Live attenuated viral vaccines (LAV) have saved millions of lives globally through their capacity to elicit strong, cross-reactive and enduring adaptive immune responses. However, LAV can also act as a Trojan horse to reveal inborn errors of immunity, thereby highlighting important protective elements of the healthy antiviral immune response. In the following article, we draw out these lessons by reviewing the spectrum of LAV-associated disease reported in a variety of inborn errors of immunity. We note the contrast between adaptive disorders, which predispose to both LAV and their wild type counterparts, and defects of innate immunity in which parenterally delivered LAV behave in a particularly threatening manner. Recognition of the underlying pathomechanisms can inform our approach to disease management and vaccination in a wider group of individuals, including those receiving immunomodulators that impact the relevant pathways.

减毒活病毒疫苗 (LAV) 通过其引发强烈、交叉反应和持久的适应性免疫反应的能力在全球挽救了数百万人的生命。然而，LAV 也可以作为特洛伊木马来揭示先天的免疫错误，从而突出健康抗病毒免疫反应的重要保护因素。在接下来的文章中，我们通过回顾在各种先天性免疫缺陷中报告的 LAV 相关疾病谱来总结这些教训。我们注意到适应性障碍（易患 LAV 及其野生型对应物）与先天免疫缺陷之间的对比，其中肠胃外递送的 LAV 以特别具有威胁性的方式表现。