Immunodeficiency-45 (IMD45) is an autosomal recessive immunologic disorder with specific clinical features. Patients may present with life-threatening respiratory infections with COVID-19 or influenza and with severe adverse reactions (e.g., meningoencephalitis and hemophagocytic lymphohistiocytosis) to live attenuated viral vaccination. Laboratory studies show impaired response to alpha-interferon (see 147660), impaired type I interferon signature after stimulation, and heightened vulnerability to multiple viruses in vitro (summary by Duncan et al., 2015; Passarelli et al., 2020; Duncan et al., 2022).

Immunodeficiency-44 (IMD44) is an autosomal recessive primary immunodeficiency characterized by increased susceptibility to viral infections and adverse multisystemic reaction to vaccination in some patients. Affected individuals appear to have defects in mitochondrial fission and fusion (summary by Shahni et al., 2015).

Immunodeficiency-106 (IMD106) is an autosomal recessive immunologic disorder characterized by increased susceptibility to viral infections beginning in infancy or early childhood. Some patients present with recurrent respiratory infections or other viral infections. In many cases, the susceptibility to viral infections due to IMD106 only becomes apparent after initial vaccination with live attenuated viral (LAV) vaccines, most notably MMR and yellow fever. A subset of IMD106 patients who demonstrate adverse reactions to MMR or other LAV vaccinations develop a severe acute hyperinflammatory response reminiscent of hemophagocytic lymphohistiocytosis (HLH) and may show encephalopathy, acute respiratory distress syndrome, and multiorgan failure. However, some patients with IMD106 tolerate MMR vaccination without sequelae. IFNAR1 deficiency may also predispose to severe respiratory infection with SARS-CoV-2 and to herpes simplex virus-1 (HSV1) encephalitis (HSE). The disorder results from an impaired type I interferon signaling response (Bastard et al., 2022).