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Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine)

Questions & Answers

What flu viruses does the nasal spray vaccine protect against?

All nasal spray flu vaccines for the 2015-2016 season will provide protection against four flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and two influenza B viruses.

Are any of the available flu vaccines recommended over the others?

For the 2015-2016 flu season, ACIP recommends annual influenza vaccination for everyone 6 months and older with either LAIV or IIV with no preference expressed when either vaccine is available.

There are many vaccine options to choose from, but the most important thing is for all people 6 months and older to get a flu vaccine every year. If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

Who can be vaccinated with the nasal spray flu vaccine?

The nasal spray is approved for use in people 2 through 49 years of age.

Who should not be vaccinated with the nasal spray flu vaccine?

  • Children younger than 2 years
  • Adults 50 years and older
  • People with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine
  • People who are allergic to eggs
  • Children or adolescents (2 years through 17 years of age) on long-term aspirin treatment.
  • Pregnant women
  • People with weakened immune systems (immunosuppression)
  • Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months.
  • People who have taken influenza antiviral drugs within the previous 48 hours.
  • People who care for severely immunocompromised persons who require a protective environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine).

There are also other “warnings and precautions” for the nasal spray flu vaccine. These include:

  • People of any age with asthma might be at increased risk for wheezing after getting the nasal spray vaccine.
  • The safety of the nasal spray vaccine has not been established in people with underlying medical conditions that place them at high risk of serious flu complications. This includes children and adults who have lung disease, heart disease (except isolated hypertension), kidney disease (like diabetes), kidney or liver disorders, neurologic/neuromuscular, or metabolic disorders. See “People at High Risk of Developing Flu–Related Complications.” Moderate or severe acute illness with or without fever is a general precaution for vaccination.
  • GBS within 6 weeks following a previous dose of influenza vaccine is considered a precaution for use of all influenza vaccines.

How effective is the nasal spray seasonal flu vaccine?

Influenza vaccine effectiveness (VE) can vary from year to year, among different age and risk groups and by vaccine type. Both the nasal spray vaccine and the flu shot have been shown to be effective in children and adults. While some early studies suggested that the nasal spray vaccine might be more effective in young children, more recent studies have not confirmed that. ACIP and CDC do not have a preference for either the shot or the nasal spray vaccine. For more information about vaccine effectiveness, visit How Well Does the Seasonal Flu Vaccine Work? For information specific to this season, visit About the Current Flu Season.

Should the nasal spray flu vaccine be given to patients with chronic diseases?

There is a precaution against giving the nasal spray flu vaccine to people with certain chronic health conditions because the safety of this vaccine in people with those conditions has not been established.

Should pregnant and postpartum women avoid contact with people who were recently vaccinated with the nasal spray vaccine?

Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with the nasal spray flu vaccine. However, the nasal spray flu vaccine should not be given to women who are pregnant. Postpartum women can receive the flu shot or the nasal spray flu vaccine.

Are there any contraindications to giving breastfeeding mothers the nasal spray vaccine?

Breastfeeding is not a contraindication for the nasal spray vaccine. Breastfeeding mothers younger than 50 years can get the nasal spray flu vaccine as long as they don’t have any contraindication to getting that vaccine. See Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) – United States, 2015-2016 Influenza Season - August 7, 2015 for a list of contraindications and precautions for the nasal spray vaccine.

Can the nasal spray flu vaccine be given to patients when they are ill?

The nasal spray flu vaccine can be given to people with mild illnesses (e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, if nasal congestion is present that might limit delivery of the vaccine to the nasal lining. Delaying vaccination with that vaccine until the nasal congestion is reduced should be considered.

Can people who have gotten the nasal spray flu vaccine spread the vaccine viruses to others?

Yes, it is possible, but it is very rare. Data indicate that both children and adults vaccinated with nasal spray flu vaccine can shed vaccine viruses after vaccination, although in lower amounts than typically occurs during shedding of wild-type influenza viruses. Rarely, shed vaccine viruses can be transmitted from vaccine recipients to unvaccinated persons. However, serious illnesses have not been reported among unvaccinated persons who have been infected inadvertently with vaccine viruses.

Can contacts of people with weakened immune systems get the nasal spray flu vaccine?

People who are in contact with others with severely weakened immune systems requiring care in a protective environment (for example, people with hematopoietic stem cell transplants), should not get the nasal spray vaccine, or they should avoid contact with those persons for 7 days following receipt of the nasal spray vaccine. People who have contact with people with weakened (but not severely weakened) immune systems due to underlying illness (e.g. diabetes, asthma, and heart disease, can get the nasal spray vaccine.

What side effects are associated with the nasal spray flu vaccine?

In children, side effects can include runny nose, headache, wheezing, vomiting, muscle aches, and fever. In adults, side effects can include runny nose, headache, sore throat, and cough. Fever is not a common side effect in adults receiving the nasal spray flu vaccine.

When should the nasal spray flu vaccine be given?

Flu vaccination should begin soon after vaccine is available, if possible by October. However, as long as flu viruses are circulating, it’s not too late to get vaccinated, even in January or later. While seasonal influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

Children aged 2 through 8 years who need two doses of vaccine this season should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart. (Children 6 months to 2 years of age should only receive the flu shot.)

How often should the nasal spray flu vaccine be given?

One dose of the nasal spray flu vaccine (or the flu shot) should be given during each influenza season. Some children 6 months through 8 years of age require two doses of influenza vaccine and should receive the two doses at least 28 or more days apart. Your child’s health care professional can tell you whether two doses are recommended for your child.

Can people who got an inactivated influenza vaccine (flu shot) last year get the nasal spray flu vaccine this year?

Yes, people who got inactivated influenza vaccine (the flu shot) last year can get the nasal spray flu vaccine this year, as long as they are within the approved age group to receive the nasal spray vaccine (2-49 years) and have no other contraindications.

Can the nasal spray flu vaccine be given while taking influenza antiviral medications?

No. If a person is taking an influenza antiviral drug (including Tamiflu® or Relenza®), then the nasal spray flu vaccine should not be given until 48 hours after the last dose of the influenza antiviral medication was given. If a person takes antiviral drugs within two weeks of getting the nasal spray flu vaccine, that person should get revaccinated, because the antiviral drugs may prevent the vaccine from working. The flu shot can be given while taking influenza antiviral drugs since the flu shot (given with a needle) does not contain live virus.

Are there special vaccination instructions for children?

Children 6 months to 2 years of age should only receive the flu shot. Also, some children 6 months through 8 years of age will need two doses of influenza vaccine. Children in this age group who are getting vaccinated for the first time will need two doses. Some children who have received influenza vaccine previously also will need two doses. Your child’s health care professional can tell you whether two doses are recommended for your child.

Does the nasal spray flu vaccine contain thimerosal?

No, the nasal spray flu vaccine does not contain thimerosal or any other preservative.

Can the nasal spray flu vaccine give you the flu?

No. While the nasal spray flu vaccine does contain live viruses (unlike the flu shot), the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist. Some children and young adults 2 years through 17 years of age have reported experiencing mild reactions after getting the nasal spray flu vaccine, including runny nose, nasal congestion or cough, chills, tiredness/weakness, sore throat and headache. Some adults 18 years through 49 years of age have reported runny nose or nasal congestion, cough, chills, tiredness/weakness, sore throat and headache. These side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.

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