
    • People with defects in the nuclear factor kappa B pathway that present as a combined immunodeficiency should not receive any live viral or live bacterial vaccines.
  • can safely receive non-live vaccines according to routine schedules
  • may need extra vaccines or extra doses of some non-live vaccines

For more details, see:

Complement deficiency: recommendations for vaccination

Complement deficiency makes a person susceptible to infections with Neisseria meningitidis and other encapsulated bacteria (such as Streptococcus pneumoniae and Haemophilus influenzae), depending on which part of the complement pathway is affected. Conditions include deficiencies in complement, properdin, factor D or B, or mannan-binding lectin.

Complement deficiency can also be acquired if the person is receiving complement inhibitor therapies, such as eculizumab, ravulizumab and pegcetacoplan. See Secondary (acquired) immunodeficiency due to medical therapies.

People with complement deficiency (either primary or secondary):

  • can safely receive all live vaccines
  • can safely receive non-live vaccines according to routine schedules
  • may need extra vaccines or extra doses of some non-live vaccines

For more details, see:

See also:

Table. Vaccination for people with inborn errors of immunity (IEI)
Category of IEI Examples of specific immunodeficiency diagnoses Risk-specific recommended vaccines Contraindicated vaccines
Antibody (B-cell) immunodeficiencies

Less severe antibody immunodeficiencies, such as:

  • selective IgA deficiency
  • specific polysaccharide antibody deficiency
  • IgG subclass deficiency 

Some vaccines have altered primary dosing schedule:

  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

 Live vaccines are generally contraindicated, except MMR and monovalent varicella vaccines, which can be given to people with partial antibody immunodeficiency and known intact T-cell immunity.

Severe antibody immunodeficiencies, such as:

  • X-linked agammaglobulinaemia
  • common variable immunodeficiency

Some vaccines have altered primary dosing schedule:

  • 2-dose schedule of COVID-19 vaccine and can consider a 3rd dose
  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

 All live vaccines are contraindicated.
T-cell or combined (T- and B-cell) immunodeficiencies

Less severe or partial immunodeficiencies, such as:

  • incomplete DiGeorge syndrome
  • Wiskott–Aldrich syndrome
  • ataxia telangiectasia
    hyper-IgM syndrome
  • hyper-IgE syndrome
  • X-linked lymphoproliferative disease

Some vaccines have altered primary dosing schedule:

  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

 Live vaccines are generally contraindicated, except MMR and monovalent varicella vaccines, which can be given to people with partial T-cell or less severe combined immunodeficiencies with a CD4+ count >500 cells/μL and normal mitogen response.

Severe immunodeficiencies, such as:

  • severe combined immunodeficiency
  • complete DiGeorge syndrome

Some vaccines have altered primary dosing schedule:

  • 2-dose schedule of COVID-19 vaccine and can consider a 3rd dose
  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

 All live vaccines are contraindicated.
Phagocytic and neutrophil disorders Congenital neutropenia Cyclic neutropenia Leukocyte adhesion and migration defects Chronic granulomatous disease Myeloperoxidase deficiency Chédiak–Higashi syndrome

Some vaccines have altered primary dosing schedule:

  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

 Live bacterial vaccines are contraindicated. Live viral vaccines are generally contraindicated, except for patients with chronic granulomatous disease. All live vaccines are contraindicated in people with leukocyte adhesion defect, myeloperoxidase deficiency and Chédiak–Higashi syndrome, and other defects of cytolytic granule release.
Defects of innate immunity IFNAR defects IFN-gamma/IL-12 axis defects Defects in cytokine generation Toll-like receptor signalling pathway deficiencies (IRAK4 and MyD88 deficiency)

Some vaccines have altered primary dosing schedule:

  • 3-dose schedule of HPV vaccine
  • 2-dose schedule of recombinant zoster vaccine

Additional doses of some vaccines are generally recommended:

Live vaccines are contraindicated according to susceptibility to pathogens.

  • Live bacterial vaccines are contraindicated in people with IFN-gamma/IL-12 axis defects.
  • Live viral vaccines are contraindicated in people with IFN signalling or production defects.
  • All live vaccines are contraindicated in people with nuclear factor kappa B pathway defects.

People with defects in the IFN-gamma/IL-12 axis can receive live viral vaccines.
Complement deficiency Primary deficiencies in complement, properdin, factor D or B, and mannan-binding lectin Secondary deficiencies due to complement inhibitor therapies, such as eculizumab, ravulizumab and pegcetacoplan (see Secondary (acquired) immunodeficiency due to medical therapies)

Additional doses of some vaccines are generally recommended:

 No vaccines are contraindicated.

Acronyms used:

  • BCG = bacille Calmette–Guérin 
  • HPV = human papillomavirus
  • IEI = inborn errors of immunity 
  • HPV = human papillomavirus
  • FN = interferon
  • IFNAR = interferon-alpha/beta receptor
  • Ig = immunoglobulin
  • IL = interleukin
  • IRAK4 = interleukin-1 receptor-associated kinase 4
  • MenACWY = meningococcal ACWY
  • MenB = meningococcal B
  • MMR = measles-mumps-rubella
  • MyD88 = myeloid differentiation primary response 88
  • PCV = pneumococcal conjugate vaccine
  • PPV = pneumococcal polysaccharide vaccine
Table. Vaccination for people with inborn errors of immunity: non-live vaccines
Non-live vaccine Antibody (B-cell) immunodeficiency T-cell or combined (T- and B-cell) immunodeficiency Phagocytic and neutrophil disorder Defect of innate immunity Complement deficiency
Cholera (non-live) Use if indicated Use if indicated Use if indicated Use if indicated Use if indicated
COVID-19 Severe immunodeficiency: 2-dose schedule and consider a 3rd dose Severe immunodeficiency: 2-dose schedule and consider a 3rd dose Follow routine schedule Follow routine schedule Follow routine schedule
Diphtheria-tetanus-pertussis-containing vaccinea Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule
Haemophilus influenzae type bb Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule
Hepatitis A Use if indicated Use if indicated Use if indicated Use if indicated Use if indicated
Hepatitis B Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule
Human papillomavirus 3-dose schedule recommended 3-dose schedule recommended 3-dose schedule recommended 3-dose schedule recommended Follow routine schedule
Influenza Recommended annually Recommended annually Recommended annually Recommended annually Recommended annually
Japanese encephalitis (non-live) Use if indicated Use if indicated Use if indicated Use if indicated Use if indicated
Meningococcal ACWY Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Primary and booster dose recommended
Meningococcal B Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Primary and booster dose recommended
Mpox (live, non-replicating) Use if indicated Use if indicated Use if indicated Use if indicated Use if indicated
Pneumococcal (conjugate) Additional dose at 6 months of age (or at diagnosis) Additional dose at 6 months of age (or at diagnosis) Additional dose at 6 months of age (or at diagnosis) Additional dose at 6 months of age (or at diagnosis) Follow routine schedule
Pneumococcal (polysaccharide) 1st dose at 4 years of age, with a booster dose 5 years later 1st dose at 4 years of age, with a booster dose 5 years later 1st dose at 4 years of age, with a booster dose 5 years later 1st dose at 4 years of age, with a booster dose 5 years later Follow routine schedule
Poliob Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule Follow routine schedule
Rabies Use if indicated. Post-exposure vaccination: 5-dose schedule intramuscularly, and possibly HRIG Use if indicated. Post-exposure vaccination: 5-dose schedule intramuscularly, and possibly HRIG Use if indicated. Post-exposure vaccination: 5-dose schedule intramuscularly, and possibly HRIG Use if indicated. Post-exposure vaccination: 5-dose schedule intramuscularly, and possibly HRIG Use if indicated.
Immunisation against respiratory syncytial virus (vaccines or monoclonal antibodies) 1 dose recommended 1 dose recommended 1 dose recommended 1 dose recommended Use if indicated
Typhoid (non-live) Use if indicated Use if indicated Use if indicated Use if indicated Use if indicated
Zoster (herpes zoster, recombinant) 2-dose schedule recommended (1-2 months apart) 2-dose schedule recommended (1-2 months apart) 2-dose schedule recommended (1-2 months apart) 2-dose schedule recommended (1-2 months apart) Use if indicated

Acronym used:

HRIG = human rabies immunoglobulin

Footnotes:

a Use DTPa for children <10 years of age, and dTpa for those ≥10 years of age. 

b This may be given as a combined vaccine.
Table. Vaccination for people with inborn errors of immunity: live vaccines
Live vaccine Antibody (B-cell) immunodeficiency T-cell or combined (T- and B-cell) immunodeficiency Phagocytic and neutrophil disorder Defect of innate immunity Complement deficiency
BCG Contraindicated Contraindicated Contraindicated Contraindicated, or consult a specialist Use if indicated
Cholera (live) Contraindicateda Contraindicateda Contraindicateda Contraindicateda Use if indicated
Japanese encephalitis (live) Contraindicateda Contraindicateda Contraindicateda Contraindicateda Contraindicated
Measles-mumps-rubellab Contraindicated, except for partial antibody deficiency with known intact T-cell immunity Contraindicated, except for partial T-cell or combined deficiencies with a CD4+ count >500 cells/μL and normal mitogen response Generally contraindicated, except for chronic granulomatous disease Contraindicated, except for IFN-gamma/IL-12 axis defects Follow routine schedule
Q fever Contraindicated, or consult a specialist Contraindicated, or consult a specialist Contraindicated, or consult a specialist Contraindicated, or consult a specialist Use if indicated
Rotavirus Contraindicated Contraindicated Generally contraindicated, except for chronic granulomatous disease Contraindicated, or consult a specialist Follow routine schedule
Typhoid (live) Contraindicateda Contraindicateda Contraindicateda Contraindicateda Use if indicated
Varicella (monovalent)b Contraindicated, except for partial antibody deficiency with known intact T-cell immunity Generally contraindicated, except for partial T-cell or combined deficiencies with a CD4+ count >500 cells/μL and normal mitogen response Generally contraindicated, except for chronic granulomatous disease Contraindicated, except for IFN-gamma/IL-12 axis defects Follow routine schedule
Yellow fever Contraindicated, or consult a specialist Contraindicated, or consult a specialist Generally contraindicated, except for chronic granulomatous disease Contraindicated, or consult a specialist Use if indicated

Acronyms used:

  • BCG = bacille Calmette–Guérin
  • IFN = interferon
  • Ig = immunoglobulin
  • IL = interleukin 

Footnotes:

a If indicated for use, choose the non-live vaccine option.

b Measles-mumps-rubella-varicella combination vaccines are not recommended.
 

References

  1. Tangye SG, Al-Herz W, Bousfiha A, et al. Human inborn errors of immunity: 2022 update on the classification from the International Union of Immunological Societies Expert Committee. Journal of Clinical Immunology 2022;42:1473-507.
  2. Orange JS, Ballow M, Stiehm ER, et al. Use and interpretation of diagnostic vaccination in primary immunodeficiency: a working group report of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma and Immunology. Journal of Allergy and Clinical Immunology 2012;130(3 Suppl):S1-24.
  3. Heimall J, Buckley RH, Puck J, et al. Recommendations for Screening and Management of Late Effects in Patients with Severe Combined Immunodeficiency after Allogenic Hematopoietic Cell Transplantation: A Consensus Statement from the Second Pediatric Blood and Marrow Transplant Consortium International Conference on Late Effects after Pediatric HCT. Biology of Blood and Marrow Transplantation 2017;23:1229-40.
  4. Australasian Society of Clinical Immunology and Allergy (ASCIA). ASCIA-TAPID Consensus Guideline — diagnosis, management and transplantation of SCID in Australia and New Zealand. 2019. https://www.allergy.org.au/hp/papers/ascia-guidelines-scid-tapid
  5. Bastard P, Hsiao KC, Zhang Q, et al. A loss-of-function IFNAR1 allele in Polynesia underlies severe viral diseases in homozygotes. Journal of Experimental Medicine 2022;219.
  6. Hernandez N, Bucciol G, Moens L, et al. Inherited IFNAR1 deficiency in otherwise healthy patients with adverse reaction to measles and yellow fever live vaccines. Journal of Experimental Medicine 2019;216:2057-70.

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