Live Attenuated Influenza Vaccine

Aka: Live Attenuated Influenza Vaccine, Flumist, LAIV

1. See Also
   1. Influenza
   2. Influenza Vaccine
2. Indications
   1. See Influenza Vaccine for indications
   2. Was NOT recommended by CDC in 2016 due to lower efficacy
      1. http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
   3. Alternative option in 2018 for Influenza Vaccine age 2 years to 49 years old who refuse Influenza Vaccine injection
      1. Flumist was previously thought to have higher efficacy than the injection and was preferred ages 2-8 years
      2. Later was thought to have equivalent efficacy as injection, but that is in question as of 2016
3. Contraindications
   1. Includes Influenza Vaccine Contraindications (including severe egg allergy)
   2. Pregnancy
   3. Concurrent Aspirin therapy in age under 18 years (Reye's Syndrome Risk)
   4. Recurrent Wheezing or Asthma (esp. if age 2-4 years old)
   5. Immunocompromised (any cause) or close contacts with severe immunosuppression
   6. Chronic disease (lung, cardiac, renal, liver, neurologic, hematologic, metabolic)
   7. Exercise caution in severe congestion or acute illness
   8. Asplenia (anatomic or functional)
   9. Cochlear Implant
   10. Influenza antiviral medications within prior 48 hours
4. Preparation
   1. Quadrivalent Vaccine only as of 2013 (covers an additional B strain)
5. Dosing
   1. Timing
      1. Same as for TIV Vaccine
      2. May be given as early as July
   2. Dose
      1. One half vial in each nostril
      2. Divider is removed after first half is instilled
   3. Indications for a second dose
      1. First Immunization season
      2. Give second dose before December and at least 28 days after the first
6. Safety
   1. Contains no thimerosol
7. Efficacy
   1. Efficacy expected to be equivalent to inactivated Vaccine against strains in 2019
      1. (2019) Presc Lett 26(10): 55-6
      2. (2018) Presc Lett 25(8)
   2. In 2016 U.S., intranasal flu Vaccine efficacy has been as low as 3% in children and teens
      1. ACIP did not recommend the intranasal Influenza Vaccine in U.S., 2016
      2. http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
   3. Initial studies: Moderately more effective than the Inactivated Influenza Vaccine (TIV Vaccine)
      1. Belshe (2007) N Engl J Med 356(7):685-96 [PubMed]
   4. Later observational studies did not demonstrate superiority of Live Vaccine over TIV
      1. http://www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-2014-10.pdf
8. Resources
   1. CDC Immunization Schedules (last accessed 10/28/2020)
      1. https://www.cdc.gov/vaccines/schedules/
9. References
   1. (2015) Presc Lett 22(9):49-50