While the numbers are starting to go down and it looks like this year's record-setting flu season is ending, the CDC and other health experts are still trying to make sure that flu vaccinations are as effective as possible. Each flu season brings with it a few different strains of the virus, and no immunization can prevent every case of the flu.
For the past two years, a flu vaccine that is applied nasally as a spray of tiny droplets has been unavailable because the manufacturers could not make a formulation that was effective against some of the most common strains of flu that impact children. That could change for next year, however.
The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts that, along with the CDC, develop policy and recommendations on vaccines. Each year, they issue recommendations on more than 20 specific vaccines as well as guidelines on a variety of immunization and public health concerns. Astra Zeneca, a pharmaceutical company, makes the only needle-free flu vaccine on the market. It's been approved by the FDA since 2003 and has never been stripped of that approval; however, for the past two years, the ACIP has refused to recommend it. Drug companies will put a product on the market without an ACIP recommendation, even though they would be allowed to market and sell any medication that has FDA approval. If a drug is classified as "Recommended" by the ACIP, insurance companies must cover it.
The recommendation was hardly a ringing endorsement, however. The announcement read, "For the 2018-19 season, immunization providers may choose to administer any licensed, age-appropriate, influenza vaccine (including LAIV, IIV, and RIV). LAIV4 is an option for influenza vaccination for persons for whom it is otherwise appropriate." The vote to place FluMist back on the list of vaccines that can be used was 12-2. In an NBC news article, Dr. Henry Bernstein, a professor of pediatrics at Cohen Children's Medical Center in New York and a member of the ACIP was quoted, saying, "I have real mixed emotions about this because I think we want to protect as many people as we can, particularly, as a pediatrician, for children." Dr. Grace Lee, the other vote on the ACIP against recommendation was also quoted, stating, "It's better than nothing."
The concern is that if a particular vaccine is recommended and then doesn't work, the public will be less likely to get vaccinated against the flu because of low confidence in its effectiveness. In both the 2016-17 flu season and this year, FluMist was not recommended because it was found that it was less than 3% effective against H1N1, which was a dominant strain of the virus. Each year different strains of influenza circulate and knowing which one will be most common is sometimes difficult to predict. Also, FluMist is a live attenuated vaccine, whereas other vaccines are inactive or genetically engineered, so patients with some health conditions are not able to use it.
Hopefully, now that one of the worst flu seasons is finally starting to subside, the focus can shift to making next year's vaccines more effective. The video below has additional information, check it out and stay well, it's almost over.