Current recommendations suggest children with asthma get an inactivated flu shot (the flu virus is dead) instead of the live nasal spray vaccine to avoid wheezing and a potential full-blown asthma attack.
However, the latest study shows these kids do just as well with the live nasal mist as the inactivated flu shot, and most kids would gladly choose a nasal mist over a needle.
"The most important thing we learned is that in this study of children with asthma, including severe asthma, the intranasal vaccine (FluMist) did not lead to wheezing events or asthma exacerbations," said study author Dr. C. Buddy Creech. He is director of the Vanderbilt Vaccine Research Program and chair of pediatrics at Vanderbilt University Medical Center in Nashville, Tenn.
"While we have exercised caution historically, due to increased wheezing events in young children during the clinical trials of FluMist, we can now have a great deal more confidence that it does not do the same thing in children with asthma," he said.
For the study, 151 children with asthma, aged 5 to 17, received a flu shot or nasal mist vaccine for two flu seasons. Rates of wheezing and asthma attacks were the same for both groups 42 days after they got their vaccines, the study findings showed.
There are many potential benefits to getting the live nasal mist vaccine, Creech said.
For starters, most kids would gladly opt for a nasal spray over a shot. "Previous data show that [the live flu vaccine] can trigger a broader array of immune responses than typical inactivated flu shots and may be more protective as a result," he said
Giving the vaccine as a nasal mist may also lead to additional defense around the lining of the nose, where most viruses enter the body, Creech said.
"There are sometimes flu shot availability issues, and it may be easier to get one vaccine over another," he said.
Each year, the flu shot is a bit of a gamble as researchers scramble to predict what strain/s will circulate, and they don't always get it exactly right. "There are data to suggest that when the vaccine strain we choose doesn't match the strain that ends up circulating, live vaccines may be able to provide more protection than the inactivated vaccines," Creech said.
The findings were published online March 28 in Pediatrics.
"Annual influenza vaccination for children with asthma is considered best practice and highly recommended to reduce influenza-related exacerbation and death in this population," said Dr. Shilpa Patel. She's the medical director of the Children's National Hospital asthma clinic in Washington, D.C.
"Although it was a small study, it was well designed, and the findings are consistent with prior studies supporting the safety of live attenuated influenza vaccine in children with persistent asthma," said Patel, who has no ties to the new research.
Next flu season, the U.S. Centers for Disease Control and Prevention's advisory committee on immunization practices can consider this evidence when they update their annual influenza vaccination recommendations, she said.
Currently, the CDC suggests that people with asthma should not receive the live nasal mist vaccine.
The Asthma and Allergy Foundation of America has more on the flu for people with asthma.
SOURCES: Buddy Creech, MD, director, Vanderbilt Vaccine Research Program, Edie Carell Johnson Chair in Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn; Shilpa Patel, medical director, Children's National Hospital IMPACT DC Asthma Clinic, Washington, D.C.; Pediatrics, March 28, 2022, online