Have Flu Vaccination Rates Changed After CDC Stopped Recommending Nasal Spray?

With more states reporting local flu activity, a new study indicates that influenza vaccination rates among children are holding steady despite changes in vaccine options.

For the week ending October 14—the second week of the 2017-2018 flu season—surveillance data from the Centers for Disease Control and Prevention (CDC) shows a growing flu season across the United States. According to the weekly FluView report, local influenza activity was reported by five states — California, Colorado, Massachusetts, Oklahoma and South Carolina – up from two states the previous week, while the US Virgin Islands and 38 states reported sporadic influenza activity.

On October 24, the New Mexico Department of Health reported the state’s first flu death of the season, involving an 82-year-old man from Bernalillo County who had recently been hospitalized. His death came following an early season flu outbreak in a health care facility that has seen four additional confirmed flu cases. “Now that flu season in New Mexico has started, I want to remind New Mexicans about the importance of getting their annual flu shot,” said department secretary Lynn Gallagher in a recent statement. “Flu vaccination is the single best way to protect you, your family, and the most vulnerable community members, such as those residing in long-term care facilities, from flu and its complications.” Health officials are recommending that everyone aged 6 months and older receive a flu shot by the end of October, especially young children, the elderly, and immunocompromised individuals.

In 2016, the CDC’s Advisory Committee on Immunization Practice voted to stop recommending the nasal spray live attenuated influenza vaccine (LAIV), while continuing to recommend the injectable inactivated influenza vaccine (IIV) or recombinant influenza vaccine for everyone 6 months of age and older. The decision came following data indicating that the nasal spray vaccine was only 3% effective at preventing illness in children ages 2 to 17. In a new study published in the journal Pediatrics, researchers from the Oregon Health Authority examined whether the discontinued use of the LAIV would reduce influenza vaccination rates among children. The paper’s authors looked at immunization rates from the 2012—2013 flu season, when the nasal spray vaccine was still available, through the 2016–2017 flu season. They also analyzed matched cohorts of children selected based on receipt of either a LAIV or an IIV during the 2015–2016 season and assessed the differences in flu shot rates between the cohorts for the 2016–2017 season.

The researchers found that flu vaccination rates did not change following the discontinued recommendation of the nasal spray vaccine. Children who had previously received an IIV in the 2015-2016 season were slightly more likely to receive a shot the following season than those who had received a LAIV that year. “The good news is that there were no significant changes in vaccine rates between 2015-16 and 2016-17 and while those who got IIV in 2015-16 were slightly more likely to return, this difference was not clinically significant compared to those who got LAIV the year before,” said the editor-in-chief of Pediatrics, Lewis First, MD, MA. “Since the new flu recommendations for this year are essentially the same as last and the LAIV continues to not be recommended, this study is helpful and should encourage you to continue to get all your patients in for flu vaccine this year, just as you did last.”

Feature Picture: This image depicts the packaging that contains the MedImmune, Influenza Vaccine Live, Intranasal FluMist Quadrivalent, for 2014-2105. Feature Picture Source: CDC / Heather Richmond, MedImmune.