ACIP says nasal spray beats flu shots for kids

The Advisory Committee on Immunization Practices (ACIP) has taken the unusual step of recommending nasal spray vaccine over flu shots for healthy children aged 2 to 8 years.

ACIP based its unanimous recommendation to the Centers for Disease Control and Prevention (CDC) on a review of available studies, which suggested that the nasal spray may provide better protection against influenza than a flu shot in children this age, although both are safe and effective. The Advisory Committee considers the evidence supporting its recommendation to be moderate to high quality.

The nasal spray (FluMist quadrivalent) is a live attenuated influenza vaccine (LAIV); the flu shot is an inactivated influenza vaccine (IIV). A 2011 meta-analysis of randomized, controlled trials of influenza vaccines found 83% efficacy for LAIV in children aged 6 months to 7 years but not in older children and adults.

The Advisory Committee emphasizes that both LAIV and IIV are effective. The nasal spray should be given if immediately available, but if not, the child should receive a flu shot to avoid missing or delaying vaccination. Children who have had wheezing or asthma in the past year, who have egg allergies, who are on aspirin or immunosuppressive therapy, or who are allergic to vaccines or their components shouldn’t get LAIV.

Once the CDC director accepts the ACIP recommendation, it will be included in the 2014-2015 influenza protection and control recommendations and become official CDC policy.

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