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Using Nasal Spray Flu Vaccine in Children with Asthma

THE CENTERS for Diseases Control and Prevention (CDC) currently does not recommend using the nasal spray flu vaccine in children with asthma, pointing to an increased risk of exacerbations. However, vaccination is important for this patient population as influenza can exacerbate inflammation of the airways and lungs. Now, a small clinical trial has indicated that the intranasal quadrivalent live attenuated influenza vaccine (LAIV4) is just as safe for children as the intramuscular quadrivalent inactivated influenza vaccine (IIV4). Research was conducted by C. Buddy Creech, Professor of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA, and colleagues.

The study was conducted during the 2018 and 2019 flu seasons at three sites across the USA. In total, 151 participants aged 5–17 years with persistent asthma were enrolled.

Within 42 days of vaccination, 10.8% of children who received LAIV4 experienced an asthma exacerbation compared with 14.7% of those who received IIV4. Among those with mild asthma, one of the 25 children who received LAIV4 experienced an asthma exacerbation versus three of 16 in the IIV4 group. In those with moderate-to-severe asthma, exacerbations occurred in seven of 49 in the LAIV4 group and seven of 52 in the IIV4 group. Based on this, Creech and collaborators commented: “These data add to the compelling safety record of LAIV in children, including those with persistent asthma.”

The research findings also highlighted that there were no significant differences between the two groups in the frequency of chest tightness, cough, unscheduled albuterol use, wheezing, and other asthma-related symptoms within 14 days of administration.

In regard to the wider relevance of their results, the authors noted: “These data support re-examining precautions to using LAIV4 in children with asthma, which could be particularly important during influenza pandemics, at times when IIV4 supplies are limited, in situations of public or school mass vaccination clinics using LAIV, or for children with significant needle aversions.”