II. Indications
- See Influenza Vaccine for indications
- Was NOT recommended by CDC in 2016 due to lower efficacy
- Alternative option for Influenza Vaccine (for those who refuse Influenza Vaccine injection)
- Approved for non-pregnant patients, age 2 years to 49 years old
- Flumist was previously thought to have higher efficacy than the injection and was preferred ages 2-8 years
- Later was thought to have equivalent efficacy as injection, but that is in question as of 2016
III. Contraindications
- Includes Influenza Vaccine Contraindications (including severe egg allergy)
- Pregnancy
- Concurrent Aspirin therapy in age under 18 years (Reye's Syndrome Risk)
- Recurrent Wheezing or Asthma (esp. if age 2-4 years old)
- Immunocompromised (any cause) or close contacts with severe Immunosuppression
- Chronic disease (lung, cardiac, renal, liver, neurologic, hematologic, metabolic)
- Exercise caution in severe congestion or acute illness
- Asplenia (anatomic or functional)
- Cochlear Implant
- Influenza Antiviral Medications within prior 48 hours
IV. Preparation
- Quadrivalent Vaccine only as of 2013 (covers an additional B strain)
V. Dosing
- Timing
- Same as for TIV Vaccine
- May be given as early as July
- Dose
- One half vial in each nostril
- Divider is removed after first half is instilled
- Indications for a second dose
- First Immunization season
- Give second dose before December and at least 28 days after the first
VI. Safety
- Contains no thimerosol
- Live Vaccine
VII. Efficacy
- Efficacy expected to be equivalent to inactivated Vaccine against strains in 2019
- (2019) Presc Lett 26(10): 55-6
- (2018) Presc Lett 25(8)
- In 2016 U.S., intranasal flu Vaccine efficacy has been as low as 3% in children and teens
- ACIP did not recommend the intranasal Influenza Vaccine in U.S., 2016
- http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
- Initial studies: Moderately more effective than the Inactivated Influenza Vaccine (TIV Vaccine)
- Later observational studies did not demonstrate superiority of Live Vaccine over TIV
VIII. Resources
- CDC Immunization Schedules (last accessed 10/28/2020)
IX. References
- (2015) Presc Lett 22(9):49-50