FluMist vaccine now in good standing

Thursday, Dec. 11, 2003 | 11:22 a.m.

A month ago the Clark County Health District discouraged people from using FluMist, a new aerosol vaccine for the flu, and told the public to instead rely on the injected form of influenza vaccine.

Health departments in other states, however, are suggesting that people who can take FluMist should use it, in large part because the injection vaccines are in short supply coast-to-coast -- and that means vulnerable populations, such as the young, the elderly and those with serious illnesses, who can only take the injected form may not have it.

The director of the federal Centers for Disease Control and Prevention, Dr. Julie Gerberding, said this week that FluMist appears to be "just as effective" as the older versions of flu vaccines -- and a new study from the producer suggests it may in fact be more effective.

Dr. Donald Kwalick, Clark County district chief health officer, said through a spokeswoman Wednesday that the injected vaccine "is still the gold standard." However, with supplies of that form exhausted at the health district and hard to find elsewhere in Las Vegas, people could turn to FluMist.

"It certainly is an alternative," health district spokeswoman Jennifer Sizemore said.

Kwalick in November noted that FluMist vaccinations, which are administered in a nasal spray, were more expensive than the traditional vaccinations, running at about $50 to $60 a dose versus $25 for the injected form -- although FluMist manufacturers are now offering a $25 rebate for the product. Perhaps more significantly, medical insurance typically does not cover any of the FluMist cost because it is a new drug, introduced to the market this year.

Kwalick said FluMist was available only because people feared needles and called the injected form "a better way to make sure you protect family and everyone."

But MedImmune, the Maryland-based company that produces FluMist with pharmaceutical giant Wyeth, suggested this week that their product may in fact be better than the injected vaccine for the strain of flu that is circulating.

Neither form of vaccine is truly on target because they were not tailored for this strain on the virus, which is why even vaccinated individuals could still get sick with this flu. But MedImmune, citing a study by a Saint Louis University researcher, says preliminary results indicate that FluMist produces a four-fold greater antibody response.

"These new data demonstrate that live, attenuated, influenza vaccines may have a greater potential to produce a broad immunity to influenza, including drifted strains, than the inactivated flu vaccines," said Dr. Robert B. Belshe, a professor at the Missouri school and lead investigator of the FluMist pediatric trial. "This potentially important advantage of a live, attenuated vaccine over inactivated influenza vaccines needs to be further explored in clinical trials."

The difference between the shot and the spray is that FluMist uses a weakened form of the live virus, while the injected vaccine uses a dead virus. Jamie Lacey, MedImmune spokeswoman, said some people hesitate to use FluMist because it is a live virus.

"FluMist has been shown in studies of more than 20,000 people to be safe and effective," Lacey said. "Live virus vaccines have been used for years to safely and effectively treat many diseases."

Among other vaccines that use live viruses are those for measles, mumps, rubella, and chicken pox.

Still, FluMist is not for everyone. The Food and Drug Administration has approved the product for people ages 5 through 49, who do not have any other serious illnesses. Small children, the elderly and people with other medical conditions are those who most need vaccination from the flu, according to health authorities. Health professionals or people with family members who are sick also should not use FluMist, because they could transmit the virus to others.

Older, younger and ill populations are among those most likely to die from influenza, a disease the kills on average about 36,000 Americans yearly. Medical authorities locally and nationally have warned that this flu season could be worse than average.

This year, otherwise healthy people also have been lining up for the injected vaccine despite alternatives. FluMist, noted Gerberding, is an option for those who "want to help us retain the injectable vaccine for those people who are at high risk from flu complications."

In the dozen states where the flu has been circulating, the injected vaccine that vulnerable populations can use have been in short supply. However, Lacey said FluMist is readily available. By the mid-part of last month, only 10 percent of the 4 million doses produced for this year had been used.

While 83 million doses of the injected vaccine where produced and distributed, the demand is exceeding supply. The health district is trying to obtain more injected vaccines in Las Vegas, but even private providers are running out of the shots.

That has some concerned that those who might need the shots most won't have them.

"There is always a concern that the people who are most at risk (need to) have the shot available," said Jody Smith, associate state director of the AARP in Nevada. The group is an advocacy organization for older Americans.

"This is just underlining the fact that people at risk should get the shots when told to do so," she said.