Influenza Vaccine Live Intranasal and GBS

• Generic Name: influenza virus vaccine, live, trivalent
• Dosage Forms: n.a.
• Other Brand Names:

  FluMist 2018-2019, Flumist, FluMist 2010-2011, FluMist 2011-2012, FluMist 2012-2013, FluMist 2013-2014, FluMist 2014-2015, FluMist 2015-2016, FluMist 2016-2017, FluMist Quadrivalent 2019-2020, FluMist Quadrivalent

Prevention of seasonal influenza virus infection in children ≥2 years of age, adolescents, and adults 18 through 49 years of age.

Influenza is an acute viral infection; influenza viruses spread from person to person mainly through large-particle respiratory droplet transmission. In the US, annual epidemics of seasonal influenza occur, usually during the fall or winter. Influenza viruses can cause illness in any age group; children have highest rate of infection. Influenza can exacerbate underlying medical conditions or lead to pneumonia in certain individuals. Adults ≥65 years of age, children <2 years of age, and individuals with chronic medical conditions have highest risk of influenza-related complications and death.

Annual vaccination is the primary means of preventing seasonal influenza and its complications.

CDC Advisory Committee on Immunization Practices (ACIP), AAP, and others recommend routine influenza vaccination for all adults, adolescents, children, and infants ≥6 months of age using an age-appropriate seasonal influenza vaccine, unless contraindicated. Vaccination against seasonal influenza recommended for otherwise healthy individuals as well as those who have medical conditions that put them at increased risk for influenza-related complications or at higher risk for influenza-related outpatient, emergency department, or hospital visits.

Several different types of influenza vaccines may be available in the US for prevention of seasonal influenza: influenza virus vaccine inactivated (IIV), influenza vaccine recombinant (RIV), and influenza vaccine live intranasal (LAIV). Influenza virus vaccine inactivated is available as trivalent formulations containing influenza antigens representing 2 influenza A strains (H1N1 and H3N2) and an influenza B strain (Victoria lineage) and quadrivalent formulations containing antigens representing these 3 influenza strains and another influenza B strain (Yamagata lineage). Influenza vaccine live intranasal and influenza vaccine recombinant are only available as quadrivalent formulations.

Select specific seasonal influenza vaccine based on individual’s age and whether they have certain underlying medical conditions that put them at increased risk of influenza complications (e.g., pregnancy, immunocompromising disease or therapy), are in close contact with severely immunocompromised individuals, or have a personal history that contraindicates use of certain vaccines. For many individuals, more than one vaccine type may be appropriate.

For prevention of influenza in adults, adolescents, children, and infants ≥6 months of age, ACIP and AAP state that when more than a single type of influenza vaccine is appropriate and available, there are no preferential recommendations for any specific vaccine type or trade name, provided an age-appropriate vaccine is chosen based on FDA-labeled indications and contraindications.

ACIP and AAP do not state a preference for a trivalent or quadrivalent formulation. If an age-appropriate vaccine is available and there are no contraindications, do not delay vaccination to obtain a specific product.

Healthy Children ≥2 Years of Age: ACIP and AAP state that either parenteral influenza virus vaccine inactivated or influenza vaccine live intranasal can be used for prevention of seasonal influenza in healthy children ≥2 years of age, provided the specific vaccine is chosen based on FDA-labeled indications and contraindications.

Individuals with altered immunocompetence: Efficacy of influenza vaccine live intranasal not evaluated in individuals with altered immunocompetence. ACIP, IDSA, AAP, and others state that influenza vaccine live intranasal should not be used in children or adults who are immunocompromised because of disease or immunosuppressive therapy. (See Individuals with Altered Immunocompetence under Cautions.) Use age-appropriate seasonal influenza virus vaccine inactivated or influenza vaccine recombinant in such individuals.

Close contacts of individuals with altered immunocompetence: ACIP, IDSA, AAP, and others state that influenza vaccine live intranasal should not be used in health-care workers, household members, or other individuals who have close contact with severely immunocompromised individuals who require care in a protective environment (e.g., hematopoietic stem cell transplant [HSCT] recipients within 2 months after transplant or with graft-versus-host disease [GVHD], individuals with severe combined immune deficiency [SCID]). (See Close Contacts of Individuals with Altered Immunocompetence under Cautions.) Use age-appropriate influenza virus vaccine inactivated or influenza vaccine recombinant in such individuals.

Travelers: All travelers (including those at high risk for influenza complications) who were not vaccinated during the preceding fall or winter should receive seasonal influenza vaccine ≥2 weeks before departure if they will be traveling to the tropics, traveling to the Southern Hemisphere from April through September, or traveling with organized tourist groups at any time of the year. Revaccination not recommended for travelers who received influenza vaccine during the preceding fall and will be traveling during the summer. Risk for exposure to seasonal influenza during travel depends on time of year and destination. In the Northern Hemisphere, influenza season may begin as early as October and extend until May; in the Southern Hemisphere, influenza season may begin in April and last through September. In many tropical and subtropical areas, influenza viruses generally circulate throughout the year.

Seasonal influenza vaccines not effective against all possible strains of influenza, but may be effective against those strains (and possibly closely related strains) represented in the vaccines. (See Limitations of Vaccine Effectiveness under Cautions.)

Current information regarding influenza surveillance and updated recommendations for prevention and treatment of seasonal influenza is available from CDC.