AAP Favors Flu Shot Over Nasal Spray Vaccine

Pam Harrison

May 24, 2018

The inactivated influenza vaccine provides superior protection against influenza infection compared with the nasal spray vaccine and should be the first choice for immunization during the upcoming 2018-2019 flu season, the American Academy of Pediatrics (AAP) said in a statement this week. Physicians should use the nasal spray vaccine only as a last resort for children who refuse the shot, the AAP indicated.

The AAP will publish its formal policy statement on the prevention and treatment of influenza in September, but announced its vaccine recommendation now because physicians are already placing orders for vaccines to use later this year.

"We really want to immunize as many children as we can against the flu with what we think will be the most effective vaccine. That's why we're recommending the flu shot," Henry Bernstein, DO, associate editor of the AAP's Red Book Online, said in the statement.

In February, the Advisory Committee on Immunization Practices (ACIP) decided to make the quadrivalent live attenuated influenza vaccine (FluMist, Medimmune LLC) available for the 2018-2019 flu season on the basis of published research and indirect study data from the manufacturer that suggest the new formulation would be effective.

The ACIP did not recommend the nasal spray vaccine for either the 2016-2017 or the 2017-2018 influenza season because data indicated that the vaccine was not effective against the H1N1 influenza strain and that it was less effective than expected against the H3N2 virus.

A more recent review of the same data continues to favor the injectable form of the vaccine, which has been shown to be more consistently effective against most influenza strains over the past several influenza seasons than the nasal spray vaccine.

The AAP still recommends the nasal spray vaccine for those children who would otherwise receive no influenza vaccine, according to the same statement.

However, the AAP cautions that vaccinating children against influenza with the nasal spray vaccine could leave them at higher risk for infection than they otherwise might have been had they received the inactivated influenza vaccine.

Moreover, the nasal spray vaccine is not recommended for children younger than 2 years or for children with a chronic medical condition such as asthma.

"The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all," Flor Munoz, MD, member of the AAP's Committee on Infectious Diseases, said in a statement.

"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," she added. "The efficacy of this new formulation has not yet been determined," Munoz cautioned.

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