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CDC may recommend nasal flu spray for children

| Thursday, Nov. 22, 2012, 4:54 p.m.

When it comes to flu vaccines, most kids clearly and loudly prefer the nasal spray, at least compared with the traditional shot in the arm.

As it turns out, those instincts are right on the nose.

With mounting evidence that the FluMist nasal spray works much better in kids than an injection, flu experts are considering whether the Centers for Disease Control and Prevention should steer young children toward the less painful alternative.

The deliberations reflect a growing sense among infectious disease experts that people of different ages may get better protection from different types of vaccines, says Gregory Poland, a professor at the Mayo Clinic in Minnesota and an adviser to the CDC.

The CDC issues only general recommendations for the flu. The agency encourages everyone older than 6 months to get an annual flu vaccine, but it does not specify which kind.

An influenza work group, part of the CDC's Advisory Committee on Immunization Practices, is considering whether the CDC should begin tailoring those recommendations, by expressing a preference for FluMist in healthy kids ages 2 to 8, says Poland, a group member.

“We've treated all flu vaccines the same, but they are not,” says Arnold Monto, a professor at the University of Michigan School of Public Health. “We're moving away from a one-size-fits-all flu vaccine.”

Canada and the United Kingdom express a preference for nasal spray vaccines for children.

A person's immune system changes with age, says Robert Belshe, director of the vaccine center at St. Louis University.

In a study of children published in The New England Journal of Medicine, Belshe found that kids who got FluMist were half as likely to get influenza as those given an injection.

FluMist offered broader protection than the shot, even when the strain of flu virus in circulation wasn't a good match to the strain used in the vaccine, his study found.

In that study, about 5 percent of children vaccinated with FluMist came down with influenza, compared with 10 percent of those given an injection.

Not all kids can get FluMist, Belshe says. While injectable vaccines are approved for those older than 6 months, FluMist isn't recommended for kids with asthma or babies younger than 2, because of a slightly increased risk of wheezing.

Young children seem to respond better than older kids and adults to FluMist, which uses a live, but weakened, virus that can't cause influenza, Belshe says. FluMist doesn't cause the flu because the viruses are specially engineered to grow only at the relatively cool temperatures of the nose. The viruses in FluMist can't reproduce in the lungs, which are a degree or two warmer, says Chris Ambrose, vice president for medical and scientific affairs at MedImmune, which makes FluMist.

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