Will Lack of Nasal Spray Flu Vaccine Cut Immunization Rate?

Disclosures

September 29, 2016

Public health leaders worry that a government decision not to recommend a live attenuated influenza vaccine (LAIV; FluMist Quadrivalent, MedImmune) in the form of a nasal spray for the current flu season could cause more people, especially children, to go unimmunized.

Those worries emerged at a press conference today organized by the National Foundation for Infectious Diseases (NFID) to promote influenza vaccination. There, Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), noted that its Advisory Committee on Immunization Practices (ACIP) concluded that the nasal spray vaccine was ineffective in preventing flu illness in the prior 3 seasons and therefore should be removed from the vaccine supply for the 2016-2017 season. The American Academy of Pediatrics concurred.

FluMist was widely used in 2015-2016, accounting for roughly 14% of all flu vaccinations, and 33% of those in children. "For a lot of kids, it's certainly preferable to getting a shot," Dr Frieden said at the press conference.

Parents accustomed to having their children receive the nasal spray should not use that as a reason to skip immunization this fall, said NFID Vice President Patricia Whitley-Williams, MD, a professor of pediatrics at Rutgers Robert Wood Johnson Medical School. "Flu shots have proven to be effective, and parents need to make sure their children are protected."

"That's not an excuse," added NFID Medical Director William Schaffner, MD, about people forgoing a shot because they can't get the nasal spray. Dr Schaffner is a professor of preventive medicine at Vanderbilt University School of Medicine.

In an interview with the Washington Post, the CDC's Dr Frieden put these exhortations for people to get the jab in a clearer context. "We're concerned that vaccination rates could be lower this year because the mist isn't available," he said.

The overall flu vaccination rate in 2015-2016 was 45.6%, down from 47.1% the season before.

Hoping for a Nasal Spray Vaccine Comeback

At the press conference, Dr Frieden said the nation will have enough flu shots to make up for the loss of the nasal spray. "There are going to be between 157 million and 168 million doses," he said. "There's plenty for everyone."

The shots will come in the form of either inactivated or recombinant influenza vaccines.

However, Dr Frieden repeatedly said that he wants an effective LAIV nasal spray vaccine with ACIP approval back on the market. "We hope this option will be available as soon as possible," he said.

AstraZeneca, MedImmune's parent company, shares that goal. In a statement emailed to Medscape Medical News, AstraZeneca spokesperson Michele Meixell said the company is investigating why its LAIV nasal spray vaccine has performed poorly in recent seasons. The Food and Drug Administration and outside scientific experts are providing input.

"We have seen, through both our data and investigation in the labs, that the H1N1 strain [in the vaccine] is not replicating as well as it should," said Meixell. "Our goal is to select a better performing A/H1N1pdm09 LAIV strain for inclusion in future seasons, including the upcoming [2017-2018] season."

Follow Robert Lowes on Twitter @LowesRobert

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