CDC's ACIP recommends against 'nasal spray' flu vaccine for next season
ATLANTA - The Center for Disease Control and Prevention's Advisory Committee on Immunization Practices on Wednesday voted that live attenuated influenza vaccine, also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season.
ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine or recombinant influenza vaccine, for everyone 6 months and older.
ACIP is a panel of immunization experts that advises the Centers for Disease Control and Prevention. This ACIP vote is based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016.
In late May, preliminary data on the effectiveness of LAIV among children 2 years through 17 years during 2015-2016 season became available from the U.S. Influenza Vaccine Effectiveness Network. That data showed the estimate for LAIV VE among study participants in that age group against any flu virus was 3%. This 3% estimate means no protective benefit could be measured. In comparison, IIV (flu shots) had a VE estimate of 63% against any flu virus among children 2 years through 17 years.
How well the flu vaccine works (or its ability to prevent flu illness) can range widely from season to season and can be affected by a number of factors, including characteristics of the person being vaccinated, the similarity between vaccine viruses and circulating viruses, and even which vaccine is used. LAIV contains live, weakened influenza viruses. Vaccines containing live viruses can cause a stronger immune response than vaccines with inactivated virus. LAIV VE data before and soon after licensure suggested it was either comparable to, or better than, IIV. The reason for the recent poor performance of LAIV is not known.
Vaccine manufacturers had projected that as many as 171 million to 176 million doses of flu vaccine, in all forms, would be available for the United States during the 2016-2017 season. The makers of LAIV had projected a supply of as many as 14 million doses of LAIV/nasal spray flu vaccine, or about 8% of the total projected supply. LAIV is sold as FluMist Quadrivalent and it is produced by MedImmune, a subsidiary of AstraZeneca. LAIV was initially licensed in 2003 as a trivalent (three-component) vaccine. LAIV is currently the only non-injection-based flu vaccine available on the market.
Today’s ACIP vote could have implications for vaccine providers who have already placed vaccine orders. The ACIP recommendation may particularly affect pediatricians and other vaccine providers for children since data from recent seasons suggests nasal spray flu vaccine accounts for about one-third of all flu vaccines given to children. CDC will be working with manufacturers throughout the summer to ensure there is enough vaccine supply to meet the demand.
The ACIP recommendation must be reviewed and approved by CDC’s director before it becomes CDC policy, the agency cautioned. The final annual recommendations on the prevention and control of influenza with vaccines will be published in a CDC Morbidity and Mortality Weekly Report, Recommendations and Reports in late summer or early fall.