{"id":1088,"date":"2016-07-05T15:00:01","date_gmt":"2016-07-05T15:00:01","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1088"},"modified":"2017-08-21T10:51:51","modified_gmt":"2017-08-21T10:51:51","slug":"primary-care-corner-with-geoffrey-modest-md-flu-nasal-spray-ineffective","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/07\/05\/primary-care-corner-with-geoffrey-modest-md-flu-nasal-spray-ineffective\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Flu Nasal Spray Ineffective"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>There was a recent CDC evaluation of the effectiveness of the live attenuated flu vaccine (LAIV), finding essentially no protective effect last year (see\u00a0<a href=\"http:\/\/www.cdc.gov\/media\/releases\/2016\/s0622-laiv-flu.html\">http:\/\/www.cdc.gov\/media\/releases\/2016\/s0622-laiv-flu.html<\/a>\u00a0).<\/p>\n<p>Results:<\/p>\n<ul>\n<li>In May, the CDC found\u00a0preliminary data of vaccine effectiveness for those 2-17 yo:\n<ul>\n<li>LAIV: 3% (CI: -49 to 37%), so <strong>no significant effect<\/strong>!!<\/li>\n<li>Inactivated influenza vaccine (IIV): 63% (52-72) effective<\/li>\n<\/ul>\n<\/li>\n<li>Bottom line:\u00a0&#8220;CDC\u2019s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the \u201cnasal spray\u201d flu vaccine, <strong>should\u00a0not\u00a0be used<\/strong> during the 2016-2017 flu season&#8221;<\/li>\n<li>The annual flu vaccine for anyone &gt;6 months old should be one of the shots: the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)<\/li>\n<\/ul>\n<p>Commentary:<\/p>\n<ul>\n<li>There has been a pretty consistently poor showing for LAIV over the past few years: the prior 2 seasons found significantly decreased effectiveness as well. and before then, even when there was pretty much similar effectiveness of LAIV and IIV in kids, there were diminishing effectiveness in adults &gt;30 yo (on my review of the age-based effectiveness published by the CDC)<\/li>\n<li>These results were pretty surprising, since\n<ul>\n<li>LAIV is a live virus, and is associated with higher antibody responses, and some suggestion of more efficacy than IIV with influenza virus genetic drift<\/li>\n<li>The flu virus attacks through the nasal mucosa, and the local\u00a0IgA response to the live vaccine should increase its protection over the injected killed vaccine<\/li>\n<li>Earlier studies found at least equal and some superior efficacy of LAIV: 80% in 2012<\/li>\n<li>There was even early speculation that it could be given less often (perhaps every 2 years, given the increased immunogenicity)<\/li>\n<li>As a result of the above logic, I have been preferentially using LAIV in kids, when appropriate, though not in those &gt;30 yo<\/li>\n<\/ul>\n<\/li>\n<li>So, I am really not sure why there is less effectiveness for the live vaccine over the past several years. But the data speak volumes, given their consistency&#8230;. and we should not use this vaccine on anyone in the upcoming year or in the future, barring documented improvements in technology\/efficacy.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Flu Nasal Spray Ineffective  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/07\/05\/primary-care-corner-with-geoffrey-modest-md-flu-nasal-spray-ineffective\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1088","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1088","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1088"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1088\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1088"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1088"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1088"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}