Flu Vaccine 2016-2017 Season

Flu Vaccine Drama. Every Year It's Something!

Every year since I've been in practice there has been a hitch of some sort or another with flu vaccine production and/or administration. This year it's a big hitch. The Advisory Committee on Immunization Practices (ACIP) has recommended that the FluMist not be given to children.

Wow. That will make a lot of kids unhappy.

Dr Mellick and many of our staff have used FluMist over the years.

I always say we should never promise "no shots until ____".

This season' vaccine isn't here yet, but here's me getting a flu shot a few years ago. (I've gotten the FluMist for the past few years...)

Nasal Flu Vaccine (FluMist) Update

• The ACIP has advised that the attenuated influenza vaccine (LAIV), AKA “nasal spray” flu vaccine (FluMist), should not be used in kids during the 2016-2017 flu season. 
• About 8% of all flu vaccines were projected to be FluMist this year.
• FluMist uses live but weakened strains of flu virus to stimulate the immune system to protect against the flu virus strains in the vaccine.
• Initially FluMist was thought to work better than the injectable flu vaccine -- until the 2013/14 season. 
• The 2015-2016 FluMist is estimated to have been only 3% effective protecting against any strain of flu in children 2 years to 17 years of age. The injectable flu vaccine is estimated to have been 63% effective in this age group.
• The H1N1 component of the vaccine is the part that has not maintained effectiveness and has led to serious illness among people who have had the FluMist.
• The reason for the poor effectiveness of FluMist in recent seasons is not known. One thought is that the same strain in the vaccine year after year does not give the body the boost it needs since it already recognizes the flu strain.
• It has taken several years of data to show a pattern, which is why after the first year the nasal spray didn't seem as effective it was not pulled from the market. 
• There are many things to take into consideration when making flu vaccine recommendations. 

• It is difficult to know the overall number of cases of influenza since many people do not see a doctor when sick. This makes it difficult to assess effectiveness of flu vaccines in general. 

•  Flu vaccine effectiveness varies year to year because the strains of virus that circulate change.

• It could be one lot that wasn’t effective from a process problem, such as poor refrigeration. This is a fixable problem, so does not affect future lots if addressed properly. This was what vaccine manufacturers thought happened in 2014.  

• Studies in the UK do not show the same poor effectiveness in children, so it might be only US FluMist stock that was less effective for an unknown reason. Ongoing surveillance and studies will continue.

• It is possible that the FluMist will once again be recommended. It depends on what they find out most likely caused the decline in effectiveness and if they can overcome that obstacle.

Isn't something better than nothing? (In other words, my child hates shots... can't we just do the nose spray?)

I know many parents will wonder if their child can still get the nose spray because they hate shots. After all, they've had the nasal spray vaccine for several years and have been okay, so it should be fine for them, right? 

While one could argue that if the choice is a flu vaccine that might be less effective is better than no vaccine at all, most of us can see that 3% effectiveness isn't much to rely upon - especially if the injectable vaccine has a better track record. A few minutes of hearing a child cry due to a shot is preferable to watching them get seriously ill or die. I don't want to sound like a fear-monger, but death can be the consequence of influenza. My friend's niece was sadly one of the healthy children who died of flu last season after being vaccinated with the FluMist. Her family will forever wonder if the shot would have saved her life. 

We need to use the information we have to make the best decisions, and that is to use the injectable flu vaccine this season.

If your child fears shots, have them learn why they're important. Don’t Just Vaccinate Your Kids, Teach Them the Science Behind Vaccines has a number of links to games and booklets that can help. Knowledge is power. If your kids know why they're getting a shot, they are more likely to go willingly.

And if that doesn't help, teach them to blow out or cough during the shot. Those tricks really help! More shot survival tips are on Kid's Health.

Flu Vaccine General Facts

• Influenza virus kills between 4,000 and 50,000 people per year in the US. 
• Most deaths from influenza are among infants, elderly, pregnant women, or people with underlying illnesses (such as asthma and immune deficiencies). Some healthy children, teens, and young adults without known risks die from influenza.
• The flu vaccine continues to be recommended for everyone over 6 months of age.
• Every year the flu vaccine targets the anticipated types of flu for the season. This year’s strains are:

o A/California/7/2009 (H1N1)pdm09-like virus
o A/Hong Kong/4801/2014 (H3N2)-like virus
o B/Brisbane/60/2008-like virus (B/Victoria lineage)
o B/Phuket/3073/2013-like virus (B/Yamagata lineage) (quadrivalent vaccine only)

• The CDC does not expect any shortages of flu vaccine at this time despite the FluMist not being used.

Does this prove flu vaccines are not safe or worthwhile? Does our system work?

Many people wonder if this finding and recommendation supports that the flu vaccine in general is not effective and shouldn't be used. I don't think so at all.  

This shows that the continuous monitoring of vaccine safety and effectiveness allows changes to be made to make them more safe and effective. The process works. It takes time and isn't perfect, but it helps to continuously improve the vaccines we have.

I know some are angry that it took "so long" for this to come out. As mentioned above, the process takes time. The government wasn't hiding anything. They had to collect enough data to make an informed decision. Knee jerk reactions with limited information would cause its own problems. 

Scientists are working on a universal flu vaccine. Hopefully that will soon be available and the yearly flu vaccine won't be needed!

Until we know more or have a universal flu vaccine, please follow the ACIP recommendations and get everyone over 6 months of age vaccinated against the flu each season. The more people vaccinated, the better the herd immunity and the better we are all protected!