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

Questions & Answers

Note: On June 22, 2016, CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a change to U.S. influenza vaccination policy for 2016-2017. The ACIP recommendation must be reviewed and approved by CDC’s Director, and the final recommendations will be published in a CDC Morbidity and Mortality Weekly Report (MMWR), in late summer or early fall. The content of this website will be reviewed and updated prior to the 2016-2017 influenza season.

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, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for everyone 6 months and older with either live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (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 2 years through 17 years of age who are receiving aspirin therapy or aspirin-containing therapy.
  • 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.

People who have ever had a severe allergic reaction to eggs can get recombinant flu vaccine if they are 18 years and older or they should get the regular flu shot (IIV) given by a medical doctor with experience in management of severe allergic conditions. People who have had a mild reaction to egg—that is, one which only involved hives—may get a flu shot with additional safety measures. Recombinant flu vaccines also are an option for people if they are 18 years and older and they do not have any contraindications to that vaccine. Make sure your doctor or health care professional knows about any allergic reactions. Most, but not all, types of flu vaccine contain a small amount of egg.

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