Flu Mist or Flu Vaccine?

What you need to know about the flu mist versus a flu shot.

Flu shot reminders abound during fall months. Whether it's a poster at the pharmacy or via emails from your doctor or reminders on your health care app, the push for flu vaccines has begun. For children, an alternative to a flu shot is the flu mist vaccine. We talked to Dr. Kasey Scannell, a pediatrician with Novant Health Symphony Park, to get the lowdown on the flu mist versus the flu shot, and why it is a choice for children.

MH: In 2017, the flu mist wasn't used. Why is that and why is it back as an option for the 2018 flu season?

KS: The flu mist was removed due to questions about it's effectiveness, especially in regards to the influenza A H1N1 strain in younger patients. Interestingly, this lack of effectiveness was mainly noted in the U.S. and not in other countries. The vaccine was removed from the market to be redesigned. The manufacturers have now replaced the particular H1N1 strain (Bolivia strain) with a different H1N1 strain (Slovenia strain). The current studies show much improved shedding in the nose, which is one measure of effectiveness. 

MH: So is the flu mist as effective as the flu shot?

KS: Prior to 2014 we thought it was, but reduced effectiveness was noted in the U.S. in regards to influenza A H1N1 strain. Current studies regarding shedding are promising and further studies after the re-launch of the flu mist will solidify its effectiveness. To complicate matters more, the American Academy of Pediatrics and the Center for Disease Control actually put out contrasting statements on whether the flu mist is recommended this season. Both groups do agree however that any flu vaccine is far better than no vaccine at all. 

MH: What are the pros of the flu mist? What are the cons?

KS: The pro of the flu mist is certainly the means of administration. It is a small amount of fluid sprayed in the nasal passage. Some do not like this sensation, but most prefer it to an injection. As it is placed directly into the nasal passage you may have a slight increased risk of runny nose, sore throat and congestion for a brief period after administration of the vaccine. 

Another difference is that the flu mist is a live attenuated vaccine that contains a weakened live virus versus the flu shot that contains an inactivated or "killed" virus. Both methods are proven to be safe and effective means of vaccination, however live vaccines are sometimes contraindicated if you are in close contact with severely immunocompromised family members. The flu mist vaccine may not be recommended for all patients, such as those under age 2 or those of a certain age that have asthma or other chronic disease. 

Scannell also noted that the supply of flu mist may be somewhat limited due to its new launch this year. She recommends fall as the best time of year to get a flu vaccination and not to wait for the availability of flu mist.

Michele Huggins is the editor of Charlotte Parent magazine.