After a two-year hiatus, the nasal flu vaccine will be available again in the United States for the coming flu season, but the American Academy of Pediatrics (AAP) said it should be used in children only as a last resort.
Instead, the AAP has recommended that families choose immunization with inactivated influenza vaccine, to protect children age 6 months through 18 years from the influenza virus.
"There are no vaccine effectiveness estimates available for the new formulation of the intranasal product that will be used in the 2018-2019 season," Henry H. Bernstein, DO, MHCM, FAAP, tells Drug Topics.
Bernstein, who is a member of the Advisory Committee for Immunization Practices (ACIP) for the CDC and an associate editor of the AAP Red Book Online, said because of this lack of effectiveness data, the AAP wanted to take a limited approach to the intranasal vaccine.
The ACIP made the decision in February to have the intranasal spray, which is a quadrivalent live attenuated influenza vaccine (LAIV4), available for the coming season after reviewing previous research and indirect study research from the manufacturer that showed it could be effective.
"There is a slight difference between what the ACIP/CDC and the AAP are recommending," Bernstein says. "Both of them have recommended reintroducing the intranasal product for the upcoming flu season because both groups want to achieve adequate vaccination coverage and optimally protect kids of all ages; however, the AAP is taking a more limited approach than that of the CDC."
The AAP has stated the nasal spray could be considered as an option for those children who would otherwise not receive any flu vaccine.
"Some protection is always better than no protection, so both the CDC and the AAP want to get as high coverage rates for flu vaccines in infants and children as possible and do whatever it takes to achieve those high rates," Bernstein says, who also serves as an ex officio member of the AAP's Committee on Infectious Disease.
He said the intranasal vaccine has not been used for the last two flu seasons primarily because it showed a lack of effectiveness against H1N1, a predominant strain of the flu several years ago, and more modest effectiveness against H3N2.
Because consumers will now have two vaccination options, Bernstein said pharmacists can play a valuable role in educating families about the nuances and effectiveness data linked with each option.
"It's important for them to be able to help counsel families and help explain the differences in recommendations because pharmacists are important partners in trying to get as many people as possible in the country vaccinated against the flu," he said.
According to a 2017 study led by Brendan Flannery and published in Pediatrics, vaccination reduced the risk of flu-associated death by 65% in healthy children and 51% of children with underlying high-risk medical conditions.