live attenuated influenza virus vaccine; LAIV (FluMist, FluMist Quadrivalent)

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Introduction

Influenza vaccine given as nasal spray. (FDA approved 2003)

Indications

Contraindications

Dosage

  • single dose nasal spray 0.5 mL
  • previously unvaccinated children 5-8 years of age receive 2 doses 60 days apart

Avoid antiviral agents for 2 weeks after administration[4]

Store at -15 degrees C* (use frost-free freezer[3])

May be thawed in refrigerator 24 hours before use

Shelf life: 18 weeks (2014)[13]

* 2007 formulation may be refrigerated[6]

* good for 8 hours at room temperature

Adverse effects

Mechanism of action

Notes

* Cost (2003) about $46, about $20 2007[6]

More general terms

References

  1. Prescriber's Letter 10(7):37 2003
  2. 2.0 2.1 2.2 2.3 Journal Watch 23(18):147, 2003 http://www.fda.gov/cber/label/infimed061703lb.pdf http://www.fda.gov/bbs/topic/NEWS/2003/NEW00913.html
  3. 3.0 3.1 Prescriber's Letter 10(10):56 2003
  4. 4.0 4.1 Prescriber's Letter 11(1):1 2004
  5. 5.0 5.1 Prescriber's Letter 11(9): 2004
  6. 6.0 6.1 6.2 6.3 Prescriber's Letter 14(9): 2007 Immunization Update 2007 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230923&pb=PRL (subscription needed) http://www.prescribersletter.com
  7. 7.0 7.1 Prescriber's Letter 14(10): 2007 Selected Issues in the Effective and Safe Use of Live Virus Vaccines. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231009&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. US Food and Drug Administration (FDA). FDA News. FDA approves nasal influenza vaccine for use in younger children. 2007, Sept 19 http://www.fda.gov/bbs/topics/NEWS/2007/NEW01705.html
  9. Prescriber's Letter 15(10): 2008 CHART: Stability of Refrigerated and Frozen Drugs TECHNICIAN TRAINING TUTORIAL: Handling Refrigerated Drugs and Vaccines Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241001&pb=PRL (subscription needed) http://www.prescribersletter.com
  10. 10.0 10.1 FDA News Release: Feb. 29, 2012 FDA approves first quadrivalent vaccine to prevent seasonal influenza http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm294057.htm
  11. 11.0 11.1 11.2 11.3 Ambrose CS et al Current Status of Live Attenuated Influenza Vaccine in the United States for Seasonal and Pandemic Influenza. Influenza Resp Viruses. 2008;2(6):193-202. on Medscape http://www.medscape.com/viewarticle/588302_2
  12. 12.0 12.1 Kelley KJ. Sofair A and Chavey WE (editors) CDC Panel Recommends Nasal Flu Vaccine Over Shot for Kids Physician's First Watch, June 27 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  13. 13.0 13.1 13.2 Haber P et al. Centers for Disease Control and Prevention (CDC) Notes from the Field: Reports of Expired Live Attenuated Influenza Vaccine Being Administered - United States, 2007- 2014. MMWR. Weekly. September 5, 2014 / 63(35);773-773 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6335a3.htm
  14. 14.0 14.1 Grohskopf LA et al Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 Influenza Season. MMWR. August 7, 2015 / 64(30);818-825 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm
  15. 15.0 15.1 Turner PJ et al Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study. BMJ 2015;351:h6291 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26645895 <Internet> http://www.bmj.com/content/351/bmj.h6291
    Greenhawt M. Live attenuated influenza vaccine for children with egg allergy. BMJ 2015 Dec 9; 351:h6656. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26657778 <Internet> http://www.bmj.com/content/351/bmj.h6656
  16. 16.0 16.1 Centers for Disease Control and Prevention (CDC) VACCINE INFORMATION STATEMENT. Influenza (Flu) Vaccine (Live, Intranasal): What You Need to Know. Information Fact Sheet. Feb. 2016 http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.pdf
  17. 17.0 17.1 Centers for Disease Control and Prevention (CDC) ACIP votes down use of LAIV for 2016-2017 flu season. http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
    American Academy of Pediatrics AAP Supports ACIP Recommendation for Use of Inactivated Flu Vaccine. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Supports-ACIP-Recommendation-for-Use-of-Inactivated-Flu-Vaccine.aspx
    COMMITTEE ON INFECTIOUS DISEASES Recommendations for Prevention and Control of Influenza in Children, 2016-2017 Pediatrics Sep 2016, e20162527 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27600320
  18. 18.0 18.1 Loeb M, Russell ML, Manning V Live Attenuated Versus Inactivated Influenza Vaccine in Hutterite Children: A Cluster Randomized Blinded Trial. Ann Intern Med. Published online 16 August 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27538259 <Internet> http://annals.org/article.aspx?articleid=2543271
  19. 19.0 19.1 Kim DK, Riley LE, Harrima KH et al Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017. Ann Intern Med. 2017;166(3):209-219 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28166560 <Internet> http://annals.org/aim/article/2601209/recommended-immunization-schedule-adults-aged-19-years-older-united-states
  20. 20.0 20.1 NEJM JWatch Editors Live Attenuated Flu Vaccine Coming Back in 2018-19. Physician's First Watch, Feb 22, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    Fox M FluMist nasal flu vaccine can come back, vaccine advisers say. NBC News. Feb 22, 2018 https://www.nbcnews.com/health/health-news/flumist-nasal-flu-vaccine-can-come-back-vaccine-advisers-say-n849986
    Walker M ACIP Reinstates FluMist for 2018-2019 Flu Season Committee persuaded by new efficacy analyses. MedPage Today. February 21, 2018 https://www.medpagetoday.com/meetingcoverage/acip/71298
  21. 21.0 21.1 McLean HQ, Caspard H, Griffin MR et al Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine. JAMA Netw Open. 2018;1(6):e183742 Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2709714
    Cobey S Repeated Vaccination May Protect Children From Influenza Infection. JAMA Netw Open. 2018;1(6):e183730 Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2709711