Forget the nasal mist flu vaccine—it doesn't work

Update: On September 6 2016, the American Academy of Pediatrics (AAP) released a statement specifically recommending against the use of the live attenuated influenza vaccine nasal spray this year because it was only three percent effective during the last flu season. It recommends instead the inactivated influenza vaccine (given by injection) for the upcoming flu season. Henry H. Bernstein, co-author of the AAP statement, said in a news release: "We want to provide children with the best protection possible against the flu, and these recent studies show the flu shot is likely to provide a higher level of protection." In Canada, the National Advisory Committee on Immunization (NACI) made its own statement on flu vaccines last week. While the NACI doesn't come out to say the nasal mist should not be used, it does state that the current evidence does not support a recommendation for the preferential use of the nasal mist in kids aged two to 17 years. In short, it looks like your best bet for protecting kids from the flu this year is the flu shot, not the nasal mist. For the full story from June, see below.

Like many parents, I was thrilled when our family doctor first told me about the FluMist vaccine in 2014. Instead of having to go through the annual flu shot drama with our needle-phobic daughter, who was two at the time, she could get the vaccine with a quick, painless squirt of mist up her nose. Our doctor went on to explain that there was evidence the nasal spray—which contains live strains of the flu virus—was actually more effective than the flu shot for children aged two to six. The mist made my daughter giggle as it tickled her nose, a far cry from the panicked protests that often precede her shots. I was sold. And I looked forward to sailing through the school years flu-shot-free.

But now, according to new research from the US, the FluMist vaccine hasn’t been working as well as predicted in recent years. In fact, a study presented to the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) said that in 2015-2016, the vaccine was only three percent effective at preventing the flu in American children aged two to 17—which means there was no measurable “protective benefit” to the vaccine at all. (The flu shot had an effectiveness rate of 63 percent for the same age group.) This, along with the results of other studies showing poor effectiveness of the nasal spray over the past three seasons, led the committee to recommend that the FluMist vaccine should not be used for anyone in the upcoming 2016-2017 flu season.

The CDC recommendation prompted a statement from the American Academy of Pediatrics (AAP), which agreed with the CDC and advised its members not to prescribe the nasal mist to patients this coming flu season. Flu viruses often change every year, and data from the World Health Organization and the Global Surveillance Network helps determine which strains are expected to be circulating in any a given year, says Henry Bernstein, professor of paediatrics at Hofstra Northwell School of Medicine and spokesperson for the AAP committee on infectious diseases. Manufacturers, in turn, use this information to produce millions of doses of influenza vaccine. Flu vaccines usually are not 100 percent effective, Bernstein says, but still are the best way to prevent the flu. "Whether you look at the effectiveness of the CDC data or research by other groups abroad, it's clear that the effectiveness of the intranasal vaccine did not perform nearly as well as the injectable vaccine,” he says. So far, no one knows why the FluMist spray performed so poorly in the general population. The vaccine performed well in clinical trials, which led to the AAP’s initial recommendation of the nasal spray as the preferred vaccine for young kids.

The AAP’s Canadian counterpart, the Canadian Paediatric Society (CPS) had, up until this past flu season, also been advising its members to recommend the nasal spray for children aged two to six. Joan Robinson, chair of the CPS infectious diseases and immunization committee, says many doctors were happy to have a pain-free alternative to a needle, which they thought was equally or more effective than the flu shot, but “it’s worrisome that three years in a row, this US study shows that the live vaccine didn’t seem to be very effective at all.” Robinson says she and her colleagues will now be looking to Health Canada’s National Advisory Committee on Immunization (NACI) for guidance on what to prescribe this coming flu season.

Ian Gemmill, chair of the NACI, says his committee didn’t have access to the US data until last week, and will analyze it, along with data from studies from around the world, to make its decision for the coming flu season. He says he “completely understands” why the CDC recommended against using the vaccine in view of the data they had about its poor performance, but the NACI will do its own independent review before it can make a recommendation. “At this point, in Canada, parents and doctors need to stay tuned,” says Gemmill, who points out that Canada doesn’t always mirror US recommendations on these types of issues. "We have different considerations here and our own process of analysis.” He says the committee expects to announce its final decision by the end of the summer.

Whether or not the nasal spray remains an option in Canada this coming flu season, Robinson says the last thing she wants is for parents to start thinking all flu vaccines are ineffective. “In Canada last year, there were thousands of children hospitalized with influenza, and there were some deaths,” says Robinson. She says the flu shot remains an effective option for protection against the seasonal flu, and recommends that everyone over six months, including parents, get the vaccine early in the season. “Parents getting immunized themselves goes a long way in protecting their children from the flu,” says Robinson.

As parents, it’s hard to learn that the vaccine we’ve given our children may not have been doing much to protect them. When I expressed my frustration, Bernstein argued that parents like me should be happy these types of recommendations are always changing because it means “decisions are being made with the best, most up-to-date science in mind, with the goal of protecting the most children.” He’s right, of course. But it remains to be seen how “because science says so” goes over with my four-year-old if I have to tell her we’re swapping the “nose-squirter” for a needle this fall.

Read more: Why I always give my child the flu shot Quiz: How much do you know about the flu shot? Scared of needles? A parent’s guide to making vaccination shots less painful