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FluMist Vs. Flu Shots for Kids and Adults

While getting a flu vaccine each and every year is not a question for most of us, it is becoming more common to ask if it should a flu shot or FluMist, the nasal spray flu vaccine.

Of course we are vaccinating and protecting our kids and ourselves against the flu.
Of course we are vaccinating and protecting our kids and ourselves against the flu.

What would you prefer?

FluMist Facts

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 because it was found to be less effective than flu shots against the H1N1 strain of flu.

Interestingly, studies in other countries, including Finland and the UK showed that FluMist was effective. Still, MedImmune, the company that makes FluMist, replaced the H1N1 seed virus it uses to make the vaccine, and preliminary testing showed that it to be more effective.

That’s why it became available again during the 2018-19 flu season.

And that’s why more and more people are now using it.

“For some intranasal vaccine recipients, rapid influenza-antigen detection tests yield positive results within 1 week after vaccination.”

Ali et al on Detection of Influenza Antigen with Rapid Antibody-Based Tests after Intranasal Influenza Vaccination (FluMist)

One thing to remember after getting FluMist though, it can cause a false positive on a flu test, at least in the week after being vaccinated.

“To minimize the potential risk for interference, injectable or nasally administered live vaccines not administered on the same day should be administered ≥4 weeks apart (Table 3). If injectable or nasally administered live vaccines are separated by <4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated. The repeat dose should be administered ≥4 weeks after the last invalid dose.”

General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Also remember that live vaccines can interfere with each other if they aren’t given on the same day, so make sure at least 4 weeks have passed if someone is getting FluMist and another live vaccine, like MMR, chickenpox, ProQuad, or yellow fever.

FluMist Vs. Flu Shots for Your Kids

So what goes into your decision on which to choose?

FluMist had been a good option for kids who don't want to get a flu shot every year.
FluMist had been a good option for kids who don’t want to get a flu shot every year. Photo by Vincent Iannelli, MD

Initially, when it was first approved in 2003, one selling point for FluMist was that it was thimerosal free. At the time though, the majority of flu shots still contained thimerosal. Now however, most flu shots are thimerosal-free. In fact, we have over 168 million doses of thimerosal-free or preservative-free flu vaccine this year. So while FluMist is thimerosal-free, so are most flu shots.

What about the price? In general, FluMist is still going to be a little bit more expensive than a flu shot if you have to pay cash, but if you have insurance that covers vaccines, either should be covered without a copay.

Should you be concerned that FluMist is a live virus vaccine? FluMist contains attenuated viral strains of the flu that are temperature-sensitive, so unless you are going to have close contact with someone who is severely immunocompromised in a protected environment, you don’t have to worry about shedding.

Does your child have any contraindications (do not give) to getting FluMist?

  • Children younger than 2 years
  • Children 2 years through 17 years old who are receiving aspirin- or salicylate-containing medications, because of the potential risk for Reye syndrome
  • Children 2 years through 4 years old who have asthma or who have had a history of wheezing in the past 12 months
  • Children and adults who are immunocompromised due to any cause, including but not limited to immunosuppression caused by medications, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (such as that due to sickle cell anemia)
  • Close contacts and caregivers of severely immunosuppressed persons who require a protected environment (or get FluMist and avoid contact with those persons for 7 days after getting the nasal spray vaccine)
  • Persons with active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak
  • Persons with cochlear implants, because of the potential for CSF leak, which might exist for some period after implantation
  • Receipt of influenza antiviral medication within the previous 48 hours for oseltamivir and zanamivir, previous 5 days for peramivir, and previous 17 days for baloxavir (as a live virus vaccine, taking an anti-viral medication might interfere with how the vaccine works)
  • Pregnant women

Or precautions (might give if benefit outweighs risk)?

  • Other underlying medical condition that might predispose to complications after wild-type influenza virus infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])
  • Asthma in persons aged ≥5 years
  • Moderate or severe acute illness with or without fever
  • History of GBS within 6 weeks of receipt of any influenza vaccine

While it is not an official precaution or contraindication, there is something else that can get in the way of your child getting FluMist.

“…if nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness, or another appropriate vaccine should be administered instead.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season

If your child is very congested because of a cold or allergies, then a flu shot might be a better idea than a dose of FluMist.

“No preference is expressed for any one vaccine type.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season

For other kids without any contraindications, especially if they aren’t looking forward to a shot, ask your health care provider about FluMist.

FluMist Vs. Flu Shots for Adults

Although we typically hear about FluMist being used with kids, it is important to remember that it is licensed for people between the ages of 2 through 49 years.

“Because of limited use, there have been no effectiveness estimates in the United States since LAIV was recommended again in the 2018-2019 influenza season. Data from other countries have demonstrated protection from LAIV to be similar to that of standard-dose, egg-based inactivated flu vaccine in children.”

Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine)

If you don’t have any contraindications, do want to get a flu vaccine, but don’t want a flu shot, then consider FluMist.

Most importantly, get vaccinated and protected against the flu.

“You watch,” Gallo says. “People who get the live flu vaccine will also be protected against the COVID-19. That’s the hypothesis.”

Could The Live Flu Vaccine Help You Fight Off COVID-19?

And consider that some people are theorizing that live vaccines, such as FluMist, BCG, and the oral polio vaccine, might have a non-specific effect of helping you boost your immune system to fight off unrelated respiratory diseases, including COVID-19.

Even if it doesn’t, getting vaccinated against the flu will decrease your chances of getting and dying with the flu

More on FluMist

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