The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) this week recommended against using the intranasal live quadrivalent influenza vaccine (FluMist® Quadrivalent, Astra Zeneca) in the U.S. for the 2016-2017 influenza season.1 Of note, the American College of Rheumatology recommends that killed influenza vaccinations should be given to select patients with chronic inflammatory immune diseases before initiating a disease-modifying antirheumatic drug or a biologic.2
The updated guidance from the ACIP states the vaccine should not be used in any setting, based on CDC vaccine effectiveness data from the last three influenza seasons in the US, which indicated FluMist Quadrivalent did not demonstrate statistically significant effectiveness in children 2-17 years of age.
A statement released by AstraZeneca noted that “the US CDC effectiveness data for 2015-2016 season contrast with studies by AstraZeneca as well as preliminary independent findings by public health authorities in other countries.3
These findings demonstrate FluMist® Quadrivalent was 46-58% effective overall against the circulating influenza strains during the 2015-2016 season. As influenza vaccine effectiveness varies from season to season, it is evaluated in annual observational studies.
The CDC states that when there is a good match between the strains in the vaccine and those that circulate during the influenza season, vaccines are typically 50-60% effective. AstraZeneca is working with the CDC to better understand its data to help ensure eligible patients continue to receive the vaccine in future seasons in the US.”
Recommendations by the ACIP were made following an afternoon of data about influenza vaccines, where the committee heard about vaccine efficacy, as well as safety data.
Vaccine manufacturers had projected that as many as 171 million to 176 million doses of flu vaccine, in all forms, would be available for the United States during the 2016-2017 season. The makers of FluMist® Quadrivalent had projected a supply of as many as 14 million doses of FluMist® Quadrivalent , or about 8 percent of the total projected supply.
In a statement released to the media after the recommendation, officials with the CDC noted: “Today’s ACIP vote could have implications for vaccine providers who have already placed vaccine orders. The ACIP recommendation may particularly affect pediatricians and other vaccine providers for children since data from recent seasons suggests nasal spray flu vaccine accounts for about one-third of all flu vaccines given to children.
CDC will be working with manufacturers throughout the summer to ensure there is enough vaccine supply to meet the demand.”
The ACIP recommendation must be reviewed and approved by CDC’s director before it becomes CDC policy. The final annual recommendations on the prevention and control of influenza with vaccines will be published in a CDC Morbidity and Mortality Weekly Report (MMWR), Recommendations and Reports in late summer or early fall.
1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention Newsroom. ACIP votes down use of LAIV for 2016-2017 flu season. Published online June 22, 2016. Accessed June 23, 2016. Source code.
2. Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2016;68(1):1-25.
3. Astra Zeneca Media Relations. AstraZeneca provides update on FluMist Quadrivalent vaccine in the US for the 2016-17 influenza season. Published online June 23, 2016. Accessed June 23, 2016. Source Code.
This article originally appeared on Infectious Disease Advisor