The Return of FluMist
You may have heard cheers this summer when the return of FluMist, the intranasal spray flu vaccine, was announced. This was great news for children who prefer the nose spray to the shot. Cheers were then followed by head-scratching when the AAP (American Academy of Pediatrics) came out with recommendations that were different from ACIP’s (the CDC’s Advisory Committee on Immunization Practices). Allow me to clear up some of the confusion.
The flu shot is an inactivated vaccine, meaning it uses parts of the killed virus to stimulate the immune system (I’ve answered some common questions about the flu shot in a previous post). The nasal flu vaccine is a live-attenuated vaccine. It uses a weakened form of the flu virus to fake an infection and stimulate the immune system. Live virus vaccines produce a "strong and long-lasting immune response” because they mimic the natural illness.
FluMist came on to the market in 2003. For a number of years, it was more effective than the shot, and in 2014 the CDC recommended it over the shot. Then, for three years in a row, the nasal vaccine did not protect as well as the shot, so the CDC stopped recommending it altogether. Why the sudden turn-around? Like many other flu vaccines, FluMist contains 4 strains of the influenza virus. It turns out that the particular strain used for H1N1 did not reproduce as well in the lining of the nose as the other three strains. And without reproducing well, it was unable to stimulate a strong immune response. This was especially apparent in years where H1N1 was the predominant strain causing influenza illness.
The company that makes FluMist has now changed the strain of H1N1 virus that they use, as well as improved the method of testing how well the virus reproduces in nasal epithelial cells, and has shown that all four strains reproduce equally. Therefore, it looks like FluMist should once again work well.
The CDC’s ACIP came out with a recommendation to use FluMist based on these improvements and with the goal of vaccinating as many people as possible. The AAP took a more conservative approach in their recommendation, wanting to wait until we get through a flu season and have actual effectiveness data; they recommend the shot, but allow for the use of the nasal spray for those who wouldn’t otherwise get the vaccine.
What’s the bottom line? Getting a flu vaccine is the single most important thing you can do to prevent influenza. With that in mind, we will have both forms of the vaccine available. Give us a call and schedule for one of our many flu clinics, and we will get your children protected!
Who can get FluMist?
Children 2 and older can get the FluMist. For some children with chronic medical conditions it is not recommended because of the small risk of causing mild illness.
Does the live-attenuated vaccine give people the flu?
Attenuated means weakened, so getting the live flu vaccine is like getting a weakened mini-version of the flu. Why would anyone want to do that? Well, our immune response is stronger to a live-virus vaccine than a dead virus. And for most people getting the live-attenuated flu vaccine they have no symptoms at all. For others, common symptoms are sniffles, a mild sore throat, or fever.
If my child has asthma can they get the FluMist?
Not is they’re four or younger, due to the small risk of getting upper respiratory symptoms that could lead to wheezing. But for kids five and older it can be an option. If you’re interested, make an appointment to talk to your doctor.
Watch Dr Paul Offit explain what happened with FluMist.
Read more about the nasal spray flu vaccine on the CDC site.