Who is eligible for the intranasal influenza vaccine (FluMist) (live attenuated influenza vaccine)?

Intranasal Influenza Vaccine (LAIV/FluMist) Eligibility

The intranasal influenza vaccine (LAIV/FluMist) is approved for healthy, non-pregnant individuals aged 2 through 49 years who do not have chronic medical conditions or other contraindications. 1

Eligible Populations

Age Requirements

• Approved age range: 2 through 49 years 1
• Must be healthy without underlying chronic medical conditions 1
• Not approved for infants under 2 years or adults 50 years and older 1

Health Status Requirements

LAIV can only be given to individuals who are:

• Healthy without chronic disorders of the pulmonary or cardiovascular systems 1
• Free from metabolic diseases including diabetes, renal dysfunction, or hemoglobinopathies 1
• Not immunodeficient or receiving immunosuppressive therapies 1
• Not pregnant 1

Absolute Contraindications

Medical Contraindications

The following groups must not receive LAIV:

• Children under 2 years or adults 50 years and older 1
• Persons with asthma, reactive airways disease, or chronic pulmonary/cardiovascular disorders 1
• Individuals with chronic metabolic diseases (diabetes, renal dysfunction, hemoglobinopathies) 1
• Immunodeficient persons or those on immunosuppressive therapy 1
• Pregnant women 1
• Children/adolescents receiving aspirin or salicylates (due to Reye's syndrome risk with wild-type influenza) 1
• Persons with history of Guillain-Barré syndrome 1
• Individuals with hypersensitivity/anaphylaxis to vaccine components or eggs 1

Special Pediatric Considerations

• Children aged 2-4 years with history of recurrent wheezing should not receive LAIV 1
• Healthcare providers should consult medical records to identify young children with asthma or recurrent wheezing 1
• The safety of LAIV has not been firmly established in children with chronic medical conditions, including asthma 1

Clinical Algorithm for LAIV Eligibility

Step 1: Verify Age

• Is patient 2-49 years old? If NO → Use inactivated vaccine (IIV) instead 1

Step 2: Assess Health Status

• Does patient have ANY chronic medical condition? If YES → Use IIV instead 1
• Is patient pregnant? If YES → Use IIV instead 1

Step 3: Screen for Specific Contraindications

• History of asthma or reactive airways (especially ages 2-4)? If YES → Use IIV 1
• Taking aspirin/salicylates (children/adolescents)? If YES → Use IIV 1
• Immunocompromised or on immunosuppressive therapy? If YES → Use IIV 1
• History of Guillain-Barré syndrome? If YES → Use IIV 1
• Egg allergy with anaphylaxis? If YES → Contraindicated for both vaccines 1

Step 4: If All Answers Are NO

• Patient is eligible for LAIV 1

Important Clinical Caveats

Common Pitfalls to Avoid

• Do not assume "healthy" means absence of acute illness only—chronic conditions of any type are contraindications 1
• Do not give LAIV to healthcare workers or household contacts who care for severely immunocompromised persons requiring protective isolation, as vaccine virus can be shed 1
• Do not confuse mild egg allergy with anaphylaxis—less severe or local manifestations of egg allergy are not contraindications, but anaphylaxis is 1
• For children 2-4 years, actively screen for wheezing history, as this is easily missed but represents a contraindication 1

When IIV Should Be Used Instead

If any contraindication exists, use inactivated influenza vaccine (IIV), which is approved for persons 6 months and older, including those with chronic medical conditions 1. The inactivated vaccine is the safer choice for all high-risk populations and provides substantial protection despite being administered by injection rather than intranasally 1.