The return of FluMist has hit a slight snag.
Most folks will remember that 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. So it will be available for this year’s flu season.
Many parents and pediatricians welcomed the news, as it meant that many kids could avoid getting a shot and could get the nasal spray flu vaccine instead.
It was especially good news for those kids who skipped getting a flu vaccine because they didn’t want to get a shot when Flumist wasn’t available.
Flumist as a Last Resort?
So what’s the problem?
“The Academy recommends pediatricians give children inactivated influenza vaccine in the upcoming season and use live attenuated vaccine only as a last resort.”
American Academy of Pediatrics
Members of the AAP Committee on Infectious Diseases (COID) are concerned that FluMist, even after it has been changed to address previous issues, may not work as well as a standard flu shot.
“Influenza is unpredictable from year to year, so we really want to immunize as many kids as we can against the flu with what we think will be the most effective product. That’s why we’re recommending the flu shot this coming season.”
Henry H. Bernstein, D.O., M.H.C.M., FAAP
While many of us were surprised by the “last resort” phrasing from the AAP, maybe we shouldn’t have been.
In addition to being an ex officio member of the AAP Committee on Infectious Diseases (COID), Henry H. Bernstein was one of only two members of the ACIP who voted against bringing FluMist back, going against the opinion of twelve other members who voted in favor of FluMist.
Dr. Henry H. Bernstein is also the “leading voice on AAP’s annual policy statement on preventing flu in children with flu vaccines.”
“The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all,” said Flor Munoz, MD, FAAP, member of the AAP Committee on Infectious Diseases. “If you get the nasal spray vaccine, just be aware that, depending on the performance of the new vaccine formulation, there might be a chance you will not be fully protected against H1N1 strains of flu. The efficacy of this new formulation has not yet been determined.”
It is important to note that the AAP is not saying that Flumist won’t work though.
“The effectiveness of this new formulation of LAIV4 has not been confirmed, since A/H1N1 virus has not widely circulated recently.”
AAP influenza immunization recommendations revised for 2018-’19 season
They are basically saying that if the reformulated version of Flumist doesn’t work as it is predicted to work, then your kids might not be protected. They are concerned that we haven’t seen the new version of Flumist work in real world studies against the H1N1 strain of the flu.
Flumist Is Not Just a Last Resort
Fortunately, the AAP has somewhat rephrased their message about Flumist (LAIV4). While they still recommend that the inactivated influenza vaccine (flu shots) be the primary choice for children, they now say that:
“LAIV4 may be offered for children who would not otherwise receive an influenza vaccine (and for whom it is appropriate by age and health status).”
AAP influenza immunization recommendations revised for 2018-’19 season
Importantly though, parents and pediatricians should note that the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2018–19 flu season very clearly make no preferential recommendation for the use of any influenza vaccine product over another.
“Following two seasons (2016–17 and 2017–18) during which ACIP recommended that LAIV4 not be used, for the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
And the ACIP and CDC aren’t the only ones who disagree with the AAP’s decision.
“So I think the AAP was wrong, frankly, to say that FluMist should only be used as a last-resort vaccine for influenza. Rather, they should have gone along with what the ACIP said, which was that these vaccines can now be used interchangeably for persons aged 2-49 years.”
Paul Offit, MD on FluMist: Reasonable Vaccine Option or ‘Last Resort’ for the Upcoming Flu Season?
So what should you do?
If it is going to be a battle getting your kids a flu shot and you might you might have even skipped it the last few years because Flumist wasn’t available, then your choice is very clear.
Get vaccinated with Flumist, as long as your child is at least two years old and otherwise meets the requirements.
And don’t feel bad or worried that your decision is leaving your child unprotected. Remember that Flumist is recommended by the ACIP and CDC and has been used continuously in most other countries (under the name Fluenz).
Your next battle might simply be finding Flumist. Because of the AAP’s “last resort” comment, some pediatricians didn’t even bother ordering any doses.
More on the Latest Flumist Recommendations
- FluMist: Reasonable Vaccine Option or ‘Last Resort’ for the Upcoming Flu Season?
- Which flu vaccine should kids get? CDC, AAP disagree
- CDC vaccine panel brings back FluMist for 2018-19 season
- CDC – Flumist
- MMWR – Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
- CDC – Flu Vaccination Coverage, United States, 2016-17 Influenza Season
- CDC – National Early-Season Flu Vaccination Coverage, United States, November 2017
- AAP – Give children IIV flu shot; use LAIV as last resort
- AAP – AAP influenza immunization recommendations revised for 2018-’19 season
- Flu Fighter: Hank Bernstein
- FDA Information Regarding FluMist Quadrivalent Vaccine
- Influenza ACIP Vaccine Recommendations
- FDA – FluMist Quadrivalent
- Study – Live attenuated influenza vaccine (LAIV): recent effectiveness results from the USA and implications for LAIV programmes elsewhere.
- WHO – Meeting on Live Attenuated Influenza Vaccine Effectiveness
- Study – Live Attenuated Influenza Vaccine contains Substantial and Unexpected Amounts of Defective Viral Genomic RNA
- Genetic Mutation Could, If Altered, Boost FluMist Vaccine’s Effectiveness, Research Suggests
- Review – Perspectives from the Society for Pediatric Research: Decreased Effectiveness of the Live Attenuated Influenza Vaccine
- Study – Vaccine failure and serologic response to live attenuated and inactivated influenza vaccines in children during the 2013–2014 season
- Study – Differential gene expression elicited by children in response to the 2015–16 live attenuated versus inactivated influenza vaccine
- Study Says FluMist Vaccine Does Indeed Work, Contradicting CDC