While pediatricians, parents and kids loved it, since it wasn’t a shot, it hasn’t been available since 2016 because it was found to be less effective than flu shots against the H1N1 strain of flu.
The History of FluMist
The FluMist nasal spray was first approved in 2003 for healthy kids over age 5 years and adults up to age 49 years.
In 2007, the age range was expanded to included healthy children between the ages of 2 and 5 years.
It quickly became a favorite of kids who didn’t like the idea of getting a flu shot each year, although some kids didn’t like getting something sprayed into their nose.
Next, in 2012, FluMist Quadrivalent, with protection against four strains of flu virus, was approved.
While some experts initially thought it might work better than traditional flu shots and it actually became the preferred flu vaccine for kids in 2014, by 2016, FluMist was no longer recommended in the United States.
The Return of FluMist
On February 12, 2017, at a meeting of the Advisory Committee on Immunization Practices (ACIP), members voted to once again recommended FluMist Quadrivalent to prevent the flu. It will be available for next year’s flu season, although the recommendation still has to be approved by the director of the CDC.
What happened to FluMist?
“In the 2013-2014 influenza season, when lower than expected effectiveness of FluMist Quadrivalent was first observed, Influenza A (H1N1) was the predominant circulating influenza virus strain. When the data showing lower than expected vaccine effectiveness became available, FDA began working with MedImmune to investigate potential reasons for this finding.”
FDA Information Regarding FluMist Quadrivalent Vaccine
Although they worked on a fix after the 2013-2014 influenza season, the following season showed poor effectiveness for all flu vaccines because of a drifted flu strain. So it wasn’t until the following year that it was noticed that FluMist still didn’t work as well as a flu shot against H1N1 flu strains, at least not in the United States.
Surprisingly, studies in other countries, including Finland and the UK showed that FluMist did work.
And now MedImmune, the company that makes FluMist, has replaced the H1N1 seed virus it uses to make FluMist, and preliminary testing shows that it is more effective and should be as effective as a flu shot.
That’s why the ACIP voted 12-2 to make FluMist available for the 2018-2019 flu season.
Will you get it for your kids next year, instead of a regular flu shot? If the number of parents and kids asking for FluMist this year is any guide, many will be glad it’s back.
What to Know About the Return of FluMist
FluMist has hopefully been improved, been made more effective, and will be ready to help prevent the flu for the 2018-2019 flu season. It will be an especially good option for those kids who don’t want a shot.
encouraging your kids to not touch their eyes, nose, or mouth, or to bite their nails or put things in their mouth, like their pencil or pen
cleaning and disinfecting surfaces that your child will likely touch
encouraging others to stay home from school or work when they have the flu until they are fever free for at least 24 hours, although they might be contagious for even longer
While these techniques might not work, they are certainly better than doing nothing and simply letting your kids catch the flu.
What to Do If Your Child Is Exposed to the Flu
If your kids do anything outside the home, even if they don’t go to daycare or school, there might come a time during a long flu season when they get exposed to someone with the flu.
What do you do?
“Prevention (prophylaxis) is a term used when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.”
FDA on Tamiflu: Consumer Questions and Answers
In addition to watching for classic flu symptoms to develop over the next one to four days, if your child is unvaccinated or it is a year during which the flu vaccine is not very effective, if your child is in a high risk group for severe complications from the flu (under age two to five years or any age with chronic medical problems), then you might ask your pediatrician about:
a once a day dose of Tamiflu (Oseltamivir), which is recommended as a preventative in infants as young as three months old
a once a day dose of Relenza (Zanamivir), which is recommended as a preventative in children as young as five years old, unless they have respiratory problems, like asthma
But that doesn’t mean that everyone should take these flu medicines every time they are exposed to someone with the flu. If these medicines are overused, flu viruses will develop resistance and they won’t work, just like happened to some of the older anti-viral flu medicines, amantadine and rimantadine.
Still, if your child with diabetes, uncontrolled asthma, muscular dystrophy, or healthy four month old is closely exposed to someone with the flu, then taking Tamiflu to prevent a potentially severe case of the flu is likely a good idea.
What to Do If Your Child Gets the Flu
And if your child gets the flu?
Believe it or not, most healthy school age kids with the flu don’t need to be seen by their pediatrician.
“When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen symptoms and shorten the time you are sick by about one day. They may reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults. For people at high risk of serious flu complications, early treatment with an antiviral drug can mean the difference between having milder illness instead of more severe illness that might require a hospital stay.”
CDC on What You Should Know About Flu Antiviral Drugs
You should see your pediatrician or other health care provider at the first sign of flu symptoms if they are at high risk for serious complications of the flu and they might benefit from Tamiflu, which includes those under two to five years old and children with any chronic medical problems.
And of course, seek medical attention if your child with the flu is showing signs of a severe case of the flu, such as trouble breathing, dehydration, or being inconsolable, etc.
You should also seek medical attention if your child with the flu was getting better, but then starts to get worse again, with a return of fever, worsening cough, or severe headache, etc.
When in doubt, call your pediatrician!
What to Know About Protecting Kids from the Flu
In addition to avoiding people who are sick with the flu, see your pediatrician as soon as possible if your younger, high risk child is gets sick after being exposed to someone with the flu.
The “right to choose” is being pushed by anti-vaccine groups in many states because they think that laws mandating kids to have vaccines to go to daycare, school, and college violates their parental rights and civil liberties.
“Their claim that vaccines are 100% safe and effective for all people all of the time is not based in science and is not supported by facts or evidence, making it more of a religious belief than an adequate basis for their mandate argument.”
Texans for Vaccine Choice
And of course, they use a lot of anti-vaccine talking points to try and scare parents into believing them. Vaccines are safe and they work, but no one says that they are 100% safe or that they are 100% effective.
What Is Vaccine Choice?
Right away, you should see another big problem with the vaccine choice movement.
No one is forcing anyone to get vaccinated. Everyone has a choice. It’s just that some folks don’t like the consequences that come with that choice of not vaccinating their kids – having to home school their kids instead of going to a public or private school.
In addition to facts, one big thing that is missing from the vaccine choice argument is that by pushing the idea that unvaccinated kids should be allowed to skip or delay any or all vaccines without consequences, that takes away the choice for the rest of us who want to keep our kids protected from vaccine-preventable diseases.
Can’t we just vaccinate our kids?
But that doesn’t take away all of the risk if you don’t vaccinate your kids.
“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”
Medical Advisory Committee of the Immune Deficiency Foundation
There are kids who are too young to be vaccinated or fully vaccinated, kids who can’t be vaccinated because of true medical vaccine exemptions, and folks whose vaccine didn’t work, after all, vaccines aren’t 100% effective.
The “choice” folks don’t talk about those things though.
Make an informed choice about vaccines before you think about leaving your child unvaccinated and unprotected.
What To Know About Vaccine Choice
Listen to anti-vaccine propaganda, skip or delay vaccines and leave your kids unprotected or do your research and understand that vaccines work and are safe and necessary and get them vaccinated and protected – that’s your vaccine choice.
And if you had to rank vaccines from safest to most dangerous, then yes, you could say that the original smallpox vaccine, the one with the most side effects, is the most dangerous.
Fortunately, that very same smallpox vaccine helped eradicate smallpox and few of us need to even think about getting a smallpox vaccine. It is still given to some folks in the military though and is available if necessary.
The story was about a plan to vaccinate many more people, including hospital workers. At the time, there was a worry about terrorist attacks using smallpox.
“Here’s another way to do it. We can make the vaccine. Make sure we understand who’s going to get it, who’s going to be giving it. Then wait, wait for there to be one case of documented smallpox somewhere on the face of this earth and then we can move into vaccinating people, large numbers of people.”
Paul Offit, MD
Not everyone was on board with the plan though. Dr. Offit, for one, didn’t think that it was a good idea to start vaccinating people for a threat that we didn’t know would appear, especially since the older smallpox vaccine had more side effects than other, more modern vaccines.
Again, that doesn’t mean that the smallpox vaccine is dangerous.
Smallpox is dangerous and deadly. If there is a risk that you could get smallpox, then you would much rather have the smallpox vaccine, even with its side effect profile.
And fortunately, a new attenuated smallpox vaccine, Imvamune, is also available and has less side effects. Two other smallpox vaccines, ACAM2000 and APSV, which are similar to the original DryVax vaccine that was used in the US, are also still being used until Imvamune is formally approved by the FDA.
“…it is important to recognise that the balance of media reporting does not necessarily reflect the balance of the argument among the involved professionals – by this is meant that equal weighting might be given by the media (and thus the lay community) to those for and against the vaccine although opponents of vaccination might be a very small number, as for example happened with both pertussis and MMR.”
David Baxter on Opposition to Vaccination and Immunisation the UK Experience – from Smallpox to MMR
understand the hierarchy of evidence and that a small study done in mice or a case report is probably not newsworthy, whereas a systemic review or meta analyses, especially if it was published in a high impact journal, is something we might need to hear about
Are you ready to cover your next story about vaccines or the next measles outbreak?
What to Know About Reporting on Vaccines
The way that health journalists cover vaccines and vaccine-preventable disease outbreaks can influence the behavior of people, either helping them understand that vaccines are safe and necessary, putting them on-the-fence about vaccines, or scarring them away from getting vaccinated and protected.
“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”
CDC on Transmission of Measles
Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.
“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”
CDC on Mumps Outbreak-Related Questions and Answers for Patients
How do you get mumps?
Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:
cough or sneeze
use a cup or eating utensil that you then use
touch an object or surface that you then touch (fomites)
And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.
“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”
CDC on Mumps for Healthcare Providers
The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.
Is Your Child Protected Against the Mumps?
The MMR vaccine protects us against mumps – and measles and rubella.
One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.
Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.
“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”
CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices
And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.
What to Do If Your Unvaccinated Child Is Exposed to Mumps
To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.
“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”
Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.
“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”
Manual for the Surveillance of Vaccine-Preventable Diseases
Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.
If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.
It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!
What to Do If Your Vaccinated Child Is Exposed to Mumps
If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?
Again, it depends on what you mean by fully vaccinated.
It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?
And is your child fully vaccinated for his age or has he had two doses of MMR?
Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.
“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”
Ask the Experts about MMR
In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.
And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.
An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.
“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”
Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak
This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.
You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.
Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.
What to Know About Getting Exposed to Mumps
Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.
Dr. Taz is on a mission “to transform the way we do medicine and empower and equip you with the best tools so you can live your healthiest life.”
While that sounds very nice, it doesn’t take too long to figure out that she seems like every other anti-vaccine quack we run across these days.
Who Is Dr. Taz?
Dr. Tasneem Bhatia MD (Dr. Taz) describes herself as a nationally recognized “wellness expert” who became a “pioneer and trailblazer” after overcoming her own personal health problems.
With multiple office locations and membership packages, Dr. Taz is pleased to offer many non-evidenced based services for you and your child, and she will even file your claim forms from your insurance company, although, as expected, she doesn’t actually participate in any insurance plans.
What about vaccines?
“My journey in medicine began with pediatrics, so I am well aware of the importance of vaccines and the incredible history and success of vaccination programs in reducing infant and child mortality.
Yet as my journey continues, I have had to listen to patient after patient describe a change or a shifting in their children once vaccines were administered. I experienced this as a parent. I will never forget the day that my son received a combination vaccine. Within 24 hrs., his mild reflux became severe, his weight gain over the next few months slowed and we continue to play catch up, trying to analyze our next steps. My son, however, is not autistic. He is brilliant, hilarious, and an absolute charmer.
My patients and my own children have forced me to rethink this vaccine controversy.”
Dr. Taz on Back to School Survival Series Part Two, The Vaccine Debate Continues
And parents can get a detox screen “which will directly correlate with your child’s early ability to detox and process chemicals.” That’s probably just MTHFR testing, which you don’t need and which doesn’t correlate with much of anything, besides homocystinuria.
Now, I understand that these types of holistic docs push the idea of “pulling from conventional, integrative, holistic, functional and Chinese medicine to create the best customized treatment plans possible,” but if any of these alternative therapies worked, whether it was acupuncture or Ayurveda, or homeopathy, then why do they need to integrate them all?
So what services does Dr. Bhatia offer to bring her patients to “whole health”? It’s a veritable cornucopia of quackery. Homeopathy? Check. Acupuncture? Check. (Obviously.) IV vitamin therapy? Check. Oh, and of course Dr. Bhatia offers thermograms. She even offers mobile thermograms. Never mind that thermography remains an unvalidated test for the early detection of breast cancer, much less for all the other conditions for which Dr. Bhatia recommends it, such as arthritis, fibromyalgia, back injuries, digestive disorders, “and more…”
A commercial for acupuncture masquerading as news
And how does someone go from teaching medical students and residents at Emory University to being one of Gwyneth Paltrow’s Goop experts, along with Kelly Brogan?