TIP Talk!

Tuesday August 14, 2018

Nasal Mist or Flu Shot? It Depends on Who's Asked


The nasal flu mist is back. After being shunned for two years because of findings that its effectiveness was extremely low, the makers came back with a new formulation that gained the approval of the Advisory Committee on Immunization Practices.

For many parents of young children, this might seem at first like a gift. No more frightened, wriggling children protesting against slight, momentary pinch from the shot.

Not so fast, the American Academy of Pediatrics says. It’s still recommending the flu shot as the more effective way of preventing flu for the coming season, with the flu mist used only as a last-resort backup.

But ACIP continues to believe have no preference for one vaccine over the other. It can get a little confusing, right? 

"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," Dr. Henry H. Bernstein, associate editor of the AAP Red Book Online, said in a press release from the pediatricians’ association. “Influenza is unpredictable from season to season, which means vaccine effectiveness can vary by age, health status, and type of vaccine. Recent history has shown the injected form of the vaccine to be more consistent in protecting against most strains of flu virus."

August is National Immunization Awareness Month, and among the very important vaccinations for parents to know all about are the annual ones for the flu.

The decision about flu vaccines is especially important this year after the nation suffered through a particularly severe flu season that resulted in 172 pediatric deaths. That’s the highest number ever recorded, excluding pandemics. Half of those children had no pre-existing health conditions. And 80 percent of them were unvaccinated.

Despite rumors to the contrary, last year’s vaccine was quite effective among children – close to 60 percent. That means that if 10 vaccinated children were exposed to the flu, only four of them on average would be sickened.

The nasal spray “was a popular option for those reluctant to get a shot,” the AAP release says. But two years ago, both the AAP and ACIP reviewed data showing that it was ineffective against H1N1 strains of the flu virus, and less effective than expected against H3N2. ACIP, an advisory panel of the U.S. Centers for Disease Control and Prevention, did not recommend the flu mist for the next two flu seasons. Neither did the AAP.

In February 2018, ACIP decided to make the flu mist available for the coming flu season. According to the AAP, that decision was based on” indirect study data from the manufacturer suggesting their new formulation would be effective, as well as a review of other published research."

The nasal mist vaccine is not recommended for children younger than 2 or children with chronic medical conditions like asthma.

"The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all," said Dr. Flor Munoz, member of the AAP’s Committee on Infectious Diseases. "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. The efficacy of this new formulation has not yet been determined."

But other experts disagree. ACIP met in June, after the AAP came out with its statement, but did not change its advice that parents could choose either vaccine with confidence. In addition, nationally renowned vaccine expert Dr. Paul Offit produced a video in which he explained the improvements in the nasal flu mist vaccine and said that he thought ACIP was right and the pediatriians' association was wrong. His explanation is pretty technical but still worth watching here.

Some parents might worry that this means they can't feel confident in flu vaccines. The opposite is true. The open discussion by ACIP, the open disagreement of AAP, and the explanation by Offit, all show that doctors and public-health experts are continually reviewing the data on vaccines to ensure that they are safe and effective. Both groups are transparent about their recommendations and why they make them.

This is a good discussion for you to have with your children's pediatrician when you go for their immunization.

And go you should. During its June meeting, ACIP also reviewed new research of many negative claims that have been made about the flu vaccine and continued to find it safe and worth having. 

According to a report  on the meeting by the website Shot of Protection:

The ACIP listened to vaccine safety reports provided by representatives from the Food and Drug Administration, vaccine manufacturers, and the vaccine safety surveillance systems in the U.S. – the Vaccine Adverse Event Reporting System and Vaccine Safety Datalink which is a collaboration between CDC and nine healthcare organizations that began in 1990 and analyzes up to 10 million immunization records per year to ensure ongoing safety.  After an extensive review of the safety of this season’s flu vaccines, the ACIP confirmed that there were no vaccine safety signals of concern including anaphylaxis, narcolepsy and Guillian-Barre Syndrome, each of which received increased scrutiny due to a number of news and anecdotal reports in recent years.

In other words, no matter which form of immunization you ultimately choose, protect yourself and your children with the flu vaccine. ACIP is listening to parents' concerns and examining all the latest research, which continues to show that the flu vaccine is generally safe, as well as being the most effective tool we have against a disease that has killed too many people.



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