In significant immunosuppression, which vaccines are generally contraindicated?

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In significant immunosuppression, the main safety issue is with vaccines that contain live, replicating organisms. Live vaccines can cause disease in someone whose immune system is unable to control even the attenuated organisms, so they are generally contraindicated in substantial immune compromise. Inactivated vaccines, on the other hand, do not contain live pathogens and are typically safe for immunosuppressed individuals, though the immune response may be weaker and some vaccines may still require timing considerations or caution. In milder immunosuppression, vaccination can often proceed with regard to local guidelines. Therefore, the statement that live vaccines are generally contraindicated in significant immunosuppression, with cautious use in milder cases and guideline checks, best reflects the standard approach.