What Everyone Should Know About the Nasal Flu Vaccine
Cold and flu season has officially started in the U.S., so it’s time to get your annual flu vaccine. Getting a shot in the arm isn’t exactly fun, but there is another option: the nasal flu vaccine.
Known as FluMist Quadrivalent or the live attenuated influenza vaccine, this flu vaccine lets you bypass the whole needle-in-arm scenario, making it a good option for children and people who are nervous about shots. But the nasal flu vaccine isn’t for everyone, including adults over 50. Here’s what you need to know before bypassing the shot.
What is the nasal flu vaccine, exactly?
The nasal flu vaccine is a live attenuated vaccine, meaning it contains weakened flu viruses so they won’t make you sick, the Centers for Disease Control and Prevention (CDC) explains. Those weakened viruses are specially designed to only multiply at the cooler temperatures found in your nose and not in your lungs or other areas in your body that are warmer.
Just like the “regular” flu vaccine, the nasal flu vaccine targets certain strains of influenza that researchers predict will circulate the most during that given year.
This year’s nasal flu vaccine is a quadrivalent vaccine, meaning it targets four strains of the flu, the CDC says. The 2021-2022 nasal flu vaccine will target the following strains, according to the Food and Drug Administration (FDA) and CDC:
an A/Victoria/2570/2019 (H1N1) pdm09-like virus
an A/Cambodia/e0826360/2020 (H3N2)-like virus
a B/Washington/02/2019- like virus (B/Victoria lineage)
a B/Phuket/3073/2013-like virus (B/Yamagata lineage)
How does the nasal flu vaccine work?
The process of getting the nasal flu vaccine is pretty simple, says infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. “There is a syringe type of device that contains the vaccine, it’s inserted into your nose, and it mists the vaccine into your nostrils,” he says. “The person usually sniffs it.” This method, he explains, exposes the lining of your nose (aka your nasal mucosa) to the vaccine.
How effective is the nasal flu vaccine?
The effectiveness of any flu vaccine varies from year to year, but the nasal flu vaccine is “considered comparable to the flu shot,” Dr. Adalja says.
“There have been questions of the efficacy of the nasal flu vaccine for certain influenza types such as H1N1 in the past, but that’s been addressed,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.
The CDC’s Advisory Committee on Immunization Practices does not show a preference for any type of flu vaccine over another this year, provided you meet the right qualifications.
What are potential side effects of the nasal flu vaccine?
Potential side effects can vary, depending on whether the vaccine is given to a child or an adult, the CDC says.
Side effects for kids can include:
Runny nose
Wheezing
Headache
Vomiting
Muscle aches
Low grade fever
Sore throat
For adults, they might include:
Runny nose
Headache
Cough
Who is the nasal flu vaccine good for?
The nasal flu vaccine is approved for use in healthy people who aren’t pregnant and are between the ages of two and 49, per the CDC. But there is a laundry list of health conditions that can keep you from being eligible for this flu vaccine (more on that in a moment).
“It’s sort of a niche vaccine, given that there are so many contraindications,” Dr. Russo says. “But it can be helpful for people who have a needle phobia.”
While adults can get the nasal flu vaccine, most tend to opt for the shot. “Generally, the nasal flu vaccine is more often given to kids,” says Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University.
Who shouldn’t get the nasal flu vaccine?
The CDC has a big list of people who should skip the nasal flu vaccine. That includes:
Children younger than 2
Adults 50 years and older
People with a history of severe allergic reaction to any ingredient of the vaccine or to a previous dose of any flu vaccine
Children 2 through 17 years old who are receiving aspirin- or salicylate-containing medications
Children 2 through 4 years old who have asthma or who have had a history of wheezing in the past 12 months
People with weakened immune systems (immunosuppression) from any cause
People who care for severely immunocompromised persons who require a protected environment (or otherwise avoid contact with those persons for seven days after getting the nasal spray vaccine)
People without a spleen, or with a non-functioning spleen
Pregnant people
People with an active leak between the cerebrospinal fluid and the mouth, nose, ear, or other place within the skull
People with cochlear implants
People who have taken flu antiviral drugs within a certain amount of time. (48 hours for oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir)
The CDC also cautions against using the nasal flu vaccine for people with the following health conditions:
Asthma (in people 5 years and older)
Other underlying medical conditions that can put people at higher risk of serious flu complications, including lung disease, heart disease, kidney disease (like diabetes), kidney or liver disorders, neurologic/neuromuscular, or metabolic disorders
Moderate or severe acute illness with or without fever
Developing Guillain-Barré Syndrome within six weeks following a previous dose of flu vaccine
Where can you get the nasal flu vaccine?
It’s usually available where other flu vaccines are offered. But, given that it’s not as popular as the flu shot, not every doctor’s office or drugstore will have it in stock. Dr. Adalja’s advice: “Just call first to be sure.”
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