FluMist® Nasal Spray Influenza Vaccine: Implications for Rheumatology
The Bottom Line:
a newly approved influenza vaccine, is a live attenuated vaccine;
therefore it is contraindicated in immunosuppressed patients
patients should be strongly encouraged to receive vaccination against
influenza using the standard injectable inactivated flu vaccines
- Because of the
theoretical potential for transmission, it is preferred that health
care workers and household contacts of immunosuppressed patients receive
the standard injectable inactivated flu vaccines
What Is FluMist®?
FluMist® is a newly approved (May 2003) live attenuated,
cold-adapted, temperature-sensitive mutant strain influenza vaccine.
The vaccine is approved for the prevention of influenza A and B in
healthy persons age 5-49 years. Like inactivated flu vaccine, it contains
three strains: two “A”strains and one “B”strain.
The formulation will change each year based on surveillance data collected
worldwide. The primary advantage of FluMist® is ease of use and
administration. It is given as a nasal spray. It is as efficacious
as the standard injected trivalent inactivated vaccine. In addition,
antiviral drugs are available for both prevention and treatment of
Side Effects of FluMist®
In 20 clinical trials with over 20,000 subjects, the
most common adverse events were low-grade fever, sore throat, and
runny nose –all self-limited; no serious adverse events have
been reported among patients from 5-49 years old.
- Persons with asthma,
reactive airways disease or other chronic disorders of the pulmonary
or cardiovascular systems; persons with other underlying medical conditions,
including such metabolic diseases as diabetes, renal dysfunction,
and hemoglobinopathies; or persons with known or suspected immunodeficiency
diseases or who are receiving immunosuppressive therapies. For rheumatologists,
this means that patients on chronic corticosteroid therapy, chemotherapy,
and anticytokine therapies, such as anti-TNF or anti IL-1 agents,
and patients who are otherwise immunosuppressed should not be vaccinated.
- Children or adolescents
receiving aspirin or other salicylates (because of the association
of Reye syndrome with wild-type influenza infection)
- Persons with a
history of Guillain-Barré syndrome
- Pregnant women
- Persons with a
history of hypersensitivity, including anaphylaxis, to chicken eggs.
Vaccination in Health
Care Workers and Close Contacts of Immunocompromised Persons
FluMist® vaccine is contraindicated in immunocompromised
persons. Shedding of virus can occur with FluMist®, although no disease
as a result of transmission has yet been detected. Nevertheless, in the absence
of sufficient data, and given the theoretical risk of virus transmission
and infection, the Advisory Committee on Immunization Practices has stated
that it is preferable to give Health Care Workers in contact with immunocompromised
persons the inactivated vaccine.
The acquisition cost of FluMist® is about $46.00/dose
(the acquisition cost for injectable inactivated influenza vaccine
is roughly $7.38 to $10.80; prices may vary somewhat by region and
health care system).
Hotline Authors: Eric
L. Matteson, MD, MPH; Arthur Kavanaugh, MD; Gregory Poland, MD.
Dr. Poland is Professor of Medicine, Molecular Pharmacology and Experimental
Therapeutics, Infectious Diseases and Director of the Mayo Vaccine Research
Group, Mayo Clinic, Rochester, Minnesota
Disclosure: None of the authors has anything to disclose
Hotline is provided
by the ACR Communications and Marketing Committee as a service to members.
This Hotline reflects the views of the author and does not represent
a position statement of the College.
2003 American College of Rheumatology
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