Indications for FluMist (Live Attenuated Influenza Vaccine)
FluMist is indicated for healthy, nonpregnant persons aged 2 through 49 years who do not have medical conditions that predispose them to complications from influenza. 1
Approved Population and Administration
FluMist is administered intranasally using a prefilled, single-use sprayer containing 0.2 mL of vaccine (0.1 mL in each nostril). The vaccine contains live attenuated influenza viruses that are:
- Cold-adapted (replicate efficiently at 25°C)
- Temperature sensitive (replication restricted at higher temperatures)
- Designed to replicate in the nasopharynx to promote immune response 1
Specific Indications
FluMist is appropriate for:
- Healthy children aged 2-49 years
- Healthy, nonpregnant adults aged 18-49 years
- Individuals who wish to reduce their likelihood of becoming ill with influenza or transmitting it to others 1
- Persons who provide essential community services
- Students or others in institutional settings (e.g., dormitories, correctional facilities) 1
Contraindications
FluMist should NOT be administered to:
- Children younger than 2 years 1
- Adults older than 49 years 1
- Pregnant women 1
- Persons with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine 1
- Children aged 2-4 years with asthma or a history of wheezing in the past 12 months 1
- Persons who are immunocompromised due to any cause 1
- Children and adolescents receiving concomitant aspirin or salicylate-containing medications 1
- Close contacts and caregivers of severely immunocompromised persons requiring a protected environment 1
- Organ transplant recipients 1
Special Considerations
Nasal Congestion
If nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, consider:
- Deferring administration until resolution of the illness, or
- Administering an inactivated influenza vaccine instead 1
Sneezing After Administration
If the vaccine recipient sneezes immediately after administration, the dose should not be repeated 1
Egg Allergy
Because of relative lack of data demonstrating safety of LAIV for persons with egg allergy, egg-allergic persons should receive inactivated influenza vaccine rather than LAIV 1
Effectiveness Considerations
- LAIV has demonstrated greater relative efficacy compared to inactivated influenza vaccine (IIV) in several studies conducted among younger children 1
- A significantly greater relative efficacy of LAIV compared with IIV has been noted in:
- Children aged 6 through 71 months in a randomized, open-label study
- Children aged 6 through 59 months in a randomized blinded trial
- Children with asthma aged 6 through 17 years in a randomized blinded trial 1
Common Side Effects
The most commonly reported reactions to LAIV in children include:
- Runny nose or nasal congestion (32%)
- Headache (13%)
- Decreased activity (10%)
- Sore throat (9%)
- Decreased appetite (6%)
- Muscle aches (4%)
- Fever (7%) 1
Important Precautions
- Moderate or severe acute illness with or without fever is a general precaution for vaccination 1
- Guillain-Barré Syndrome within 6 weeks following a previous dose of influenza vaccine is considered a precaution for use of all influenza vaccines 1
- No concomitant use with influenza antiviral medications: LAIV should not be administered until 48 hours after cessation of influenza antiviral therapy, and influenza antiviral medications should not be administered for 2 weeks after receipt of LAIV 1
By understanding these indications and contraindications, healthcare providers can appropriately select patients for whom FluMist would be a suitable option for influenza prevention.