The Arkansas Department of Health is providing the following update on seasonal and H1N1 flu and the arrival of nasal flu vaccine in the state.
What is the nasal spray flu vaccine?
What is the nasal spray flu vaccine? There are two types of flu vaccine: the flu shot and the nasal spray vaccine. Both types of vaccine are being made against 2009 H1N1. The nasal spray flu vaccine (sometimes called LAIV for Live Attenuated Influenza Vaccine) is a vaccine made with live, weakened viruses that cannot grow at normal body temperature and is given via a nasal sprayer. This vaccine was approved for seasonal influenza viruses in 2003 and tens of millions of doses of the vaccine have been given in the United States.
How is the 2009 H1N1 nasal spray vaccine different from the seasonal nasal spray vaccine?
The 2009 H1N1 nasal spray vaccine is being made in the same way as the seasonal nasal spray vaccine, but instead of containing three weakened live flu viruses, it only contains weakened 2009 H1N1 virus. (That is why it' is called a "monovalent" vaccine.). The recommendations for who can get the 2009 H1N1 nasal spray vaccine are the same as for seasonal nasal spray vaccine. LAIV is recommended for use in healthy* people 2 years to 49 years of age who are not pregnant.
Who should not be vaccinated with the 2009 H1N1 nasal-spray flu vaccine LAIV?
Certain people should not get a nasal spray flu vaccine, including the 2009 H1N1 nasal spray vaccine. This includes:
* People younger than 2 years of age;
* Pregnant women;
* People 50 years of age and older;
* People with a medical condition that places them at higher risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system;
* Children younger than 5 years old with a history of recurrent wheezing;
* Children or adolescents receiving aspirin therapy;
* People who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a flu vaccine,
* People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components.
Are there any contraindications to giving breastfeeding mothers the 2009 H1N1 vaccine?
Breastfeeding is not a contraindication for the nasal spray flu vaccine. Women who are breastfeeding can get the nasal spray vaccine, including 2009 H1N1 vaccine.
Can the nasal-spray flu vaccine be given to patients when they are ill?
The nasal-spray flu vaccine can be given to people with minor illnesses (e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, if nasal congestion is present that might limit delivery of the vaccine to the nasal lining, then delaying of vaccination until the nasal congestion is reduced should be considered.
Can people receiving the nasal-spray flu vaccine LAIV pass the vaccine viruses to others?
In clinical studies, transmission of vaccine viruses to close contacts occurred only rarely. The current estimated risk of getting infected with vaccine virus after close contact with a person vaccinated with the nasal-spray flu vaccine is low (0.6 percent-2.4 percent). Because the viruses are weakened, infection is unlikely to result in influenza illness symptoms since the vaccine viruses have not been shown change into typical or naturally occurring influenza viruses.
What side effects are associated with the nasal-spray flu vaccine?
In children, side effects can include runny nose, headache, wheezing, vomiting, muscle aches, and fever. In adults, side effects can include runny nose, headache, sore throat, and cough. Fever is not a common side effect in adults receiving the nasal spray flu vaccine.
How effective is the nasal-spray seasonal flu vaccine?
In one large study among children aged 15-85 months, the seasonal nasal-spray flu vaccine reduced the chance of influenza illness by 92 percent compared with placebo. In a study among adults, the participants were not specifically tested for influenza. However, the study found 19 percent fewer severe febrile respiratory tract illnesses, 24 percent fewer respiratory tract illnesses with fever, 23-27 percent fewer days of illness, 13-28 percent fewer lost work days, 15-41 percent fewer health care provider visits, and 43-47 percent less use of antibiotics compared with placebo. A recent study suggested that seasonal LAIV may not be as effective as seasonal inactivated vaccine in adults, but more data are needed to confirm if one is better than the other. Both vaccines are expected to be effective against 2009 H1N1.
How many doses of nasal spray vaccine are needed?
In adults, only one dose of 2009 H1N1 vaccine, including the 2009 H1N1 nasal spray vaccine, is needed for protection.
All children 2 through 9 years of age getting a 2009 H1N1 vaccine will need two doses of 2009 H1N1 vaccine (either the 2009 H1N1 flu shot or the 2009 H1N1 nasal spray vaccine), The first dose should being given as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose of vaccine when they need two doses may have reduced or no protection. Be sure to follow up to get your child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.
Can the nasal-spray flu vaccine be given at the same time as other vaccines?
The nasal spray flu vaccine can be given at the same time or around the same time as an inactivated (killed) vaccine or any other live vaccine except for the seasonal nasal spray vaccine. (The seasonal nasal spray vaccine and the 2009 H1N1 nasal spray vaccine should not be given at the same time.) The 2009 H1N1 flu shot (inactivated 2009 H1N1 vaccine) can be given at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine.
Can the 2009 H1N1 nasal spray vaccine and the seasonal nasal spray vaccine be given at the same time to the same person?
No. The seasonal nasal spray vaccine and the 2009 H1N1 nasal spray vaccine should not be given at the same time. This is because the nasal spray vaccines might not be as effective if given together. It is fine to receive the 2009 H1N1 nasal spray at the same time as the seasonal influenza (flu) shot, or the seasonal flu shot at the same time as the 2009 H1N1 nasal spray vaccine.
Can the nasal-spray flu vaccine be used together with influenza antiviral medications?
If a person is taking an influenza antiviral drug (including Tamiflu or Relenza, then the nasal spray flu vaccine should not be given until 48 hours after the last dose of the influenza antiviral medication was given. If a person takes antiviral drugs within two weeks of getting the nasal spray flu vaccine, that person should get revaccinated. (The antiviral drugs will have killed the vaccine viruses that are supposed to cause the immune response against those viruses.)
Can health care workers who cannot receive the nasal spray vaccine (e.g., pregnant women, older adults, persons with chronic medical conditions) administer this vaccine to others?
Yes. Health care workers who cannot get the nasal spray vaccine themselves can administer the vaccine to others.
Does the nasal spray flu vaccine contain thimerosal?
No, neither the seasonal nor the 2009 H1N1 nasal-spray flu vaccines contain thimerosal or any other preservative.
Can the nasal spray flu vaccine give you the flu?
Unlike the flu shot, the nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist. Some children and young adults 2 years to 17 years of age have reported experiencing mild reactions after receiving seasonal nasal spray flu vaccine, including runny nose, nasal congestion or cough, chills, tiredness/weakness, sore throat and headache. Some adults 18 years to 49 years of age have reported runny nose or nasal congestion, cough, chills, tiredness/weakness, sore throat and headache. These side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.
* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.