Tag: flu vaccines

Can You Really Get a Flu Shot If You Are Allergic to Eggs?

Are you still worried about your child’s egg allergy and getting them a flu vaccine?

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. Even kids with egg allergies. Photo by Gabriel Saldana (CC BY-SA 2.0)

That’s not surprising, as we once warned people about residual egg proteins in flu vaccines and the possibility of immediate hypersensitivity reactions in those with severe egg allergies.

Flu Vaccines and Egg Allergies

Of course, that advice has now changed, even though most flu vaccines are still prepared in chicken eggs.

“Recent studies have shown that even individuals with confirmed egg allergy can safely receive the flu vaccine. The Joint Task Force on Practice Parameters of the American Academy of Allergy Asthma and Immunology and the American College of Allergy Asthma and Immunology as well as the American Academy of Pediatrics state that no special precautions are required for the administration of influenza vaccine to egg-allergic patients no matter how severe the egg allergy.”

Egg Allergy and the Flu Vaccine

In fact, it began to change in 2011, when we got the recommendation that it was okay to give flu shots to people with egg allergies, if they only get hives as their reaction. It was still recommended that those with more severe allergic reactions to eggs “be referred to a physician with expertise in the management of allergic conditions for further risk assessment before receipt of vaccine.”

Before that, we would sometimes do skin testing on high risk egg allergic kids, desensitization, or regular chemoprophylaxis.

In 2013, the recommendation changed so that those with severe allergic reactions to eggs should get their flu shot “by a physician with experience in the recognition and management of severe allergic conditions.”

The recommendations were again modified in 2016, removing the recommendation that egg-allergic flu vaccine recipients be observed for 30 minutes and that those with severe egg allergies “should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.”

Why the changing advice?

It’s because severe allergic reactions to vaccine are rare (in a million doses rare). And even in the flu vaccines that still use eggs, almost all of the egg protein is removed from the final vaccine. So that residual amount of egg protein is unlikely to trigger an allergic reaction. And that’s what we saw as the recommendations were slowly changed year after year.

Getting a Flu Shot When You Are Allergic to Eggs

And that’s why we have our current recommendations:

  • Those with a history of egg allergy who only get hives can get any age-appropriate flu vaccine.
  • Those with a history of egg allergy who have severe reactions, including angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or another emergency medical interventions, can still get any age-appropriate flu vaccine, but they should get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office). And the vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
  • Those who can eat eggs without reaction can get any age-appropriate flu vaccine.

Do you still have to be observed after getting your flu vaccine if you have an egg allergy?

No postvaccination observation period is recommended specifically for egg-allergic persons.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Nope. But that’s likely because although they are rare, reactions might not occur right away.

So yes, you can and you should get a flu vaccine if you are allergic to eggs.

More on Flu Vaccines and Egg Allergies

 

Which Flu Vaccine Should You Get?

After decades with a single type of flu vaccine – the flu shot – there are now many different kinds of flu vaccines that many of us can choose from. And your choices are not just between the nasal spray flu vaccine vs a flu shot. There are also a lot of different kinds of flu shots available now.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

Having choices is nice.

It would be also be nice to have a little more guidance on what to do with these choices.

Are any of the flu vaccines better than others?

Which Flu Vaccine Should You Get?

This year, we will have:

  • quadrivalent flu shots – Afluria, Fluarix, FluLaval, Fluzone, Fluzone Pediatric Dose
  • quadrivalent flu shots that are cell-culture based – Flucelvax
  • quadrivalent flu shots that can be given intradermally – Fluzone Intradermal
  • trivalent flu shots – Afluria
  • trivalent flu shots that are adjuvanted – Fluad
  • high dose trivalent flu shots – Fluzone High-Dose
  • quadrivalent flu shots that are made with recombinant technology – Flublok
  • nasal spray flu vaccine – Flumist

Which one should you get?

It is actually easy to start by asking which one you should get for your kids, as many of these flu vaccine options are only available for adults and seniors.

Flu Vaccine Options

Before you start thinking too long and hard about potential options, keep in mind that you might not have as many options as you think.

“Not all products are likely to be uniformly available in any practice setting or locality. Vaccination should not be delayed in order to obtain a specific product when an appropriate one is already available.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Doctors and clinics might not stock multiple brands or types of flu vaccines, so you might have to get whatever flu vaccine that they have available.

“Within these guidelines and approved indications, where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

And that’s okay. In most cases, there haven’t been head to head studies showing that one flu vaccine is better than another.

Flu Vaccine Options for Kids

Still, since these options might be available to you, it is good to know about them.

This year, younger kids, between the ages of 6 months and 3 years, can either get:

  • FluLaval Quadrilvalent
  • Fluarix Quadrivalent
  • Fluzone Quadrivalent Pediatric

While you are unlikely to notice a difference, both FluLaval and Fluarix are given at a 0.5ml dose containing 15 µg of HA per vaccine virus, while Fluzone is given at a 0.25ml dose containing 7.5 µg of HA per vaccine virus. Why the difference? “Safety and reactogenicity were similar between the two vaccines,” even at the different doses.

Basically, these are just different brands of the same type of flu shot.

There are even more options as your kids get older though, including  Fluzone Quadrivalent (age three and above), Afluria Quadrivalent or Trivalent (age five and above), Flucelvax Quadrivalent (age four and above), FluLaval and Fluarix.

Of these, some folks wonder if Flucelvax, since it isn’t made in chicken eggs, might be more effective than the others. Remember, one of the things that are thought to make the flu vaccine less effective than most other vaccines is that they are made in eggs, leading to mutations. And there is actually some evidence that those flu vaccines that are not made in eggs might be more effective.

“And the University of Pittsburgh Medical Center is taking that a step further, saying it will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. That’s because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.”

Guidance on which flu vaccine to get: Shots for kids, maybe go egg-free

Again, remember that the CDC has made “no preferential recommendation” for one flu vaccine over another. Why not? We don’t have enough information to make that kind of recommendation.

Should parents only ask for Flucelvax? That would only work if they made enough doses for every kid to get vaccinated, which they didn’t. Should you hold out until you can find FluceIvax for your kids? No, since doing that might leave them unvaccinated once flu season hits.

What else should you know about your flu vaccine options? While over 80% of flu vaccines are now thimerosal free, most of these flu vaccines are still available in multi-dose vials with thimerosal.

Also thimerosal free, this year, Flumist is back as an option. It is available for healthy kids who are at least two years old. Although the AAP has issued a preference for flu shots this year, the ACIP says that kids can get either Flumist or a flu shot.

What about if your kids are allergic to eggs?

“Persons who report having had reactions to egg involving symptoms other than urticaria (hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Unless they had a severe allergic reaction to a previous flu vaccine, they can get any available flu vaccine, especially if the previous reaction was only hives or they are able to eat eggs.

What if you want a flu vaccine without aluminum? Take your pick. While it would be safe it was, aluminum is not an ingredient in flu vaccines.

Flu Vaccine Options for Adults

In addition to all of the flu vaccines available for older kids, adults have a few more options:

  • Afluria Quadrivalent or Trivalent can be given by jet injector  to those between the ages of 18 and 64 years
  • Flublok Quadrivalent – a recombinant flu shot that can be given to those who are at least 19 years old
  • Fluzone High-Dose – a trivalent flu shot with a higher dose of flu virus antigens (4 times the amount of antigen as a regular flu shot) that is available for seniors who are at least 65 years old
  • Fluad – a trivalent flu shot with an adjuvant that is available for seniors who are at least 65 years old

Why get a flu vaccine with a jet injector instead of a standard needle? High-pressure jet injectors don’t use needles!

Like FluceIvax, Flublok is not made in chicken eggs. The recombinant hemagglutinin(HA) proteins are made in insect cell lines. Does Flublok work better than egg based flu vaccines? That’s the theory, but again, there is no preference for one of these vaccines over another.

Seniors have even more choices.

Should they get Fluzone High-Dose, Fluad, or one of the other flu vaccines? Both have been shown to be more effective than standard flu vaccines in seniors, but they have not been compared against each other.

“In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.”

CDC on People 65 Years and Older & Influenza

But neither Fluzone High-Dose nor Fluad are quadrivalent, so only protect against three flu virus strains.

Is there a quadrivalent flu shot for older adults that might work better than standard flu shots?

Yes. FluceIvax and Flublok are non-egg based quadrivalent flu shots that might be more effective than standard flu vaccines.

So are you more confused now that you know you have so many options? Just remember that for most people, the mistake isn’t about choosing the right flu vaccine, it is about not getting vaccinated.

What to Know About Your Flu Vaccine Options

While it might seem like you have a lot more options in a flu vaccine this year and that some might be more effective than others, keep in mind that availability will likely greatly limit these “options.”

And the best flu vaccine is the one that you actually get, as it will be the one that reduces your risk of getting the flu. Missing your chance to get vaccinated and protected because you are waiting for a specific brand or type of flu vaccine isn’t going to help keep the flu away.

More on Your Flu Vaccine Options

Can Flu Shots Cause the Flu?

Most folks get a flu shot each year.

Most, but not all.

Some people still think that getting a flu shot will cause them to have the flu.
Some people still think that getting a flu shot will cause them to have the flu.

Why do some people skip it?

Can Flu Shots Cause the Flu?

Yes, some people think that getting a flu shot will actually cause them to get the flu.

It’s not hard to see why though.

The flu vaccine is not the most effective vaccine we have, so it is certainly possible that you can still get sick with the flu even though you have had your flu vaccine. Of course, that’s not a good reason to skip getting a flu vaccine, as they have lots of benefits.

Some other reasons you might still think that the flu vaccine can cause the flu include that:

  • side effects after a flu shot can include a soreness, low-grade fever, headache and muscle aches, which some people might confuse with a mild case of the flu
  • many other respiratory viruses can make you sick during cold and flu season, none of which the flu vaccine protects you against
  • since the flu vaccine takes about two weeks to work, if you got sick shortly after being vaccinated, you may have already been exposed and developed the flu before the vaccine became effective

But why can’t the flu shot cause the flu?

That’s easy.

It’s because the flu shot is an inactivated vaccine. The influenza virus is killed or inactivated, the viral particles are purified and split up, with only the HA and NA surface glycoproteins remaining. Those glycoproteins can not cause a natural flu infection.

What about Flumist, the nasal spray flu vaccine?

While Flumist is a live virus vaccine, it is made with attenuated or weakened strains of the flu that are cold-adapted, unable to replicate at the warmer temperatures that are found in the lungs and other areas of our bodies.

So Flumist doesn’t cause the flu either.

Hopefully this is one vaccine myth that folks will stop spreading. Remember, flu vaccines don’t cause you to get sick with the flu. Get vaccinated. Flu vaccines are your best protection against the flu.

What about those folks who say that they are going to skip the flu shot because they never get sick with the flu?

They are gambling.

It is estimated that about 5 to 20% of people get the flu each year. Unless you are rarely around other people during flu season, the chances are that you will eventually get the flu, especially if you are unvaccinated and unprotected.

More on the Myth that Flu Shots Cause the Flu

When Should I Get My Flu Shot?

For most the folks, the real question isn’t if they should get a flu shot, but when.

When Should I Get My Flu Shot?

The original flu shot recommendations  were based on the fact that flu vaccine became available for distribution in September, but was not completed until December or January. And that high-risk folks should get vaccinated “to avoid missed opportunities for vaccination” if flu vaccine was available in September and they were already at a doctor’s appointment or in the hospital.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

But for most people, the original recommendation was really that “the optimal time for vaccination efforts is usually during October–November.”

“Persons and institutions planning substantial organized vaccination campaigns (e.g., health departments, occupational health clinics, and community vaccinators) should consider scheduling these events after at least mid-October because the availability of vaccine in any location cannot be ensured consistently in early fall. Scheduling campaigns after mid- October will minimize the need for cancellations because vaccine is unavailable.”

Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (2006)

What was the problem with this strategy?

Early flu seasons.

And trying to vaccinate over 100 million people in such a short time.

While it might work fine if flu season doesn’t hit until January or February, waiting until mid-October could leave a lot of folks unvaccinated if you had an early flu season that was peaking in November or December.

Fortunately, we don’t have to rush to get people vaccinated so quickly anymore. For one thing, manufacturers have gotten much better at distributing flu vaccine and are able to get a lot of the doses out at the very beginning of flu season. And with more manufacturers, we are seeing fewer delays and shortages of flu vaccine than we used to.

That’s why the recommendation on the timing of flu vaccination has changed over the years.

“In general, health-care providers should begin offering vaccination soon after vaccine becomes available and if possible by October. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health-care visits or during hospitalizations whenever vaccine is available.”

Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (2010)

That nice, simple message has changed yet again though.

To balance the concerns that getting a flu shot too early might leave you unprotected at the end of a late flu season, but getting a flu shot too late might leave you unprotected at the beginning of an early flu season, the latest recommendations from the CDC on the timing of flu vaccination aren’t so clear cut:

  • Balancing considerations regarding the unpredictability of timing of onset of the influenza season and concerns that vaccine-induced immunity might wane over the course of a season, it is recommended that vaccination should be offered by the end of October.
  • Community vaccination programs should balance maximizing likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after onset of influenza circulation occurs.
  • Revaccination later in the season of persons who have already been fully vaccinated is not recommended.
  • Vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available.
  • To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations.
  • Optimally, vaccination should occur before onset of influenza activity in the community.
  • Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons.

What’s the problem with these recommendations?

If everyone waits until the end of October to get vaccinated, then you might have a hard time getting a flu vaccine. And you might get stuck if you try and time your flu shot with the onset of flu activity. Unless you have a crystal ball, you don’t know when flu season is going to start.

Still, it is important to note that the CDC doesn’t actually say to wait until the end of October. They say to get vaccinated by the end of October. Getting your kids vaccinated as soon as you can is the best way to make sure that happens.

Could getting a flu shot early leave your kids unprotected at the very end of flu season?

Maybe, but that’s typically when flu activity is low. And we have that same type of low flu activity in early October, well before flu season peaks.

So just remember that your child could end up unvaccinated and unprotected if you mistime their flu vaccine.

What to Know About the Best Time to Get a Flu Vaccine

Experts say to get vaccinated by the end of October. Getting your kids vaccinated as soon as you can is the best way to make sure that happens.

More on the Best Time To Get a Flu Vaccine

Flumist Is Not Just a Last Resort

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.

Why did flu vaccine rates drop in younger school age kids when Flumist wasn't available?
Why did flu vaccine rates drop in younger school age kids when Flumist wasn’t available?

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

The Strategic Plan to Develop a Universal Influenza Vaccine

Even before you get to talk about problems with flu vaccine effectiveness,  it becomes clear that everyone wants a better flu vaccine.

One big problem with the current generation of flu vaccines?

You have to get them each and every year.

Developing a Better Flu Vaccine

So what would we all want in a new and better flu vaccine?

It would:

  • last longer, so you didn’t have to get a new vaccine every year
  • be more effective
  • cover more flu vaccine strains, so it wasn’t a “guess” about which flu strains to include in the flu vaccine each year and we didn’t have to worry about drifted flu vaccine strains or new and emerging strains for which there is no vaccine

A universal flu vaccine, which covers all possible flu strains, would be ideal.

So why haven’t we been working on developing a universal flu vaccine?

Well, we have.

It just isn’t that easy.

Many different research teams have been working on a universal flu vaccine for years and some have already had some success.

Does that mean we will see a universal flu vaccine soon?

Unfortunately, of the almost 40 organizations working on improved flu vaccines, including a universal flu vaccine, about 30 are still in preclinical or phase 1 trials. So the answer is no, we will not see a universal flu vaccine soon.

The Strategic Plan to Develop a Universal Influenza Vaccine

Maybe that will change now that more and more folks are pushing for a better flu vaccine and we see the effects of severe flu seasons without a good vaccine.

Of course, talk isn’t enough.

“A priority for the National Institute of Allergy and Infectious Diseases (NIAID) is development of an influenza vaccine providing durable protection against multiple influenza strains, including those that may cause a pandemic, i.e., a universal influenza vaccine. To invigorate research efforts, NIAID developed a strategic plan focused on knowledge gaps in three major research areas, as well as additional resources required to ensure progress towards a universal influenza vaccine. NIAID will use this plan as a foundation for future investments in influenza research and will support and coordinate a consortium of multidisciplinary scientists focused on accelerating progress towards this goal.”

Erbelding et al on A Universal Influenza Vaccine: The Strategic Plan for the National Institute of Allergy and Infectious Diseases

That’s why it is also encouraging that we have seen the:

  • The Flu Vaccine Act would help fund a universal flu vaccine.the Pathway to a Universal Influenza Vaccine workshop convened by the National Institute of Allergy and Infectious Diseases (NIAID) in 2017
  • the Strategic Plan for Developing a Universal Influenza Vaccine by the NIAID that was announced in 2018
  • U.S. Sen. Ed Markey (D-MA) introduced the Flu Vaccine Act, which would invest $1 billion towards development of a universal flu vaccine

Knowing that developing a universal flu vaccine is a priority of the NIAID and that so many organizations are already working towards this goal is very reassuring.

Hopefully we are a lot closer than some folks thing.

Until then, a seasonal flu vaccine is the best way to avoid the flu and serious flu complications.

What to Know About Developing a Universal Influenza Vaccine

Developing a better flu vaccine, including a universal flu vaccine, is an even bigger priority with the announcement of the Strategic Plan for Developing a Universal Influenza Vaccine.

More on Developing a Universal Influenza Vaccine

FluMist Is Coming Back

FluMist is a live, attenuated nasal spray flu vaccine.

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

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

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.

More on the Return of Flumist