Fluenz - Groups For Whom FluMist Is Recommended

Groups For Whom FluMist Is Recommended

Influenza vaccine is a cost-effective counter-measure to the threat of seasonal or pandemic outbreaks of influenza.

In Canada, the National Advisory Committee on Immunization (NACI), the group that advises the Public Health Agency of Canada, currently recommends that everyone aged 2 to 64 years be encouraged to receive annual influenza vaccination, and that children between the age of 6 and 24 months, and their household contacts, should be considered a high priority for the flu vaccine.

In February 2008, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended vaccination for all children and teenagers between six months and 18 years of age.

FluMist is a vaccine of demonstrated effectiveness against seasonal influenza. Reviews conducted in 2008 and 2011 suggest that FluMist may be equal to or more effective than injected influenza vaccines in children aged 6–71 months and in children aged 6–17 years.

In 2007, FluMist received additional approval from the U.S. Food and Drug Administration (FDA) extending the age groups it is approved for, to include healthy children two years old and onward. And the CDC's Advisory Committee on Immunization Practices (ACIP), endorsed the needle-free vaccine as a good option for healthy (non-asthmatic) children aged 2 through 4 years. This extended approval supplemented approvals for children over four years of age that were already effective. The sum of these approvals is that FluMist is approved and recommended from the child's 25th month through the adult's 49th year of age.

FluMist is currently recommended for all healthy persons at least two years old and under 50 years of age wishing to protect themselves from influenza and its complications, or to avoid spreading the flu to members of certain vulnerable groups:

"All healthy, non-pregnant persons age 49 yrs and younger who want to reduce the likelihood of becoming ill with influenza, or of spreading it to others who meet any of the criteria listed below:

-Working or living with at-risk people as listed in the section above.

-Healthcare personnel or other persons who provide direct care to at-risk people (except persons in close contact with severely immunosuppressed persons).

-Household contacts and out-of-home caregivers of children age 0–59m.

-Travelers who may be among people from areas of the world where there is current influenza activity (e.g., on organized tours).

-Students or other persons in institutional settings (e.g., dormitory residents)."

For comparison, only Sanofi-Aventis's injectable influenza vaccine is approved for children 7 months of age and older; FluMist is approved after the second year, and other injectable vaccines from four years of age onward. Injectable influenza vaccine approvals have no upper age limit, while FluMist has not yet been tested or presented for FDA approval for use by persons 50 or older.

Within the age groups they are approved for, injectable vaccines do occasionally present mild side effects such as soreness, redness, swelling, fever, and aches, and FluMist sometimes causes brief and mild symptoms such as a runny nose. Side effects of both FluMist and injected vaccines tend to be slightly more prevalent the first year, and to diminish with vaccinations given in subsequent years.

Tests against injected (killed virus) vaccinations have shown that FluMist is more effective than needle shots in preventing influenza, especially in children aged 6 to 17 but one smaller study in adults showed lower effectiveness against influenza B viruses in adults.

In past years when flu vaccine has been in short supply, healthy people were requested to abstain from vaccination early in the season, to leave the limited supply for the most vulnerable groups. Flu vaccine supplies are now abundant, and since healthy people benefit from vaccination they are now encouraged to protect themselves and others by being vaccinated.

The 2007 recommendations by the US Advisory Committee on Immunization Practices (ACIP) include six principal changes or updates. These stress that all persons who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated, and that young children not previously vaccinated should be vaccinated twice, and include these specific recommendations:

ACIP reiterates a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated (see Box and Recommendations for Using TIV and LAIV During the 2007--08 Influenza Season).

ACIP emphasizes that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season (see Timing of Vaccination).

ACIP recommends that health-care administrators consider the level of vaccination coverage among health-care personnel (HCP) to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination) (see Additional Information Regarding Vaccination of Specific Populations).

In 2000, a study found FluMist be well tolerated in 57 adults with asymptomatic HIV and median CD4 counts of 541. The FluMist patient information further clarifies, "Although FluMist was studied in 57 asymptomatic or mildly symptomatic adults with HIV infection, data supporting the safety and effectiveness of FluMist administration in immunocompromised individuals are limited." In 2008, FluMist was tested and found safe for children suffering from HIV and taking anti-retrovirals.

However, the U.S. Centers for Disease Control state clearly that people with HIV/AIDS should not receive FluMist and that advice is augmented by the suggestion that close household contacts or caregivers of severely immunocompromised individuals should not receive FluMist due to transmission risks from individuals immunized with FluMist.

The vaccine was approved for use in the European Union by the European Medicines Agency in 2011. Marketing approval in Europe, where it will be called Fluenz, is for the prevention of seasonal influenza in children aged from two to less than 18 years, though distribution will not likely begin until 2012.

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