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.
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.
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
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.
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 thatís currently available is
injectable," said Dr. Tina Tan, an infectious disease
physician at Lurie Childrenís Hospital and professor at
Northwestern Universityís Feinberg School of Medicine.
"Thereís no use giving someone a vaccine if it doesnít
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.
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
contains a weakened, live flu virus intended to provoke a
stronger reaction from the bodyís defenses. The flu shot
delivers an inactivated virus.
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.
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.
FluMistís 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.
is no better than if you gave somebody salt water," Tan
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 ó 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
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.
in the Chicago area said that while the news was surprising,
the CDC research was incontrovertible. They also said there
was a silver lining to the development, even if it meant
eliminating a promising alternative to the flu shot.
me, and to the medical community, itís a good example of
medicine and public health constantly and continuously looking
at the data and reassessing the decisions they make,"
said Fricchione, medical director of the public health
departmentís immunization program. "It was the right
decision to make for the individual patient, and (the CDC)
felt it was not ethical to recommend a vaccine with no
Vora, a pediatrician at Advocate Childrenís Hospital in Oak
Lawn, Ill., agreed.
is why we do the research," Vora said. "This is why
we look at vaccination rates. Because weíre constantly
re-evaluating what weíre doing, we found this out now. If
something is not working, we shouldnít be doing it."
doctors say, the policy shift occurred long enough before cold
and flu season to not cause panic or crisis. The CDC and the
American Academy of Pediatrics worked closely with providers
and vaccine manufacturers to replace all the now-worthless
nasal spray vaccines with injectable doses.
soon as it became apparent that (FluMist) would not be
recommended, the other manufacturers increased their
production and increased distribution," CDC director Dr.
Tom Frieden said at a news conference Thursday. "With the
availability of up to 168 million doses this year, we donít
think there will be any shortage."
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said about 10 percent of the vaccines the cityís public
health department ordered from the CDC were the nasal sprays,
but the department has received its full supply of injected
doses for the season.
canceled its order of 7,000 FluMist doses for its pediatric
and family medicine practices, and ordered injected versions
instead, pharmacist Rami Rihani said. It was approved for
5,000 flu shots and put on a wait list for the other 2,000.
said they have had plenty of time to discuss flu shots with
parents, and in many cases, parents have arrived at
appointments already well-versed on the issues.
were able to start early with our parents to educate
them," Vora said. "We told them the FluMist is
basically the same as not vaccinating your child against the
said the vast majority of parents are fine with giving their
children the flu shot. Fricchione said some parents may have
had to make that same choice in past years.
of the problems we had historically were that parents would go
in and ask for the nasal spray vaccine, and it would be out of
stock," Fricchione said. "So I donít think the new
decision is going to change how many kids are vaccinated. I
think parents will adapt fairly quickly, and I think the
providers will be able to get the same (vaccination)
Bobbi Selvik, mother of two teenagers who used the spray for
years, going back to the shots is a no-brainer. Selvik, of
Palatine, said her 13-year-old son contracted the H1N1 flu
virus years ago.
never, never want my kids to experience anything like that
again," she said. "It was so much worse than the
regular flu. So if thereís a flu shot, FluMist, whatever it
is thatís going to prevent the kids from getting this
terrible disease ó absolutely, weíre going to do it."
future of FluMist is uncertain.
have noted that the nasal spray vaccine has been shown to work
well in other countries, like the United Kingdom and Finland.
The FDA challenged the reliability of the research findings,
pointing to studies showing FluMistís success overseas, and
still endorses the nasal spray. AstraZeneca stands by its
product and is continuing to distribute FluMist in other
countries this year.
of the CDC, said federal authorities want to bring that type
of immunization back into the fold if it can be proven to
work. CDC figures show around 42 million children total got a
flu vaccine last year, so about 14 million chose the nasal
is a significant number, and for a lot of kids, itís
certainly preferable to getting a shot," Frieden said.
"So we hope that this option will be available as soon as
Robert S. Daum, professor of pediatrics, microbiology and
molecular medicine at the University of Chicago, said he
understands the ambivalence some may feel about flu shots
because of this. But whatever limitations flu vaccines have,
medical professionals agree they still are vital tools to keep
you look at the health care advances in the last 100 years,
there are vaccines," Daum said. "My parents used to
get scared stiff about paralytic polio. Thatís not a problem
anymore. People can be skeptical all they want, but (flu
vaccines) are still the best way we have to prevent this