Shot or spray? CDC brings back nasal flu vaccine

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COLUMBIA – This flu season, the CDC is recommending a nasal spray for the first time in two years.

The CDC did not recommend the spray as a vaccination option in the 2016-2017 or the 2017-2018 season because it was not effective against a certain strain of the flu virus.

LAIV4 (FluMist Quadrivalent) is a nasal spray that contains a live flu virus. The CDC’s Advisory Committee on Immunization Practices (ACIP) did not recommend it for the two seasons because it was ineffective against the H1N1, or Influenza A, virus. Since then, the spray has been reformulated, according to the CDC.

The ACIP voted in February to recommend the nasal spray this season but has no preference over which vaccine option to use. In the Morbidity and Mortality Weekly Report (MMWR), the ACIP gave vaccination providers the option to “administer any licensed, age-appropriate influenza vaccine.”

Columbia pediatricians said they plan to continue to recommend the shot vaccine to their patients.

Dr. John Wilson with CoMo Cubs Pediatrics said even though changes were made to the mist, he still has concerns.

“As far as we know, it’s probably not going to be effective this year.”

Even though the nasal spray may be easier, Wilson said it may not be as consistent as the shot. He said he will have the spray on hand, but only for children who are too afraid of the needle or children with parents who do not want their children vaccinated.

Dr. James Garber said patients may want to avoid the nasal spray if they have a family member who has a compromised immune system, since it is a live virus. He said he is not going to offer the mist.

“The [American Academy of Pediatrics] thinks the shot is better and they don’t trust the mist,” he said.

In May, the AAP announced its stand on the spray. It stated it will continue to advise patients to use the flu shot when vaccinating their children this fall. One of its reasons was the CDC decided to recommend the spray based on data from the vaccine’s manufacturer. This is confirmed in the MMWR.

Dr. Christelle Ilboudo works with pediatric infectious diseases at MU Healthcare. She said all children should have some sort of vaccination because it may protect them from the complications of influenza.

“We are recommending that children get the shot primarily as the first option, but for those families who are really against getting a shot, if the FluMist is available, it is still better than not getting any protection at all,” she said.

The CDC states the spray can be used in patients ages 2 to 49. Ilboudo said the shot can be used in patients as young as 6 months.

Ilboudo said she will recommend the shot, because the spray is unpredictable. She said the shot has been available for years and is proven to be effective.

“The issues that surround the FluMist is that you have to give it in the nose, and sometimes, we don’t give it properly, the kid sneeze it out, and it’s a live virus that we depend on to do that,” she said.

The Columbia/Boone County Department of Public Health and Health Services (PHHS) will only be offering the shot this season. According to the department, the shot will be free to all children ages 6 months to 18 years thanks to support from MU Children’s Hospital and the David B. Lichtenstein Foundation.

Eric Stann, Community Relations Specialist with PHHS, said in an email the department typically starts providing flu vaccinations in mid-September.

Ilboudo said the best time to get vaccinated is in mid-September through early October. She said, when people do contract the flu even after having the vaccine, it could be because they got the vaccine too late. She said the first wave of influenza typically hits in November, around Thanksgiving.

“If people wait for that first wave to hit, they may not have enough time for the vaccine to protect them,” she said.

Ilboudo said it is important for even healthy individuals to get vaccinated, in case their family members could contract the virus from them and develop complications.

“So I would not only do it for myself but also to protect those around me,” she said.

Last flu season, PHHS saw 5,171 lab confirmed cases of the flu. Ilboudo said there is no way to know how this season will compare. She also said one of the main reasons for last year’s outbreak was due to a lack of vaccinations.

“The vaccine does protect even in years where there is not the best match, it still offers protection where people are not as sick as long or they don’t have complications,” she said.

Ilboudo said the flu vaccine will not give someone the flu virus.

“You may get a sore arm, but other than that, it really does not make people have influenza,” Ilboudo said.

It's important to be able to recognize the signs of influenza. Ilboudo said it is more severe than a regular cold. She said the symptoms can include headache, body aches, a cough and a runny nose. If someone has those symptoms, Ilboudo said they should stay home, get tested and avoid spreading the virus.