AAP drops FluMist from 2016-17 vaccination recommendations

Citing a lack of evidence of efficacy, the AAP’s Committee on Infectious Diseases recommends that clinicians not administer the FluMist quadrivalent live-attenuated vaccine during the upcoming influenza season.

Perspective from Robert M. Jacobson, MD

The committee still recommends all persons aged 6 months and older receive an annual seasonal influenza vaccination, including children, adolescents and health care personnel, according to a recent policy statement.

Committee Chairwoman Carrie L. Byington, MD, FAAP, professor of pediatrics at the University of Utah, and colleagues wrote several key points in the update for the 2016-2017 influenza season that reiterate guidelines from the 2015-2016 season, along with additional recommendations.

“The vaccine strains are predicted to be well-matched to circulating strains with the intent of providing optimal protection,” Byington and colleagues wrote. “Vaccination is effective in reducing outpatient medical visits for illness caused by circulating influenza viruses by 50% to 75%.”

For the 2016-2017 season, the AAP recommended or updated the following:

Influenza vaccine composition in both trivalent and quadrivalent inactivated vaccines differs from the 2015-2016 vaccine, in that this season’s influenza B strain includes the Victoria lineage in the trivalent vaccine as opposed to the Yamagata lineage in last season’s strain for influenza B.
Quadrivalent live-attenuated vaccine (LAIV4, MedImmune) is discouraged for use due to lack of efficacy during the last 3 seasons, chiefly against influenza A (H1N1)pdm09 viruses.
Children with egg allergy can receive influenza vaccine without additional precautions similar to routine vaccinations.
Health care personnel should receive annual seasonal influenza vaccine in an effort to prevent influenza spread and reduce health care-associated influenza infections.
Pediatricians should identify children suspected with influenza and rapidly treat them with the neuraminidase inhibitor antiviral medications Tamiflu (oseltamivir, Roche Laboratories) and Relenza (zanamivir, GlaxoSmithKline).
All pregnant women, women who are planning to become pregnant, women postpartum and women who are breast-feeding during the influenza season should be vaccinated.

“Continued evaluation of the safety, immunogenicity and effectiveness of influenza vaccine, especially for children younger than 2 years, is important,” the researchers wrote. “The potential role of previous influenza vaccination on overall vaccine effectiveness by vaccine formulation, virus strain and subject age in preventing outpatient medical visits, hospitalizations and deaths continues to be evaluated.” – by Kate Sherrer

Reference:

Byington CL, et al. Pediatrics. 2016;doi:10.1542/peds.2016-2527.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Robert M. Jacobson, MD

I think there are two very big changes — one that is very disheartening and one that is very positive. What is disheartening is that the AAP, along with the CDC’s Advisory Committee on Immunization Practices, is no longer recommending the quadrivalent live-attenuated influenza vaccine, or nasal spray FluMist (LAIV4, MedImmune), for any group. Unfortunately, the last 3 years of data simply do not support its use over the injected form.

Previously, we have used LAIV4 to facilitate a large vaccination of groups, especially in influenza clinics where LAIV4 makes the application much easier as it is painless and quick. Our school flu vaccine programs inform me that 90% of the children were receiving the nasal spray. Suddenly, we need to vaccinate with needles and injection where we have been, for large numbers of our population, using the nasal spray. We plan to tackle this by dramatically improving our use of pain-reducing measures, such as vapor cooling sprays, vibrating ice, application topically, and comfort holds. However, we are hoping that somehow we will find a solution to this problem and have a nasal spray available sometime in the near future.

The good news of the AAP recommendation is that the AAP has reviewed the data and recommended that children with egg allergies can receive any of the influenza vaccines without concern or fear that it might provoke an egg allergy. This is a game-changer. According to the AAP, we no longer have to discriminate, using either a special nonegg-containing vaccine which is only licensed for those patients aged 18 years or older or vaccinating at a physician’s office with a 30-minute waiting period. For patients with serious egg allergies, we have even had providers referring those children to allergists to be vaccinated there. This means that many children with egg allergies — I believe up to three or four per 1,000 children have an egg allergy — can receive the influenza vaccine at a school clinic or regular busy clinic without someone watching or carefully monitoring them for an allergic reaction.

Robert M. Jacobson, MD

Professor of pediatrics

Mayo Clinic College of Medicine

Medical Director, Southeast Minnesota Region Immunization Program

Disclosures: Jacobson reports no relevant financial disclosures.