Immunization Update
Elizabeth Briand
As anyone who has ever sneezed, coughed, and groaned their way through a bout of flu knows, these viruses are not easy to ignore. That’s why every year Americans are encouraged to get their flu vaccinations and help mitigate the average of 200,000 hospitalizations and 36,000 deaths attributed to influenza.
This past September, FDA approved FluMist as the first vaccine that does not need to be administered by a health care professional. The product, which is an option for the current flu season, still requires a prescription and is approved for the prevention of flu caused by influenza virus subtypes A and B for children and adults between the ages of 2 and 49 years.
FluMist is not a new product, but it has been evolving in recent years to include more uses. It first came on the market in 2003 for ages 5 to 49 years, then the age range was expanded to 2 to 49 years in 2007, according to Krista Capehart, PharmD, professor and director of the Wigner Institute for Advanced Pharmacy Practice, Education, and Research at West Virginia University. She said FluMist was for administration by a health care provider, including pharmacists.
Now, this latest approval will permit self-administration for adults up to 49 years old and for parents and caregivers to administer it to children. Some individuals may still choose to have a health care provider administer the FluMist vaccination, but this new FDA approval provides greater flexibility for millions of people.
Experts are hoping that this flexibility could be key in increasing the number of Americans who get an annual flu shot. Fewer than half of all adults received the flu vaccine in the United States in 2023, and just under 56% of children were vaccinated. For children, that represents an 8.3% drop in coverage compared with the 2019 to 2020 prepandemic flu season. Fewer adults have also been getting vaccinated, with coverage the lowest it has been in 7 years.
Accessing FluMist
To get FluMist, patients will need to access the FluMist website where they will complete an online questionnaire that will be reviewed by a pharmacist. Upon approval, the medication will be shipped directly to the individual’s home. FluMist also will continue to be available through physicians’ offices and pharmacies, where the dose can be given by a licensed health care provider.
Not only does this new application improve convenience, it also remains a valued option for people who may forgo the flu shot out of fear.
“Because it is a nasal spray instead of a shot, it is nice for those who are afraid of needles,” said Capehart. This can be especially helpful for small children, reducing the number of shots they need to undergo each year.
For individuals whose employers mandate annual flu vaccinations—health care workers or nursing home staff, for example—the use of FluMist may require a slight revision on how they traditionally report completion of that requirement.
“This will create some significant challenges with ensuring compliance for those mandated to receive the vaccine by their employer,” said Capehart. “However, it is possible that the medication could be self-administered at the workplace to be in compliance or simply administered by a health care provider, as is typical, to still be able to utilize this product.”
Evolving care
In use for more than 2 decades, FluMist may be the evolutionary precursor of other nasal spray viral treatments now in development. This past August, researchers at the University of Houston announced the development of two new nasal sprays to treat and prevent the flu and coronaviruses.
Together, these sprays—NanoSTING and NanoSTING-SN—are designed to address multiple respiratory viruses. In the case of NanoSTING-SN, it also has been shown to fight multiple COVID-19 variants. Discoveries such as these are keeping the momentum going in vaccine development.
“Medication technology is advancing every day,” said Capehart.
Undoubtedly, medication-delivery systems will continue to evolve just as medications always have. ■