A panel of vaccination experts advising the Centers for Disease Control and Prevention made the surprising recommendation late Wednesday that FluMist Quadrivalent, the nasal spray vaccine that protects against influenza, should no longer be used.
It turns out that the spray — which is particularly popular among kids, pediatricians and parents who don’t like seeing their little ones cringe at the sight of a needle — hasn’t worked as well as the old-fashioned shot during the past few flu seasons.
Before then, FluMist protected against influenza as well as, or even better than, the flu shot. The panel’s recommendation against the spray was informed by data collected for children ages 2 through 17 that showed no evidence the nasal spray vaccine offered protection during last year’s flu season. Data also showed that FluMist performed poorly in the prior two flu seasons.
The recommendation by the Advisory Committee on Immunization Practices has to be reviewed and approved by the CDC director before it becomes official policy, but that’s usually a formality.
Scientists don’t know why the nasal spray vaccine isn’t working anymore, says Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine and longtime member of the Influenza Vaccine Working Group that offers guidance to the CDC’s panel of vaccination experts.
“The company [that manufactures FluMist], the FDA, and other investigators still haven’t been able to put their scientific finger on the exact reason, but there are several studies that have indicated that in the United States the vaccine has underperformed in a very substantial way,” he says.
Schaffner did note, however, that the spray began performing poorly when all flu vaccines were adjusted to protect against four influenza strains instead of three.
Flu vaccine manufacturers had planned to supply as many as 176 million doses of vaccines for this upcoming season. MedImmune, a subsidiary of AstraZeneca and the maker of FluMist, planned to provide about 8 percent of this total.
In response to the recommendation against FluMist, AstraZeneca said in a statement that it “is working with the CDC to better understand its data to help ensure eligible patients continue to receive the vaccine in future seasons in the U.S.”
According to Schaffner, companies that offer flu vaccine in shot form say they’ll be able to produce enough to cover kids who would have opted for the nasal spray version.
Schaffner understands that the decision to recommend against the nasal spray will be disappointing for many. “There will be grumbling among children, parents and pediatricians,” he says. “This was a sad, very discomforting decision, but I fully believe it was the correct decision.”
And for the truly shot averse, he offers some hope. “There is a lot of work being done to try to develop methods to deliver vaccines different from the traditional needle and syringe method. For example, a patch with many microneedles that doesn’t hurt — that would be nice,” he says.
Until an effective needle-free flu vaccine arrives, the CDC still recommends the injectable vaccine for just about everyone 6 months and older. Shots are no fun. But neither — most of us agree — is the flu.