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Flu Shot Vs. Nasal Spray: How To Choose The Right Vaccine For Your Child

by Jenn Rose

After a brief hiatus, FluMist is back on the list of recommended flu vaccines season, and there's understandably a lot of confusing surrounding the drug. If your child, like most, is wary of getting a shot this fall, you might be wondering if kids can get the flu vaccine nasal spray. The short answer: yes, although it may not be the best choice. The Centers for Disease Control and Prevention and the American Academy of Pediatrics endorse both the injectable and nasal mist forms of the flu vaccine, but the groups have differing recommendations with regards to which is best.

"The nasal spray vaccine worked wonderfully for a number of years," Hank Bernstein, D.O. told Consumer Reports. He's a member of both the CDC's Advisory Committee on Immunization Practices and the AAP's Committee on Infectious Diseases. But it's tough to say whether this season's formula will perform as well, Bernstein cautioned. "We just don't know what the vaccine effectiveness will be during the upcoming flu season, especially against the influenza A, H1N1, strain." H1N1 is of particular concern, because FluMist's inefficacy in protecting children against that strain during 2010-2011 through 2016-2017 seasons is what led to the CDC's decision not to recommend it last year.

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All flu vaccines formulations protect against either three or four different type of flus— two influenza A strains and one or two influenza B strains — depending on what's predicted to be most prevalent in a given season. In recent years, FluMist was found to be effective against influenza A H3N2 (a strain of influenza A) as well as influenza B, but failed to adequately protect kids ages 2 through 17 against the 2009 strain of H1N1, also known as the swine flu, according to the CDC. But this year, manufacturer AstraZeneca has reconfigured the H1N1 component of the spray, and lab tests suggest that it will provide better results.

For this reason, the CDC recommends "any licensed, age-appropriate influenza vaccine" for the 2018-2019 flu season, "with no preference expressed for one vaccine over another." Like any drug, the nasal spray is contraindicated for some patients, such as pregnant women, those under age 2 or over age 49, people with a history of severe allergic reaction to flu vaccines, and those with certain medical conditions. Mild, short-lived side effects similar to those from the injectable vaccine may occur, such as runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat, cough.

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However, the AAP isn't convinced by lab tests alone. That group recommends the flu shot as the best choice for most kids, "because it has provided the most consistent protection against all strains of the flu virus in recent years," while conceding that FluMist "may be used this year for children who would not otherwise receive the flu shot, as long as they are 2 years of age or older and healthy without an underlying medical condition."

The flu is no joke; last year, 179 children died from it, and 80 percent of them were unvaccinated. That's the highest recorded number of pediatric deaths due to flu in a single season, barring the 2009 H1N1 pandemic. Bottom line: if there's any way you can hold your child's arm still for about 10 seconds to get a flu shot, do it. But if that's impossible (due to a medical condition or plain old willfulness; I'm not judging), ask your doctor if FluMist is an option. Unlike some other nasal sprays, there's no need to sniff when it's being administered, according to the drug's website, and it's perfectly fine if your child sneezes, blows their nose, or swallows after receiving it, so cooperation isn't an issue. The spray may or may not work as well as the shot this season — only time will tell — but any protection is better than none.