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Q+A: CDC Recommends Against Nasal Flu Vaccine, Back to Needles

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Those looking to avoid the needle during this year’s flu season may be out of luck.

The Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) has recommended against the use of FluMist, a nasal mist influenza vaccine.

Approved for use in people who were between two and 49 years old, the vaccination method was viewed as a good alternative to the traditional flu shot by pediatricians hoping to avoid administering another shot to children. On top of that, FluMist was believed to be most effective in children under eight years old, making it especially appealing for the younger set.

However, the recommendation by the committee will likely bring an end to that. Esther Chernak, MD, an associate professor in the Drexel’s Dornsife School of Public Health and an infectious disease physician, said the recommendation may be revisited since it’s classified as “interim,” but the evidence is against it.

“The recommendation this week results from a review of recent data from the last three flu seasons,” Chernak explained. “It suggests that despite earlier evidence, the nasal spray vaccine is actually less effective than the shot — and it appeared to have no protective benefit in the last flu season, especially when compared to shots, which were 63 percent effective against preventing the disease.”

Chernak talked about the decision and what it might mean in the public health arena.

Why might nasal flu mist vaccines be ineffective?

The reasons for the nasal flu vaccine’s poor performance aren’t clear. It is a “live” vaccine (that uses a significantly weakened version of the virus) and it is also administered in the same way that people actually are exposed to the flu — features that should improve its effectiveness. But for some reason, they do not.

It may have something to do with the way the vaccine is prepared, manufactured, or handled; or in the host response to the way it is given.

How much of a public health issue is the flu? And how effective are the vaccines, usually?

The effectiveness of the flu vaccine varies from year to year, as the strains that circulate every season may be hard to predict and aren’t always a good match to the strains in the vaccine. The flu causes millions of illnesses each year, and is responsible for thousands of deaths.

Despite this challenge, the vaccines generally prevent between 50 and 65 percent of flu cases — saving literally thousands of lives and keeping even more people out of the hospital and doctor’s office. The statistics show the vaccine isn’t perfect, but it’s still the best way to avoid the flu.

Do you think that the absence of a non-needle option might dissuade too many people from getting vaccinated?

The loss of the nasal vaccine is unfortunate. The CDC reports that up to a third of flu shots given to children were this type of vaccine. But the flu can be a dangerous disease and hopefully people will understand a shot that takes a few seconds to give is a small price to pay for avoiding a disease that can put you in the hospital or even kill you.

Is trying to expand beyond a shot for the flu vaccine is a good idea? Or are needles just the best option?

Vaccines that can be given without a shot — for the flu and for other infections — are sorely needed (no pun intended). The availability of an oral polio vaccine has helped make polio elimination a reality in many countries today.

But it seems we’re not there yet with flu vaccines. There’s more research to be done.

Media interested in speaking with Chernak should contact Frank Otto at 215.571.4244 or

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