What are the contraindications to giving live attenuated vaccines (MMR, varicella, MMRV)?

Live attenuated vaccines contain weakened pathogens that replicate in the body; while safe for healthy individuals, they can cause disease in vulnerable groups. Contraindications: (1) Pregnancy — defer live vaccines until after delivery; advise women to avoid pregnancy for 4 weeks after live vaccine; theoretical fetal risk, though no actual harm documented; (2) Severe immunocompromise: hematologic malignancy (leukemia, lymphoma) during chemotherapy or radiation; HIV with severe immunosuppression (specific CD4 thresholds); high-dose immunosuppressive therapy; recent organ transplant; primary immunodeficiency; (3) Anaphylaxis to vaccine components (gelatin, neomycin, egg protein for some vaccines); (4) Recent receipt of blood products may delay live vaccine response (defer 3+ months). Live vaccines: MMR, MMRV, Varicella, Zoster (Zostavax — older; Shingrix is non-live and preferred), Yellow Fever, Oral Typhoid, Rotavirus, Nasal Flu (LAIV — alternative), Smallpox/Monkeypox. Live vaccines can typically be given on the same day (or separated by ≥4 weeks). Inactivated vaccines (Tdap, HPV, hepatitis, injectable flu, pneumococcal, meningococcal) are safe in immunocompromised and pregnant individuals. Mild illness, antibiotic therapy, recent vaccine exposure are NOT contraindications. Family members of immunocompromised individuals can safely receive most live vaccines; the immunocompromised person should avoid contact with rotavirus diaper changes for 4 weeks.