Pediatricians were shocked, parents were stunned, and kids were more than just a little disappointed recently when we all received word that the live, attenuated (weakened) influenza vaccine (LAIV, better known as FluMist) will not be recommended to be given this coming 2016-17 influenza season. Part of the pediatrician’s armamentarium against the nasty influenza virus for almost 15 years has been this safe and well-tolerated intranasal vaccine, accounting for about one-third of flu vaccines given to children ages 2 and up. (In the United States, the mist variety accounts for about 8% of flu vaccines given to infants, children, and adults; the rest come from more traditional inactivated flu shots.)

The Advisory Committee on Immunization Practices (ACIP) — a panel of vaccine experts that advises the Centers for Disease Control and Prevention (CDC) — voted on June 22 not to recommend FluMist this year. Why? Because ongoing scientific surveillance of circulating global strains of the influenza virus and the vaccines’ effectiveness against them showed poor protection from FluMist over the past three years. In fact, the estimated effectiveness of FluMist during the just-concluded 2015-16 flu season was just 3 percent! In contrast, the effectiveness of the standard injectable flu vaccine was nearly 70%. For flu shots, that’s very good. Maggie Fox explains why flu vaccines aren’t more effective:

Influenza is very difficult to vaccinate against. The virus is so mutation-prone that the vaccine has to be changed and made fresh every year. Even so, sometimes the circulating strains mutate faster than the vaccine makers make new vaccine. And sometimes one strain circulates in the U.S. while others predominate in Europe or Asia.

So some years the vaccine is not very protective.

In past years, FluMist has been more effective than injected flu vaccines, probably because it is a “live” virus, meaning it’s a whole influenza virus that has been weakened. Vaccination causes an extremely mild infection that, in theory, protects as well as actually having flu.

Flu’s constant mutation explains why having it once doesn’t make people immune in the same way that having measles or mumps does.

 

If you recall, the effectiveness of 2014-15’s flu shot was barely 20% because of one of those early mutations which occurred after the start of vaccine production. But 3% efficacy of the FluMist in the same season where the flu shot protects the majority of recipients? Wow, that is a shock to me. We saw a lot of kids in the office sickened by influenza this past winter and spring, most of whom received no influenza vaccine to protect them. Even though vaccinated kids can still get the flu, they typically get less sick than those kids who aren’t immunized. But, I don’t believe I saw more breakthrough infections in vaccinated children this past winter and spring who received the intranasal vaccine vs. the shot. Nevertheless, the science compels pediatricians to take a year off from giving intranasal flu vaccines until the reasons for its ineffectiveness are better understood and corrected. It took only a few hours for the American Academy of Pediatrics to hop onboard the ACIP’s recommendation to only provide inactivated influenza vaccine (IIV) in the form of injections. The AAP went further to encourage parents to make sure they and their children get flu shots the upcoming flu season:

“Flu vaccine is the best way we have to protect children and being immunized every year significantly reduces the risk of a child being hospitalized due to flu.”

 

Pediatricians expect to have plenty of flu vaccines in stock this year. Pediatric Alliance patients can expect an email to arrive in September announcing the vaccine’s availability in our offices and flu clinics. In the meantime, Seattle Mama Doc Wendy Sue Swanson offers these tips for parents whose children have become accustomed to the needle-free flu vaccine:

  • Don’t promise no-needle visits! Pediatricians will also work hard from today forward to not promise the opportunity to always offer a nasal flu vaccine option. We’ll likely get to offer it in upcoming seasons, but this year, we’re back to the shot.
  • Remember that needle phobia is real. Treat the anxiety with respect and work with your pediatrician and care team to minimize anxiety with shots.
  • Teach the “cough trick”. It’s a distraction technique (a child or teen coughs, just as the needle goes in). Ask your child to cough as the shot is being administered and studies have shown that kids feel less pain.
  • Children watch their parent’s experience with shots. Know that your reactions and comments of calm and trust go a long way.
  • Treats (ice cream, special snack, time at a special park or restaurant) after shot visits are AWESOME incentives!

 

YMMV on the treats.

 

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