Preparing for a Flu Season without FluMist

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Kaiser Permanente has ordered additional flu shots and flu vaccine program leaders said they do not expect there to be a shortage of the vaccine.

Last month a Centers for Disease Control and Prevention (CDC) advisory committee voted that the nasal spray flu vaccine marketed as FluMist should not be used during the upcoming flu season because data showed it was significantly less effective than the flu shot. In response to that recommendation, leaders of Kaiser Permanente Northern California’s flu vaccine program canceled the region’s order of FluMist and ordered additional flu shots.

The recommendation, which still must be reviewed and approved by the CDC director, was based on data from three previous flu seasons that showed the nasal spray was not as effective as the flu shot.

Preliminary data from last flu season was released in late May from the U.S. Influenza Vaccine Effectiveness Network. It showed the effectiveness of the nasal spray vaccine among children 2 through 17 years old was an estimated 3 percent — too low to offer any measurable protection. By comparison, the flu shot had an estimated effectiveness of 63 percent last season in the same age group.

The nasal spray vaccine was approved by the Food and Drug Administration for anyone 2 to 49 years old. It has accounted for one-third to one-half of all flu vaccines given to children nationally and within Kaiser Permanente.

Look InsideKP Northern California recently spoke with Randy Bergen, MD, Kaiser Permanente Northern California’s clinical lead for the Flu Vaccine Program, to learn more.

How did Kaiser Permanente respond to the CDC committee recommendation?

Our Infectious Disease Chiefs in both Northern and Southern California endorsed the CDC recommendation, and we canceled our entire order of FluMist, which was 120,000 doses this year. FluMist is a relatively small percentage of the 1.5 million doses of flu vaccine we give each year, and we have already purchased additional injectable vaccine to make up for those doses.

This is happening early enough in the season that the vaccine companies can ramp up their production, and there should not be any flu vaccine shortages.

The American Academy of Pediatrics also endorsed the advisory committee’s recommendation not to use FluMist this year. This is a dramatic change, but data on the effectiveness of the nasal spray has been disappointing for three flu seasons. Once I saw the latest data that the CDC committee had, I realized they really didn’t have a choice.

The CDC said the reason for FluMist’s recent poor performance is not known. Once scientists understand the problem, hopefully, they will improve the vaccine, and we may be able to offer a nasal spray again in future years.

What does this recommendation say about how we evaluate vaccines?

People should be reassured that the doctors of this country are monitoring the safety and effectiveness of vaccines, and we are making decisions based on the most up-to-date scientific information, even if that information is negative.

The good news is we still have the injectable flu vaccine, and its effectiveness has been pretty consistent over the years. If we can predict the right viral strains for a coming flu season, then we will have a vaccine that is consistently 50 to 70 percent effective.

Any advice for people who don’t like shots?

I understand that some people are afraid of needles, and it can be hard for parents to watch their child get a shot, especially if the child is upset. But a few moments of discomfort is better than being sick for up to two weeks.

The flu vaccine is still the best defense we have to avoid getting the flu and all the serious complications that can go along with it. The Centers for Disease Control and Kaiser Permanente physicians continue to strongly recommend that everyone 6 months and older get the flu vaccine every fall. Vaccine will be available free of charge to employees and physicians beginning in September.

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