CDC recommends flu shots over FluMist

Everything needed to give a flu shot is ready for the next person at the Mt. Airy Senior Center n Monday.
Everything needed to give a flu shot is ready for the next person at the Mt. Airy Senior Center n Monday. (KEN KOONS/STAFF PHOTO / Baltimore Sun Media Group)

The Carroll County Health Department is working with health and school officials to develop a new flu vaccination strategy after the U.S. Centers for Disease Control and Prevention issued a recommendation that people get flu shots and not use the nasally administered FluMist vaccine during this coming flu season.

The CDC's Advisory Committee on Immunization Practices voted on Wednesday to recommend that the FluMist, which contains a live, weakened form of the influenza virus, not be used this year after data from 2013 through 2016 indicated the vaccine had been only 3 percent effective. The CDC instead recommended that people use the injectable vaccine, which contains no live virus and was shown to be 63 percent effective.


"That's not to say they are going to stop using FluMist forever, but … the data show that over the last few years the FluMist has not been very effective," said Ed Singer, Carroll County health officer. "Obviously, from a planning and logistics standpoint, that's going to make things very interesting for us because normally at this time of year everybody has their flu vaccine ordered, the injectable kind and the FluMist."

The Maryland Department of Health and Mental Hygiene, Singer said, had already preordered 200,000 doses of the FluMist vaccine, some of which would have been used in the Carroll County Health Department's in-school flu vaccination clinics in the fall.


Now that the injectable vaccine is recommended over the more-easily administered FluMist, Singer said the Health Department is working quickly to develop a new strategy.

"Doing the FluMist during school, as long as we had the parent consent form, was easy. All the kids were there, they got FluMist if they had permission and that was that," he said. "Now, if we are not going to do it during the school day, you don't have that captive audience and we have to get people to come to another location, be it the schools or somewhere else. We are talking through a lot of strategies to see how we're going to reach as many of these kids that we can and to get as many people vaccinated as we can."

It is likely that whatever plan the Health Department settles on will not involve giving flu shots during the school day, Singer said, if just because most nurses prefer to have the parents present when giving injections to children. Schools might still be used as the location for flu clinics, he said, but the exact timing and circumstances remain to be worked out.

The Health Department has not offered flu shot clinics for adults in many years because the vaccine has become so readily available through other providers, particularly retail pharmacies. The problem, according to Singer, is that many such locations do not provide vaccinations for children younger than 9, making it difficult for some children to get vaccinated if not through one of the Health Department's in-school clinics.

"It would be easy if we could just tell them to go somewhere else, but there's really not a place for these folks to go, so we've got to come up with a plan," he said. "We're going to have to do our best to keep the vaccinations numbers up so that we don't have a larger flu outbreak this year because we don't get kids vaccinated."

One boon from the shift from FluMist to injectable vaccines is that the Health Department will now be using only the quadrivalent formula, which contains four different strains of dead virus and, according to Singer, has been shown to be the most effective at preventing flu or mitigating symptoms.

"There are different types of shots out there, and the quadrivalent is the most effective and that is what people should be looking for," he said. "If you are going to get a shot, you might as well get the best that's available."

Despite the logistical challenge for DHMH in shifting from an expected 200,000 doses of FluMist to injectable vaccines, Singer said the CDC does not expect there to be shortages of the injectable vaccine.

"When I read that 8 percent of the vaccinations for flu were vaccinated with FluMist, my first concern was whether there would be enough injectables to go around," he said. "We are being assured from the CDC level that they believe there will be adequate vaccine to cover this gap that is going to be created by not using the FluMist."

As for the decision not to use FluMist itself, both Singer and Deputy Health Officer Dr. Henry Taylor described it as an example of the system working as it is supposed to.

Flu vaccine production is always complicated and a moving target, Taylor said, and there is always some educated guesswork when it comes to deciding how to formulate the vaccines for each flu season — work that is always informed and adjusted according to data from previous years.

FluMist might not be gone forever, but for this year, the safe bet is a shot.


"Vaccine effectiveness is a function of the person's age, the type and subtype [of flu] circulating and the way [the vaccine] is produced. We are still looking at the data," he said. "At this time next year, we will have much more information and it will be reconsidered."



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