Stapleton Pediatrics Blog

No Flumist?! Really?!

No Flumist?!  Really?!  
(Flu vaccine info from Dr. Rich.)
I believe everyone, especially all of us at Stapleton Pediatrics, was extremely disappointed about not having Flumist this year.   For a vaccine that had created such excitement in providers, parents, and patients the past few years, it was a surprise to most of us that it is no longer recommended.   We have been receiving a lot of question about this situation, so I thought I would give you my take of the issue:

First, what is Flumist?

Flumist is the nasal spray flu vaccine that is made of a live, but greatly weakened flu virus.  (As opposed to the flu shot which is not a “live virus” and made with pieces of protein to which our body reacts.)   The Flumist vaccine creates protection to influenza by having a small amount of weakened vaccine virus infect the lining of the nose, copy itself enough to trigger a defense memory when our immune system identifies and kills the vaccine virus.   Flumist can cause very mild cold symptoms as this process occurs, but then one has immunity lining your nose and upper airways where actual influenza enters our body. 

Why we were initially excited?

Shots are stressful to most children and families.  Having an alternative to the flu shot that didn’t hurt (albeit some children prefer a shot than a spray in their nose) was a big step for our families.  Also Flumist created protection at the site of entry for influenza, and initially showed great efficacy.  Initial studies showed high rates of protection against all the included types of flu covered in the vaccine those years.   The CDC even made it the preference over the shot 2 years ago, after data from 2009-2011 showed good efficacy.  

Why is it no longer recommended?

Basically, it did not work well the past 3 years.  CDC data for 2015-2016, showed an efficacy of 3 percent.    It is not clear why the vaccine has been ineffective the past 2-3 years in the U.S.  (There are some studies in Finland and Canada that show the Flumist still working in their communities.)   Possible reasons for this:   
  • Live viruses are more difficult to keep consistent from its manufacture to its replication in a patient’s nose.   
  • The predominant strain of influenza the past 2 years has been H1N1, for which Flumist has not been protective.  It is possible to that it still may work better against other strains. 
  • Another possibility is that the immune system is killing the vaccine too quickly (and not giving the vaccine virus a chance to replicate to an amount where our immune system would make long-term protection antibodies).  The studies showing immunity were initially based on children that had not been previously vaccinated against flu. 
Should we be more or less suspicious of vaccines now?

Does the Flumist’s poor efficacy mean that all the other vaccines may not work well either?  Fortunately, this is not the case.  It is reassuring that vaccines are rigorously monitored for side effects and efficacy. For example, the first generation rotavirus (Rotashield) was pulled from the market after 9 months of being given to the public due to the possible slight increase of an intestinal blockage that is seen in infants called intussusception.  This vaccine may have increased the risk of intussusception by 1 to 2 per 10,000 infants.  There is some data showing that our current rotavirus vaccine actually decreases the risk of intussusception (implicating that actual rotavirus infection may be a triggering event).  

Why do we need flu shots every year??
  • Influenza is very common.  Without any vaccine protection, it is estimated that 40-50 million Americans, including 25% of school children, would become sick with it each year.  So even the influenza vaccine with its moderate protection can make a huge beneficial impact.
  • Influenza can cause a severe illness causing hospitalization, including intensive care support.   Although much more deadly in the elderly,   100-200 American children die each year from influenza and its complications. In fact, Influenza is the leading cause of vaccine preventable death in children.  Children under 2 are at higher risk for being hospitalized with influenza.
  • Influenza is very deceptive, easily hiding from the body’s immune response.  Its unique structure allows it to make minor or major changes to its outer coating that the body sees.  Every year the influenza viruses that are circulating are slightly different than the one that circulated the year before.  Scientists are working on a universal vaccine targeting the part of its structure that is always present and able to be seen by the immune system. This would allow protection that would last multiple years.   Until then we need to get some protection from the strains that are most likely going to be in our neighborhood this winter by getting the flu vaccine every year.
  • Although washing hands is the best way to avoid getting sick with any respiratory virus, it is difficult to wash hands well enough throughout the entire flu season.  .
So despite our clinic’s increased “volume” of protesting children desiring Flumist, getting the flu shot is incredibly important for the health of your children.  We hope to see you in the office this fall in one of our flu clinics or nurse visits for your entire family to receive its vaccination. 

Resources used for this blog:, Influenza: A vaccine we love to hate. Publish date: July 27, 2016. Stephen I. Pelton, MD.
Posted: 10/21/2016 10:58:35 AM by Stapleton Peds | with 0 comments
Filed under: flu, flumist, flushot, illness, immunization, medications, prevention, vaccine

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