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.
We often focus on what vaccines a baby will need once they are born, but it is also important that folks around your new baby get vaccinated too.
What Shots Do You Need to Be Around a Newborn?
Of course, all of your vaccines should be up-to-date, especially if you plan to be around young kids. That’s how we maintain herd immunity levels of protection for those who can’t be vaccinated and protected, including newborns who are too young to be vaccinated.
In addition to routine vaccines, it is especially important that teens and adults who are going to be around a newborn or younger infant have:
a dose of Tdap – now routinely given to kids when they are 11 to 12 years old and to women during each pregnancy (to protect newborns against pertussis), others should get a dose if they have never had one. There are currently no recommendations for a booster dose.
a flu shot – is it flu season? Then anyone who is going to be around your baby should have had a flu shot. And for the purposes of keeping a newborn safe from the flu, you can assume that flu season extends from September through May, or anytime that flu shots are still available.
Only two shots?
Yes, only two shots assuming you are either immune or are up-to-date on your other vaccines. If you have been delaying or skipping any vaccines, then you might need an MMR, the chicken pox vaccine, and whatever else you are missing.
Just because everyone is vaccinated and protected, that doesn’t mean that you should have a party welcoming your baby home and invite everyone in the neighborhood. Besides the flu, we get concerned about other cold and flu-like viruses, especially RSV.
That means to protect them, you should keep your baby away from:
large crowds, or even small crowds for that matter – in general, the more people that your baby is exposed to, the higher the chance that they will catch something
people who are sick
cigarette smoke – second hand smoke increases the risk of infections, like RSV
And make sure everyone, even if they don’t seem sick, washes their hands well before handling your baby.
“Parents or relatives with cold sores should be especially careful not to kiss babies—their immune systems are not well developed until after about 6 months old.”
AAP on Cold Sores in Children: About the Herpes Simplex Virus
Because you can sometimes be contagious even if you don’t have an active cold sore (fever blister), some parents don’t let anyone kiss their baby. Most of this fear comes after news reports of babies getting severe or life-threatening herpes infections after a probable kiss from a family member or friend.
When Can I Take My Newborn Out in Public?
When can you take your baby out in public? Most people try to wait until they are at least two months old.
Not really, as your baby won’t really be protected until they complete the primary series of infant vaccinations at six months.
Two months is a good general rule though, because by that age, if your baby gets a cold virus and a fever, it won’t necessarily mean a big work-up and a lot of testing. Before about six weeks, babies routinely get a lot of testing to figure out why they have a fever (the septic workup), even if it might be caused by a virus. That’s because younger infants are at risk for sepsis, UTI’s, and meningitis and they often have few signs when they are sick.
Keep in mind that going out in public is much different from going out. You can go for a walk with your baby at almost any time, as long as they are protected from the sun, bugs, and wind, etc., as long as there aren’t people around.
What to Know About Protecting Newborn Babies
Protect your baby by making sure everyone around them is vaccinated and protected, especially with a dose of Tdap and the flu vaccine.
People with Guillain-Barré syndrome develop the rapid onset of muscle weakness and then paralysis. They may also have numbness and a loss of reflexes.
Unlike some other conditions that cause weakness and paralysis, GBS is a symmetrical, ascending paralysis – it starts in your toes and fingers and moves up your legs and arms.
What Causes Guillain-Barré Syndrome?
GBS is an autoimmune disorder and often starts after a viral or bacterial infection, especially one that causes diarrhea or a respiratory illness.
One of the biggest risk factors is a previous Campylobacter jejuni infection, that is often linked to drinking raw milk, eating undercooked food, drinking untreated water, or from contact with the pet feces.
In less half of cases, no specific cause is found.
Fortunately, although progress can be slow, many people with GBS recover.
“On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.”
CDC on Guillain-Barré syndrome and Flu Vaccine
It is not common though.
For example, the increased risk of GBS after getting a flu vaccine is thought to be on the order of about one in a million – in adults.
Flu vaccines have not been shown to cause GBS in children.
“The risk of GBS is 4–7 times higher after influenza infection than after influenza vaccine. The risk of getting GBS after influenza vaccine is rare enough that it cannot be accurately measured, but a risk as high as one case of GBS per 1 million doses of flu vaccine cannot be reliably excluded.”
Poland et al on Influenza vaccine, Guillain–Barré syndrome, and chasing zero
It is also important to keep in mind that you are far more likely to get GBS after a natural flu infection than after the vaccine, plus the flu vaccine has many other benefits.
What about other vaccines?
“In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.”
Baxter et al on Lack of association of Guillain-Barré syndrome with vaccinations
No other vaccines that are currently being used routinely have been associated with Guillain-Barré syndrome.
In fact, many studies do not even find an association between GBS and the flu vaccine.
What to Know About Guillain-Barré Syndrome and Vaccines
Guillain-Barré Syndrome may be associated with the flu vaccine in adults in about 1 in a million cases, but does not occur with any other vaccines, and occurs far more commonly after a natural flu infection.
Is this going to be the worst flu season in history?
That certainly seems to be how the media is playing it.
Have you read any of these articles?
California’s deadly flu season could be worst in a decade
Defending against this season’s deadly flu: 5 things to know
The CDC says this year’s flu may reach ‘epidemic’ proportions
Worst of deadly flu season may still be to come, Dallas County officials say
Texas Is Suffering Through its Worst Flu Outbreak in Decades
Hospital Overrun By Flu Cases Having To Turn Them Away
Get ready, some medical experts are predicting the worst flu season in history
Worst flu season in history? Really?
Flu Season Hazard
Flu season can be deadly.
That’s not hype.
That’s why every one should get a flu shot each year.
Early flu seasons can be bad.
Why? They overlap with RSV season. That means that everyone is sick at the same time with bronchiolitis, croup, colds, and the flu.
They are especially bad because many people haven’t taken the time to get their flu shot yet.
And an H3N2-predominant flu season can be especially bad. In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.” H3N2 virus strains drift easily, so that flu vaccines are less effective.
Flu Season Hype
Right off the bat, one big problem with most of these headlines, and the way that this year’s flu season is being hyped, is folks going out of their way to use the word “deadly” every chance they can.
Every flu season is deadly!
And guess what?
Flu season reaches “epidemic proportions” each and every year!
“The United States experiences epidemics of seasonal flu each year. This time of year is called flu season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
And we get to the point, in many cities, where a hospital fills up for a few days and has to turn away flu cases. It happens with RSV too. Its called a “code Yellow” in some hospitals.
The biggest problem with the current news coverage though, is that there hasn’t been much evidence that this is going to be the worst flu season that we have seen, although it is starting to live up to some of the hype.
“The Centers for Disease Control and Prevention says flu season runs from about September to May. Most years in Texas, a number called the ILI percentage — the number of patients doctors see with flu-like symptoms — checks in at about 2 percent or 3 percent during the offseason and crests to about 6 percent during the worst of the flu season. This year, according to a model developed by a Carnegie Mellon University team led by Roni Rosenfeld, Texas’ ILI percentage has already risen above 13 percent.”
“This is really record-breaking. In the last 20 years [the estimated number of people presenting flu symptoms] hasn’t reached that height,” Rosenfeld says. “It’s the highest it’s been this early in the season, and it’s the highest it’s been period.”
Dallas Observer on Texas Is Suffering Through its Worst Flu Outbreak in Decades
Do you know what is wrong with that report in the Dallas Observer?
It misses that the ILI percentage was above 14% in Texas during the 2014-15 flu season too! So no records were being broken.
The ILI percentage was actually between 10 to just over 14% for three out of four years recently.
Will hyping the flu to make it sound even more dangerous scare folks into getting a flu shot?
An important take away from their first story? It actually reported on a lower hospitalization rate (at the time, it has since increased) this year than the 2014-15 flu season.
Why is the 2014-15 flu season important?
For one thing, looking at real data and not just trying to scare folks, we can say that this year’s flu season has looked a lot like the 2014-15 flu season. That was also an H3N2-predominant flu season that got off to an early start, but tragically, ended up killing at least 148 children.
I’m sure that few people remember, but the 2014-15 flu season looked a lot like another H3N2-predominant flu season – the 2012-13 flu season. That year, we also got off to an early start and again, tragically, we ended up with 171 pediatric flu deaths.
So, is this going to be a bad flu season?
Is there ever a good flu season?
“This season now looking like the 2014-15 season where H3N2 predominated.”
Dan Jernigan, MD, MPH Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases
It’s hard to predict, but the odds are strongly against this being the worst flu season in history.
This year’s flu season is starting to live up to some of the hype though.
“The overall hospitalization rate is higher than the overall hospitalization rate reported during the same week of the 2014-2015 season; the most severe season in recent years.”
CDC Influenza Situation Update
On the other hand, fewer pediatric flu deaths have been reported so far (84 pediatric deaths) this year than at the same point in the 2014-15 (86 pediatric deaths) flu season.
And ILI has finally peaked (hopefully).
At 7.5%, it is the highest we have seen since the 2009 pandemic.
“The majority of the influenza viruses collected from the United States during October 1, 2017 through February 10, 2018 were characterized antigenically and genetically as being similar to the cell-grown reference viruses representing the 2017–18 Northern Hemisphere influenza vaccine viruses.”
CDC Situation Update: Summary of Weekly FluView Report
And we don’t have a mismatched flu strain or a strain that has drifted to be concerned about.
That doesn’t mean that the flu vaccine is going to work perfectly, by any means, but initial reports are that this year’s flu vaccine is much more effective than expected.
The best news, besides a very good supply of flu vaccines and anti-viral medicines, like Tamiflu, this year?
We saw the same H3N2 strain in the United States last year. Although that might not guarantee immunity if you had the flu last year, it should offer some protection against severe disease.
Also, we have some new flu vaccines, including the cell-based vaccine, Flucelvax, and high dose flu shots and flu shots with adjuvants for adults 65 years of age and older.
Still, like most H3N2-predominant flu seasons, it will at best be a moderately severe flu season.
Worst ever? That’s doubtful.
Ignore the hype, but don’t ignore the advice to get vaccinated and protected against the flu. It’s never too late to get a flu shot. Even with an early start, flu season will continue into the spring.
What to Know About Flu Season Hype or Hazard
Like other H3N2-predominant flu seasons, this year’s flu season will be moderately-severe, but warnings that it could be the worst flu season ever are likely just hype.
reduce the risk of flu-associated death in children with underlying high-risk medical conditions by just over half (51%)
reduce the risk of flu-associated death in healthy children by just over two thirds (65%) – this is important, because despite what most people believe, many of the kids who die with the flu each year don’t have any underlying health problems
reduce how sick you get, even if you do get the flu, reducing “deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.”
reduce the risk of the babies getting hospitalized in their first 6 months when pregnant moms got a flu shot
reduce asthma attacks leading to emergency visits and/or hospitalizations in people with asthma
Getting vaccinated can also reduce the risk that you get sick with the flu and get someone else sick.
Considering all of these benefits, it is hard to imagine why anyone wouldn’t get a flu shot, even in year’s when it might just be 60% or even 40% effective.
I mean, it isn’t like the flu shot is actually going to give you the flu or anything…
Have you gotten your flu shot yet this flu season?
What to Know About the Benefits of the Flu Shot
In addition to helping you avoid getting sick with the flu, getting a yearly flu shot has many other indirect benefits, so that even if you get the flu, it can help you avoid getting really sick and ending up in the hospital, ICU, or getting so sick that you don’t survive.
“The vaccine effectiveness of seasonal influenza vaccines is a measure of how well the seasonal influenza vaccine prevents influenza virus infection in the general population during a given influenza season.”
WHO on Vaccine effectiveness estimates for seasonal influenza vaccines
Is the flu virus that is going around the same strain that was picked to be in the flu vaccine?
Has the flu virus drifted, even if it is the same strain that is in the flu vaccine, becoming different enough that your protective flu antibodies won’t recognize it?
Is the H3N2 strain of flu virus the predominate strain during the flu season? H3N2 predominant flu seasons are thought to be worse than others.
In general, the flu vaccine is going to be less effective in a season where there is a poor match between the circulating strain of flu virus that is getting people sick and the strain that is in the flu vaccine, especially if it is an H3N2 strain that has drifted.
Unfortunately, we usually don’t know the answer to that last question until this year’s flu season really gets going.
What about reports that the flu vaccine effectiveness will be as low as 10% this year?
It is important to note that those reports are not based on flu activity in the United States and it has been a long time since we have seen flu vaccine effectiveness that low – the 2004-05 flu season. That was the year that because of a drifted A(H3N2) virus, “only 5% of viruses from study participants were well matched to vaccine strains.”
The 10% number is instead based on reports of Australia’s flu season, in which early estimates found that the A(H3N2) component of the flu vaccine was only 10% effective. Importantly, the overall vaccine effectiveness was much higher. Including other strains, the flu vaccine in Australia was at least 33% effective this past year.
“In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.”
CDC on Influenza Prevention: Information for Travelers
Couldn’t we see a drifted A(H3N2) virus this year?
Sure, especially since an A(H3N2) virus will likely be the dominant strain, but so far “data indicate that currently circulating viruses have not undergone significant antigenic drift.”
“It is difficult to predict which influenza viruses will predominate in the 2017–18 influenza season; however, in recent past seasons in which A(H3N2) viruses predominated, hospitalizations and deaths were more common, and the effectiveness of the vaccine was lower.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
Again, it is too early to predict how effective the flu vaccine will be, but based on an undrifted H3N2 virus that is matched to the vaccine, you might expect an effectiveness between 30 to 40%.
It might be less if theories about egg-adapted mutations are true and are a factor this year.
“…some currently circulating A(H3N2) viruses are less similar to egg-adapted viruses used for production of the majority of U.S. influenza vaccines.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
It is also important to keep in mind that vaccine effectiveness numbers from Australia and the United States don’t always match up.
For example, in 2009, Australia reported an interim flu vaccine effectiveness of just 9%, but in the United States, the flu vaccine ended up being 56% effective! On the other hand, in 2014, the flu vaccine worked fairly well in Australia, but vaccine effectiveness was found to be just 19% in the United States.
Vaccine Effectiveness by Year
What does all of this mean?
“This season’s flu vaccine includes the same H3N2 vaccine component as last season, and most circulating H3N2 viruses that have been tested in the United States this season are still similar to the H3N2 vaccine virus. Based on this data, CDC believes U.S. VE estimates from last season are likely to be a better predictor of the flu vaccine benefits to expect this season against circulating H3N2 viruses in the United States. This is assuming minimal change to circulating H3N2 viruses. However, because it is early in the season, CDC flu experts cannot predict which flu viruses will predominate. Estimates of the flu vaccine’s effectiveness against circulating flu viruses in the United States will be available later in the season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
The reports about what happened in Australia should not have made headlines beyond Australia.
Folks should have waited for the yearly report on flu vaccine effectiveness from the CDC, which usually comes out in the middle of February. This year, that report states that:
the overall adjusted vaccine effectiveness against influenza A and influenza B virus infection associated with medically attended acute respiratory illness was 36%
vaccine effectiveness was estimated to be 25% against illness caused by influenza A(H3N2) virus, 67% against A(H1N1)pdm09 viruses, and 42% against influenza B viruses
the flu vaccine offered statistically significant protection against medically attended influenza among adults aged 18–49 years with an adjusted vaccine effectiveness of 33%
What about kids?
“…among children aged 6 months through 8 years, the interim estimates against any influenza and A(H3N2) virus infection were higher; the risk for A(H3N2) associated medically-attended influenza illness was reduced by more than half (59%) among vaccinated children. Also, with interim VE estimates of 67% and 42% against influenza A(H1N1)pdm09 and B viruses, respectively, vaccination provided substantial protection against circulating A(H1N1)pdm09 viruses, as well as moderate protection against influenza B viruses predominantly belonging to the B/Yamagata lineage, the second influenza type B component included in quadrivalent vaccines.”
CDC on Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness — United States, February 2018
So the flu vaccine ended up being a lot more effective than folks predicted, especially in younger, higher risk kids, although it is still far from perfect.
Unfortunately, this year’s flu vaccine was not effective at preventing medically-attended influenza illness (flu case that sends you to see a doctor) for the 9 to 17 year old age group for some reason. That’s still not a good reason to skip the flu vaccine if your child hasn’t had it though, as the flu vaccine might still work to help your child, even if doesn’t fully prevent a case of the flu.
And while it isn’t perfect, getting a flu vaccine is certainly better than remaining unprotected and simply taking your chances that you won’t get the flu and complications from the flu.
What to Know About Flu Vaccine Effectiveness
Although the effectiveness of the flu vaccine varies from year to year, depending on how well matched the vaccine is to circulating flu virus strains, which strains are dominant, and whether they have drifted, it is always a good idea to get vaccinated and protected.