CDC recommendation of FluMist provides pediatric vaccination opportunities

Litjen Tan

On Wednesday, Feb. 21, the CDC’s Advisory Committee on Immunization Practices voted 12-2 in support of influenza vaccination using nasal spray for the 2018-2019 influenza season.

This recommendation comes after the committee (ACIP) removed the recommendation of the quadrivalent live-attenuated influenza vaccine (LAIV4) for the last two influenza seasons, due to its relatively lower efficacy. The ACIP’s newest action may have a positive influence on vaccination rates in pediatric patients, according to experts interviewed by Infectious Diseases in Children.

“I think that the beauty of science is that as new data emerge, ACIP will continue to look at that and adjust their recommendation as necessary,” Litjen Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition, told Infectious Diseases in Children. “While this action certainly presents messaging challenges, especially for the public, it is essential for the progress of science and the advancement of new and better vaccines that we continue to look at the latest data and act on that latest information.”

According to the website for FluMist (LAIV4, AstraZeneca), these recommendations will be presented to the director of the CDC and the U.S. Department of Health and Human Services. The recommendation will be reviewed and potentially approved. Final guidance will be provided within an upcoming Morbidity and Mortality Weekly Report.

Jose R. Romero, MD, FAAP, FIDSA, FPIDS, professor of pediatrics, Horace C. Cabe Endowed Chair in Infectious Diseases, and director of the pediatric infectious diseases section at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, as well as director of clinical trials research at Arkansas Children’s Research Institute, told Infectious Diseases in Children that this vaccine has undergone substantial review.

Jose R. Romero

“The company is selecting the vaccine virus strain using a different method,” Romero, an Infectious Diseases in Children editorial board member, said in an interview. “They are looking at the way the virus replicates by two different methods, one of which was not being done before. It appears that the virus replicates well, and the shedding data show that it is replicating in the nasal passage… We will need to wait and see what the efficacy is of the vaccine in a real-world situation.”

Both sources mention that the ACIP recommendation may be able to positively influence vaccination rates in pediatric patients.

“Having multiple vaccination options for providers will improve their ability to get their children vaccinated,” Tan said. “This should help them protect their patients more effectively by offering an alternative to injected influenza vaccines.”

However, choosing to use FluMist for the 2018-2019 influenza season may be a difficult choice for many pediatricians.

“Certainly, physicians will have a lot to say when deciding which vaccines to use in the coming season,” Romero said. “Data show that this vaccine has good immunogenicity and vaccine efficacy against influenza B. It probably works as well as the current, inactivated vaccine for other strains. We don’t know how it’s going to work with H3N2, and that is up to the physician to decide how he or she wants to proceed. It may depend on what strain is coming up next season.”

For those concerned about the recommendation to reintroduce LAIV4 as an option for their pediatric patients, Romero and Tan suggest that multiple factors be considered before making a decision on which vaccines to use because influenza can be an unpredictable virus.

“I think that pediatricians should make their decision based on their review of the modifications the company has made in the vaccine and discussion with the parent,” Romero said. “Until we have vaccine efficacy information on this version of the LAIV, we cannot state it is less or more effective than vaccines that are currently available. I think the virus they have now is definitely a fitter virus than it was before, and it looks like it has overcome some of the problems, if not all of the problems, that they experienced previously.”

“The only thing certain about influenza is its uncertainty, so every flu season is different,” Tan said. “It will be nice to continue to gather data over multiple influenza seasons so that we are not just looking at a single season’s data to make all our influenza vaccination policy decisions.” – by Katherine Bortz

Disclosures: Tan reports having received honoraria from Pfizer and Sanofi Pasteur for service as a scientific consultant. The honoraria were donated to the Immunization Action Coalition. Romero reports no relevant financial disclosures.

Resources:

CDC: ACIP votes down use of LAIV for 2016-2017 flu season

https://www.flumistquadrivalent.com/