Photo: Douglas Jordan, M.A. | CDC
Flu season will be a little easier next year for people who hate needles.
After two years, the nasal flu vaccine, sold under the trade name FluMist, will return to doctors’ offices.
“The Advisory Committee on Immunization Practices (ACIP) voted 12 to 2 to include the live attenuated influenza vaccine (LAIV4), also known as the ‘nasal spray’ flu vaccine, as an option for doctors to use during the 2018–2019 season to prevent influenza,” a spokesperson for the Centers for Disease Control and Prevention (CDC) told Healthline.
Unlike traditional flu vaccines, which use a form of the flu that is already dead, “attenuated influenza” vaccines actually contain a live flu virus, albeit in a drastically weakened state.
The nasal spray has also been theorized to act as a preventative measure through its administration route because flu is typically spread through the respiratory system.
The nasal vaccine will be available for non-pregnant people between the ages of 2 and 49.
However, the CDC did not explicitly endorse the nasal vaccine for the next flu season, recommending instead that patients and doctors decide.
Popular but ineffective
Compared to a traditional flu shot, FluMist was a popular treatment — particularly among pediatricians — because it was easier to administer on children and individuals uncomfortable with needles.
However, the vaccine proved significantly less effective at general prevention than the flu shot. It was 0 percent effective against one major flu strain during the 2016–2017 flu season.
In some cases, the spray vaccine offered only 3 percent protection for children between ages 2 and 17, compared with up to 63 percent effectiveness from the shot.
The CDC subsequently did not include it in their list of recommended vaccines.
FluMist also showed a major chink in its armor by failing to protect against H1N1 flu virus, commonly referred to as swine flu — the strain that caused 2009’s major flu outbreak.
The treatment’s poor performance was seen as a blow to childhood flu vaccinations.
“Before this failure, this vaccine was actually preferentially recommended for children under the age of 8,” Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine, told Healthline.
Researchers at AstraZeneca, the parent company to MedImmune, the company that produces FluMist, have since presented evidence that a reformulation of the vaccine has made it more effective.
“This study validates the improvements we’ve made to our strain selection process and confirms an improved H1N1 LAIV strain was included in the 2017–2018 formulation. We are pleased that the ACIP has voted in support of a renewed recommendation for FLUMIST QUADRIVALENT in the United States and look forward to continuing to work with public health authorities to optimize protection against influenza,” said Gregory Keenan, vice president of U.S. medical affairs for AstraZeneca, in a statement.
Why it’s important to vaccinate children
Independent experts are cheering the return of the nasal vaccine for the next flu season because of its potential to increase the vaccination rate among children.
“I think it will promote even further immunization of children with influenza vaccine and that’s just terribly, terribly important,” said Schaffner.
“Children are the great distributors of the influenza virus in our communities. When they get influenza, they produce more virus than adult virus and they produce it for longer periods of time,” he said.
Kids also have a significant mortality risk from the flu. In recent weeks, 13 children have died from the disease in the United States, bringing the total to 97.
A new study published by the CDC in the journal Pediatrics also concluded that even healthy kids are vulnerable. Their data showed that half of flu-related deaths in individuals younger than 18 occurred in “otherwise healthy children.”
Will it work?
There’s no indication that this year’s flu epidemic had any bearing on the CDC’s choice to once again recommend FluMist to doctors.
The research on the new formulation of the drug has instead matured in such a way that AstraZeneca’s announcement comes in the midst of another dangerous flu season.
This year’s flu shot has been only 36 percent effective against major flu strains.
While FluMist has been approved for next year’s flu season, Schaffner cautions that the real effectiveness of the reformulated version (both in its ability to fight off flu and to increase childhood vaccination rates) won’t be known until it hits the public.
“There’s no guarantee that the new nasal spray vaccine will enhance the uptake of the influenza vaccine in children. Pediatricians would like to believe that’s true, and what was not said in public, but certainly been said in private to the pediatricians is: you’ve got to prove it,” he said.