Flu vaccine as nasal spray?

Question

Hello,

We are getting our daughter (CF, turning four in two months) a flu shot every year in the fall. Yesterday the paediatrician informed me about a new vaccine for children that is applied like a nasal spray. The advantage is that children can be spared the pain of the injection. There are a few sources on the internet where one can read that this kind of vaccine can possibly lead to facial paralysis that has occurred after spraying. [Translator’s note: a link to a German website provided in the original question was not included in the translation.]

I am now very confused about this new kind of vaccination and would like to hear an expert opinion on it. Do your recommend this new vaccine as well, or are you leaning towards the conventional vaccination method (an injection is no problem for our daughter).

I look forward to your assessment.

Many thanks.

Answer

Hello,

You are asking whether it is sensible and unobjectionable for your four-year-old-daughter, who has CF, to use the nasally applied influenza vaccine Fluenz® instead of the conventional intramuscular injection. You are concerned, since you read on the internet about side-effects of the vaccination (temporary facial paralysis).

Fluenz® has been approved in Germany [Translator’s note: and in all of the European Union – see link below] for children aged 2-17. The German Standing Committee on Vaccinations (STIKO) has not dealt with the nasal vaccine so far. Concerning patients with diseases of the respiratory tracts, the product information only gives a warning for asthmatics. There is also a warning against using this vaccine in patients with low immunity. Since there has been a growing number of hints from research that confirm a dysfunction of the immune system in CF, and since the product information gives clearly specifies disorders of the upper respiratory tracts as unwanted side effects, I would advise against using Fluenz® at this point.

You are suggesting that your daughter has not had any problems with intramuscular injections so far. I would therefore stay with the familiar vaccination type for now and wait until reliable figures on the tolerability of the vaccination in children with chronic respiratory diseases, and here also CF, are published. In addition, we would like to point out that the product information for Fluenz® does not specify facial paralysis as an unwanted side effect.

We hope your daughter will tolerate the vaccination well and make it through the winter more or less without infections.

Kind regards
Dr. H.-G. Posselt

The following is a link to information on Fluenz® on the website of the European Medicines Agency
www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001101/human_med_001405.jsp&mid=WC0b01ac058001d125&murl=menus/medicines/medicines.jsp

29.10.2012