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2007-08 INFLUENZA PREVENTION & CONTROL RECOMMENDATIONS

Comparisons of LAIV and TAIV Efficacy

On October 24, 2007 CDC's Advisory Committee on Immunization Practices (ACIP) recommended expanding the use of the nasal influenza vaccine LAIV (FluMist®) to include healthy children ages 2-4 years old (24-59 months old) without a history of asthma or recurrent wheezing. The vaccine continues to be recommended for healthy persons ages 5-49 years who are not pregnant. "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

NOTE: For 2008-09 Influenza Prevention and Control Recommendations see Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008. MMWR 2008 Jul 17; Early Release:1-60. (Also available as PDF, 586K).

NOTE: The text below is taken directly from Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007 Jul 13;56(RR06):1-54. Also available as PDF (720K).

Both TIV and LAIV have been demonstrated to be effective in children and adults, but data directly comparing the efficacy or effectiveness of these two types of influenza vaccines are limited. Studies comparing the efficacy of TIV to that of LAIV have been conducted in a variety of settings and populations using several different clinical endpoints. One randomized, double-blind, placebo-controlled challenge study among 92 healthy adults aged 18–41 years assessed the efficacy of both LAIV and TIV in preventing influenza infection when challenged with wild-type strains that were antigenically similar to vaccine strains. The overall efficacy in preventing laboratory-documented influenza from all three influenza strains combined was 85% and 71%, respectively, when challenged 28 days after vaccination by viruses to which study participants were susceptible before vaccination. The difference in efficacy between the two vaccines was not statistically significant in this limited study, but efficacy at timepoints later than 28 days after vaccination was not determined. In a randomized, double-blind, placebo-controlled trial, conducted among young adults during an influenza season when the majority of circulating H3N2 viruses were antigenically drifted from that season’s vaccine viruses, the efficacy of LAIV and TIV against culture-confirmed influenza was 57% and 77%, respectively. The difference in efficacy was not statistically significant and was based largely upon a difference in efficacy against influenza B.

Although LAIV is not currently licensed for use in children younger than 5 years of age, or in persons with risk factors for influenza complications, several studies have compared the efficacy of LAIV to TIV in these groups. LAIV provided 32% increased protection in preventing culture-confirmed influenza compared with TIV in one study conducted among children aged 6 years and older and adolescents with asthma and 52% increased protection among children aged 6–71 months with recurrent respiratory tract infections. Another study conducted among children aged 6–71 months during 2004– 2005 demonstrated a 55% reduction in cases of cultureconfirmed influenza among children who received LAIV compared with those who received TIV.

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