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Nasal flu vaccine is something to sniff at
New vaccine may increase vaccination rates
Health care workers soon will be able to receive their influenza vaccines with a couple of sniffs instead of a shot in the arm.
FluMist, an intranasal vaccine approved by the Food and Drug Administration in June, is being touted as a mechanism to increase vaccination rates nationally, including rates among health care workers.
Health care workers are a high-priority influenza vaccination group because of the risk of transmitting the disease to patients at high risk for complications. Yet just 38% of health care workers receive the influenza vaccine, according to the 2000 National Health Interview Study.
"FluMist has the potential to really expand our capability to deliver influenza vaccine," says William Schaffner, MD, chairman of the department of preventive medicine at the Vanderbilt University School of Medicine in Nashville, TN, where one of the clinical trials was held. "I think the acceptability will go up."
FluMist uses a live, attenuated virus, and studies show the virus can be detected in the nasopharynx for several days after vaccination. Because there are no data on the risk of transmitting influenza through the nasal vaccine, the Advisory Committee on Immunization Practices, a CDC advisory panel, stated that the inactivated (traditional) vaccine is "preferred for vaccinating household members, health care workers, and others who have close contact with immunosuppressed individuals."
If patients were exposed to the virus from the nasal vaccine, it would be a weakened version. "It’s not going to be as bad an event as an immunocompromised person getting vaccinated with the real flu," Schaffner notes.
Cost expected to be much higher
The biggest barrier to the new vaccine will be price, which is expected to be double or triple the cost of the current vaccine. Schaffner notes that some costs will be eliminated because the nasal spray will not require syringes and needles and will be simpler to administer.
"If you can reduce the impact of flu, you will save money in the end because you won’t be transmitting flu to your patients," notes Paul M. Mendelman, MD, vice president for clinical development at MedImmune in Mountain View, CA, which developed the vaccine. MedImmune will market the vaccine in conjunction with Wyeth Pharmaceuticals.
FluMist comes with some other caveats. The FDA approved its use in healthy children and adolescents ages 5 to 17 and healthy adults ages 18 to 49. Its efficacy has not been established for adults ages 50 to 64, and in clinical trials it was associated with an increase in asthma events for children under the age of five.
It should not be used by people who have asthma or reactive airway disease, an immune deficiency, chronic medical conditions, or by pregnant women. Common adverse events included runny nose/nasal congestion, cough, headache, sore throat, muscle aches, and fever.
Simply changing the method of administering the vaccine won’t necessarily alter the behavior of health care workers, says Jane Siegel, MD, professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas and a member of the Healthcare Infection Control Practices Advisory Committee.
"I think getting rid of the needle isn’t going to solve the problem," she says.
Caution is appropriate with a new vaccine, says Schaffner. But he predicts that, over time, the nasal version will enable the vaccination of a much wider population. "There will be a lot of intense surveillance," he says. "We hope we gain confidence in the vaccine."
(Editor’s note: More information on FluMist is available at www.medimmune.com.)