With FluMist no longer an option, it’s back to shots

BY DAWN RHODES
CHICAGO TRIBUNE/TNS

For the past few years, most adults and children had a choice of how to get vaccinated against the flu: the more common shot in the arm or the FluMist spray in the nostrils.

Kaiden Whittman, 3, receives a flu shot from medical assistant Gigi Hernandez at Advocate Children’s Hospital on Sept. 29. Children and their parents are not able to pick the needle-free nasal spray vaccine this year. (ANTONIO PEREZ/CHICAGO TRIBUNE/TNS)
Kaiden Whittman, 3, receives a flu shot from medical assistant Gigi Hernandez at Advocate Children’s Hospital on Sept. 29. Children and their parents are not able to pick the needle-free nasal spray vaccine this year.
(ANTONIO PEREZ/CHICAGO TRIBUNE/TNS)

But the less painful method no longer is an option, at least not for the foreseeable future. National health authorities determined FluMist essentially was useless last year in protecting against the dangerous influenza virus. The Centers for Disease Control and Prevention ruled FluMist should not be used at all for the upcoming season.

The disavowal of the nasal spray meant health providers had to shift gears and stock up on more injected vaccines to meet demand. And it means patients will have to grit their teeth this fall and endure the uncomfortable, brief pinch of the shots.

Must be injected
Needle-averse children and their parents are expected to be most dismayed by the change, since about a third of all children who were immunized in 2015 chose the nasal spray.

“It could be an issue for some people, but in order to provide an effective vaccine that will protect their child against influenza, the only vaccine that’s currently available is injectable,” said Dr. Tina Tan, an infectious disease physician at Lurie Children’s Hospital and professor at Northwestern University’s Feinberg School of Medicine. “There’s no use giving someone a vaccine if it doesn’t work.”

The Food and Drug Administration first licensed FluMist in 2003, approving it for people ages 5 to 49. That first spray vaccine was a trivalent, meaning it had three antigens, or components that trigger the immune system to build up defenses against disease. After successful clinical trials, the FDA later approved expanding the use of FluMist to children ages 2 to 5.

Weakened virus
In 2012, the FDA gave the green light to a new concoction of the vaccine, a quadrivalent, which had four antigens instead of three.

The nasal spray vaccine was not recommended for children younger than 2, adults older than 50, pregnant women, as well as some kids with asthma, egg allergies or immunodeficiency diseases.

FluMist contains a weakened, live flu virus intended to provoke a stronger reaction from the body’s defenses. The flu shot delivers an inactivated virus.

Early clinical trials suggested FluMist worked as well as the flu shot for groups of young children.

CDC leaders even favored the nasal spray over the shot during the 2014-15 flu season.

Results slumped
Approximately 20 million people received the nasal spray last year, about 14 percent of the estimated 144.5 million who got any sort of flu vaccination, according to the CDC.

But FluMist’s results slumped over the last three flu seasons. A CDC committee determined in June that the nasal spray showed just a 3 percent effectiveness rate in protecting against the flu among kids 2 to 17 in the 2015-16 season.

“It is no better than if you gave somebody salt water,” Tan said.

Why FluMist performed so poorly last year is a mystery for now. Even the flu shot has different success rates year to year because the predominant strains of flu change, which in turn compels adjustment to the vaccine mixtures, according to health leaders.

But the prevalent flu strain last year was H1N1 — the variety that affects children most severely and that responded least well to the nasal spray, according to Dr. Marielle Fricchione of the Chicago Department of Public Health.

Whatever the scientific reasons for FluMist failing so spectacularly, CDC leaders swiftly rejected its use and urged medical providers only to administer injected vaccines this year.

The American Academy of Pediatrics followed suit, saying children who received the nasal spray vaccine were more than 2.5 times more likely to contract any type of flu virus than those who received a flu shot.

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