FluMist option may be scarce
By Phyllis Moore
Published in News on July 13, 2016 1:46 PM
The FluMist option will be scarce this flu season, since the American Academy of Pediatrics, backed by the Centers for Disease Control and Prevention, is recommending health care providers not use the nasal vaccine.
New data extrapolated from the past three flu seasons reportedly showed that the "live attenuated influenza vaccine," or intranasal spray, has not been as effective in warding off the flu, officials said.
The CDC's advisory committee on immunization practices, or ACIP, had made the interim recommendation last month.
In previous years, the CDC and AAP had endorsed either flu vaccine option -- the injectable, approved for all patients older than 6 months, and the intranasal spray, approved for healthy patients from age 2 to 49.
Representatives from Goldsboro Pediatrics and the Health Department said this week that the FluMist will not be available in their offices.
"We are not going to order any of the mist so we're not giving the nasal mist at all," said Dr. David Tayloe of Goldsboro Pediatrics and a former AAP president, who said it had been determined that the FluMist was only "3 percent effective last year."
"The measles vaccine (for example), by the time you have had two doses of that by the time you're 4 years old, 95 percent or more of people are immune to measles and so the fact that they could not say that the nasal flu vaccine was more than 3 percent effective just means there were a whole lot of people last year that got the flu," he said.
In CDC circles, it was once believed that the nasal vaccine was a "better vaccine" because it was a live virus, Dr. Tayloe said.
"So a lot of us had pushed the people to take the nasal instead of the injectable.," he said. "Now you're going to have to reverse (the position) and we as a practice are not going to be offering the nasal vaccine."
While the flu season doesn't typically ramp up until January or February, health care providers place orders for the vaccine much earlier.
With one less option being made available, there could be fewer flu shots available, the pediatrician said.
"We usually start as early as September so we can get the vaccine in all of our offices," he said. "It takes a number of weeks to make the flu vaccine. So the fact that the CDC is making this announcement in June and we need to start giving (vaccinations) in September, doesn't give the manufacturers time to make more.
"It's going to be a weird flu vaccine experience for us. But we'll do the best we can with it."
He said he is already anticipating backlash from the change.
"We're going to have those people who come in and say, 'I want (my child) to get the flu vaccine but I don't want him to have the shot -- parents promise their child he won't have to get the shot and they'll walk out without getting it until the FluMist comes in," he said. "We're just going to have to start from the beginning this year, educating people that they're going to have to get the flu shot.
"And we don't honestly know when we're going to have the nasal vaccine again."
He said the future for the nasal spray is uncertain, with the current batch likely being tossed out because of the sketchy data. That in turn produces another potential problem.
"It won't surprise me if the price of the injectable goes through the roof because they're taking a loss on the other," Dr. Tayloe said. "I don't know whether (health director) Davin Madden has been told by the state what's going to happen with his supply. We always tell our patients if they come in and we're out, go to the Health Department."
Madden said it will be no problem complying with CDC guidelines.
"We do not carry the FluMist and we never have," he said. "The reason for that is two-fold. No. 1, I know that there had been debates in the past on the effectiveness of it.
"I looked at some of those studies awhile back. They didn't say they weren't effective, just that the intranasal was less effective."
For the Health Department, though, it all boils down to cost of services.
"It's more expensive to purchase (the mist)," he said. "Our job is to provide vaccines to anyone. Anyone can walk into the Health Department in Wayne County and get a flu vaccine. They don't have to have an appointment. They can just walk in.
"We want to keep our costs controlled."
It is cheaper to obtain the injectable, Madden said, because they can get several injections per vial.
"We always do the injectables," echoed Josa Raynor-Vaughn, communicable diseases program manager with the Health Department. "We offered a mist one year, but we didn't have many takers."
The Health Department places its vaccine orders in advance, based upon the previous year's numbers. It can be a gamble, officials said.
Their order can be submitted around February or March and is typically delivered in early September, Mrs. Raynor-Vaughn said.
"Our supply usually is more than the demand," she said. "Usually we send around 200 doses back."
There is a tricky balance, Madden said, since it is difficult to predict how the flu season will unfold.
"A couple years ago the flu season was very active. A lot of people came out and became vaccinated because we had such a high rate of influenza-like illnesses," he said. "We ended up getting two separate supplies because we were filling so many orders."