For the 2019-2020 influenza season, the Centers for Disease Control and American Academy of Pediatrics deemed FluMist, the nasal flu vaccine spray, safe and is recommended for patients 2 through 49 years of age.

This is especially beneficial for pediatric patients who are hesitant about needles, as well as children who would not otherwise receive the vaccine.

“Every effort should be made to ensure that all children receive their influenza vaccine every year before influenza viruses begin circulating in the community,” Flor M. Munoz, MD, FAAP, a member of the AAP Committee on Infectious Diseases, said. “Any licensed influenza vaccine given as indicated for age and health status can be used to protect children against influenza in 2019-’20.”

In the 2016-17 and 2017-18 flu season, the AAP and CDC did not recommend the nasal spray due to poor effectiveness against the H1N1 strains. Since then, manufacturer AstraZeneca changed the formulation to include a new strain that would produce better antibody responses. 

However, AstraZeneca struggled in growing two of this year’s flu virus strains. As a result, it’s been announced that the company shipped only three lots of FluMist to the U.S. for this season. Three lots, comprising approximately 758,000 doses, are one-third the number shipped last year. Pediatricians in places such as Israel and Canada were informed there would be no FluMist available for this season.

FluMist is a live, attenuated influenza (LAIV) vaccine that is sprayed into the nose. It can be used in children, adolescents, and adults ages 2 through 49. Possible side effects include muscle aches, vomiting, fever, sore throat, and cough. In addition, runny nose or nasal congestion, wheezing, and headache may occur.

The CDC's Advisory Committee on Immunization Practices made a preferential recommendation for FluMist in healthy kids ages 2 to 8 in 2014 since it seemed to provide better protection. This was reversed the next year due to a disappointing performance against the 2009 H1N1 strain.

AstraZeneca presented results from a U.S. study in children ages 2 to 4 on shedding and antibody responses of the H1N1 strain in the latest version of the quadrivalent vaccine. The results showed that the 2017-18 post-pandemic 2009 H1N1 LAIV strain performed significantly better than the 2015-16 post-pandemic LAIV strain. As such, the CDC's Advisory Committee voted to include FluMist in the vaccine line-up for the 2018-19 flu season. For the 2019-20 season, the AAP did not express a preference between the flu shot and nasal spray vaccine for children.