What happened to FluMist?

A nurse is giving a elementary age boy a flu shot at the doctor's office. No more flumist.Earlier this summer, the Advisory Committee on Immunization Practices (ACIP) of the CDC recommended against using nasal flu vaccine (or flumist) for children due to lack of effectiveness. This recommendation was echoed by the American Academy of Pediatrics (AAP). This was very disappointing news for some kids and parents who prefer a squirt in the nose over a poke. But more disappointing was the data informing the recommendation which showed that FluMist was not only ineffective at preventing most strains of influenza, it was even worse against H1N1, the swine flu.

Remember the summer of 2009? I do! The pediatrician’s office in summer is usually lazy days of school physicals and summer-fun-related injuries. But that summer the office was packed with high fevers, cough and severe body aches: summer camps shut down, entire families suffered together. That was the H1N1 epidemic, which caused a public health emergency in the US and globally.

In 2003, nasal flu vaccine was introduced with three strains, the same as those included in the injectable vaccine. Early studies showed good efficacy, in fact, even better efficacy for the mist than the injection. (Joy!) When the H1N1 strain was incorporated in the nasal vaccine in 2013, it appears that the efficacy plummeted. Vaccine effectiveness for H1N1 with mist was -21%! Kids who got mist were almost 4 times more likely to get influenza than kids who got the injectable vaccine. There are multiple hypotheses for why this happened: perhaps there was a problem with the H1N1 strain, or perhaps the 4th strain caused interference, or perhaps as more kids are in the “previously vaccinated” category, the mist does not generate an adequate immune response.

No matter the reason, here we are: no FluMist. ACIP and AAP still recommend flu vaccination for all kids 6 months and over. Alternative vaccine forms are in the works, some already approved for adults, like a jet injector (very Star Trek), but for now kids will get a flu injection.

Janesta Noland MD

Janesta is a practicing pediatrician with a personalized and relaxed style that emphasizes education and cooperative decision-making. Her focus is on helping children grow into healthy, secure, participating members of the family and on supporting the family as a whole. Please follow @DrJanesta on Twitter.

Note: This Perspectives Blog post is written by a guest blogger of DrGreene.com. The opinions expressed on this post do not necessarily reflect the opinions of Dr. Greene or DrGreene.com, and as such we are not responsible for the accuracy of the information supplied. View the license for this post.

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  1. CL

    Great article. Thanks for the explanation. What do you think next year holds? FluMist or no?


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