Why Canada recommends nasal-mist flu vaccine against U.S. advice

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FluMist, the nasal spray version of the influenza vaccine, is still being recommended for children in Canada, even though pediatricians in the U.S. have been told it’s ineffective.

The Public Health Agency of Canada says that for children without a medical reason that prevents them from receiving it, the influenza vaccine is recommended — either by nasal or needle.

Asked Thursday about the Canadian versus U.S. decision, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said: “It is a surprising finding, and we really do hope that we can get an effective internasal vaccine or nasal spray back on the market and back available and recommended as soon as possible.”

He rolled up his sleeve to receive his flu shot and encouraged others to do the same, saying the illness often doesn’t get enough respect.

The U.S. has found that there was no convincing evidence that the nasal spray worked and that the jab did.

Canada’s National Advisory Committee on Immunization (NACI) reviewed the evidence on FluMist but came to a different conclusion.

“FluMist nasal spray remains recommended, but is no longer preferentially recommended for children 2-17 years of age,” a PHAC spokeswoman said in an email.

“FluMist will continue to be offered in most provincial and territorial public immunization programs across Canada.”

At his pediatric practice in Toronto, Dr. Daniel Flanders said parents following media reports from the U.S. have been surprised to find out Canadian health authorities still recommend FluMist.

Dr. Danuta Skowronski

There isn’t enough evidence to assert that the nasal spray vaccine is superior to the injectable vaccine; nor can we confidently say that it may be inferior, so both are safe and approved options in Canada, says Dr. Danuta Skowronski. (CBC)

“It can be difficult to understand how one country can make one recommendation and another country can make what appears to be the complete opposite,” Flanders said.

Part of the reason is that flu viruses are constantly changing. Flu vaccine makers try to keep up by switching up which strains to target each flu season. Their challenge is to predict which strain of flu virus will spread the fastest and cause the most illness.

In the U.S., researchers found no protection with the nasal spray vaccine against the H1N1 component, whereas other countries, including Canada, the United Kingdom and Finland, showed the nasal spray was protective against H1N1, said Dr. Danuta Skowronski, a physician and epidemiology lead in the influenza program at the BC Centre for Disease Control in Vancouver.

“It’s not like in Canada we have ignored the signal from the United States,” Skowronski said. “We just concluded the evidence isn’t strong enough for us to recommend against the vaccine.”

In Canada, seasonal flu activity can begin as early as October.

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Why Canada recommends nasal-mist flu vaccine against U.S. advice

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