Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine)
Questions & Answers
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- What flu viruses does the nasal spray vaccine protect against?
- Are any of the available flu vaccines recommended over the others?
- Who can be vaccinated with the nasal spray flu vaccine?
- Who should not be vaccinated with the nasal spray flu vaccine?
- How effective is the nasal spray seasonal flu vaccine?
- Should the nasal spray flu vaccine be given to patients with chronic diseases?
- Should pregnant and postpartum women avoid contact with people who were recently vaccinated with the nasal spray vaccine?
- Are there any contraindications to giving breastfeeding mothers the nasal spray vaccine?
- Can the nasal spray flu vaccine be given to patients when they are ill?
- Can people receiving the nasal spray flu vaccine pass the vaccine viruses to others?
- Can contacts of people with weakened immune systems get the nasal spray flu vaccine?
- What side effects are associated with the nasal spray flu vaccine?
- When should the nasal spray flu vaccine be given?
- How often should the nasal spray flu vaccine be given?
- Can people who received inactivated influenza vaccine (the flu shot) last year get the nasal spray flu vaccine this year?
- Can the nasal spray flu vaccine be given while taking influenza antiviral medications?
- Are there special vaccination instructions for children?
- Does the nasal spray flu vaccine contain thimerosal?
- Can the nasal spray flu vaccine give you the flu?
All nasal spray vaccines for the 2013-14 season will provide protection against four flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and two influenza B viruses.
CDC has not expressed a preference for which flu vaccine people should get this season except for one: Starting in 2014-2015, CDC recommends use of the nasal spray vaccine in healthy children 2 to 8 years of age when it is immediately available and if the child has no contraindications or precautions to that vaccine. If the nasal spray vaccine is not immediately available and the flu shot is, vaccination should not be delayed and a flu shot should be given. For more information about the new CDC recommendation, see Nasal Spray Flu Vaccine in Children 2-8 Years Old or the 2014-2015 MMWR Influenza Vaccine Recommendations.
While there will be more than one vaccine option for many people to choose from, including high-dose vaccine, intradermal vaccine and the regular flu shot, the only preferential recommendation is for the nasal spray vaccine in children 2 to 8 years of age. 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 health care provider.
The nasal spray is approved for use in healthy* people 2 through 49 years of age who are not pregnant.
- 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 with asthma
- Children or adolescents on long-term aspirin treatment.
- Children and adults who have chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic disorders
- Children and adults who have immunosuppression (including immunosuppression caused by medications or by HIV)
- Pregnant women
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 influenza vaccines.
Influenza vaccine effectiveness (VE) can vary from year to year and among different age and risk groups. 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.
No. The nasal spray flu vaccine is approved for use only in healthy* people 2 through 49 years of age who are not pregnant.
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 vaccine. However, the nasal spray vaccine is not licensed for use in women who are pregnant. Postpartum women can receive the flu shot or the nasal spray vaccine.
Breastfeeding is not a contraindication for the nasal spray vaccine. See Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immunization Practices (ACIP), May 28, 2004, for a list of contraindications for the nasal spray vaccine.
The nasal spray flu vaccine can be given to people with minor 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, then delaying of vaccination until the nasal congestion is reduced should be considered.
Yes, but its rare. Data indicate that both children and adults vaccinated with nasal spray can shed vaccine viruses after vaccination, although in lower amounts than occur typically with 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.
See Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2013-14: Live Attenuated Influenza Vaccines: Shedding, Transmission, and Stability of Vaccine Viruses for more information.
People who are in contact with others with severely weakened immune systems when they are being cared for in a protective environment (for example, people with hematopoietic stem cell transplants), should not get 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.
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.
Flu vaccination should begin soon after vaccine is available, ideally 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.
One dose of LAIV should be given during each influenza season. Some children 6 months through 8 years of age require 2 doses of influenza vaccine and should receive the two doses at least 28 or more days apart. Your child’s health care provider can tell you whether two doses are recommended for your child.
Can people who received inactivated influenza vaccine (the 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.
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.
Some children 6 months through 8 years of age require 2 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 will also need two doses. Your child’s health care provider can tell you whether two doses are recommended for your child. Children 6 months up to 2 years of age should only receive the flu shot (TIV).
The 2009 H1N1 virus continues to circulate. The seasonal flu vaccine wasn’t formulated to protect against the 2009 H1N1 virus until the 2010-2011 flu season. This means that children who did not get the monovalent 2009 H1N1 vaccine in 2009-2010, or a seasonal flu vaccine in 2010-2011 or later, will not be fully protected from the 2009 H1N1 virus until they receive two doses of the 2013-2014 flu vaccine.
No, the nasal spray flu vaccine does not contain thimerosal or any other preservative.
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 2-17 years of age have reported experiencing mild reactions after receiving nasal spray flu vaccine, including runny nose, nasal congestion or cough, chills, tiredness/weakness, sore throat and headache. Some adults 18-49 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.
* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.
- Page last reviewed: September 10, 2013
- Page last updated: August 14, 2014
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