During the June 2016 ACIP meeting, the committee recommended against use of the nasal spray influenza vaccine (LAIV) for the 2016-2017 influenza season. This version of the influenza vaccine was expected to represent about 8 percent of the season’s vaccine stock, and previous vaccination usage suggest that about one-third of children vaccinated against influenza received the nasal spray. So, why did the ACIP recommend this and what should you tell patients?
What happened with LAIV?
LAIV effectiveness in children between 2 and 17 years of age during the 2015-2016 season was found to be only about 3 percent (CI -49 to 37 percent) compared with about 63 percent (CI 52 to 72 percent) in the same age group who received any other version of influenza vaccine (IIV). These findings follow two previous seasons during which LAIV effectiveness was also lower than expected. The reasons for this ineffectiveness have yet to be determined; however, researchers will be looking at a few different possibilities. Watch this video of Dr. Offit explaining some of these ideas. This LAIV recommendation is considered to be an interim recommendation. Therefore, once the problem is better understood, and assuming it can be resolved, it is possible that nasal spray inoculations will resume at some point in the future.
What do we know about influenza vaccine supply for the 2016-2017 season as a result of the LAIV situation?
Early projections of influenza vaccine supply for the upcoming season were between 171 and 176 million doses, of which LAIV represented about 14 million doses. It is expected that the IIV supply will be sufficient to meet demand although providers are being advised that they may need to contact more than one supplier.
Providers who have pre-ordered vaccine are recommended to contact the manufacturer or provider for additional information related to their specific situation.
What should we tell patients?
First, be honest about what we know and do not know about the LAIV situation. Second, reassure patients that the vaccine supply will be sufficient such that anyone who wants an influenza vaccine should be able to get one. For patients who want the nasal version, let them know that although the vaccine is not recommended this season, the hope is that once researchers figure out what happened, the vaccine will return to the list of recommended influenza vaccine options. Finally, use the opportunity to point out that this is why vaccines continue to be monitored once they become available and that this situation should provide reassurance that when a concern arises, it is addressed.
VEC resources update
We have updated our website to reflect these changes and posted a news story and video to address this issue.
The English version Q&A, Influenza: What you should know, has been updated and will be available in Spanish and print versions in the coming weeks. The online videos, mobile app and trivia game have also been updated.
Watch for updates to our booklets in the coming weeks.
Information from the CDC — Media statement
Information on Medscape — Dr. Offit discusses “The Rise and Fall of Flumist — Can the Nasal Spray Flu Vaccine Be Redeemed?”