Why is the nasal spray flu vaccine still offered in Canada?

By Dr. Samira Mubareka

As healthcare providers, we know that the best protection against the influenza virus is to get the flu shot. For children, there are two options for influenza vaccination: the intranasal live attenuated vaccine (the nasal spray) or the inactivated vaccine (the shot).

However, deciding which method to use in children has recently become more confusing. The Centers for Disease Control and Prevention (CDC) in the U.S. announced that, based on the data they had collected, the nasal spray was not effective last flu season. As a result, many parents have been asking their healthcare providers whether they should be giving the nasal spray flu vaccine to their children.

So, why are we still offering the nasal spray flu vaccine in Canada? And how should we respond when parents inevitably ask why we aren’t following the U.S.’s lead in only offering the needle this year?

Flu strains change

First, it’s important to mention that researchers continue looking at vaccine effectiveness every year, and that the findings from Canadian data are different from the U.S. Using data from previous flu seasons, researchers work hard to predict which flu strain will be most prominent during the next flu season, months in advance. This means there may be year-to-year variation in how well the vaccine and circulating flu virus strains match. Still, significant protection against getting the flu is provided even during years where the vaccine isn’t a perfect match.

Because the flu strain you’re being protected against is constantly changing, you should get the flu vaccine every year, and you should encourage your patients to do the same.

Influenza can cause serious illness and death, particularly among the elderly, very young children, pregnant women and those with chronic medical conditions. As such, the flu vaccine is universally recommended in Canada.

It bears repeating that not everyone can get the flu vaccine, including babies younger than six months old (who are too young to receive it), making it essential that people who spend time with these vulnerable groups get the flu shot – including moms of infants.

Differences in data

Canada isn’t the only country that continues to recommend the nasal spray. In fact, the U.S. is one of only a few countries that are not recommending it this flu season.

The difference comes down to different findings in studies conducted on either side of the border. In the data that’s been collected in Canada and other countries, such as Finland and the United Kingdom, we haven’t seen the low level of effectiveness of the nasal spray that American studies have found. In fact, a recent Canadian study showed no difference between the two types of vaccine in terms of protection from influenza.

While we can’t ignore the U.S. data, we must also keep our own data in mind. Though it can be difficult to understand how one country can make a recommendation that differs from another, the fact remains that the evidence was not strong enough for Canada to remove its recommendation of the nasal spray.

What should parents do?

Deciding between the nasal spray or flu shot can be difficult, particularly for a parent who has to make a decision about which to give to their child. Speak with your family physician about which vaccine method is best for your child.

In addition to getting the vaccine, parents and children should be reminded of other ways to prevent the spread of the flu. It’s important to clean hands before and after using the washroom or handling food, covering coughs and sneezes with tissue (and disposing of the tissue immediately in the garbage) and then cleaning your hands. Practice healthy habits to keep the immune system strong, like having a balanced diet and getting enough sleep, and stay home from work, daycare or school when sick. These are all good habits to adopt, and will increase your chances of staying healthy through the flu season.

I made sure my own children were vaccinated this year, one way or another. While one of my kids got the flu shot, the other got the nasal spray – he simply wouldn’t do it any other way. Sometimes, the decision comes down to how your child reacts to needles!

As a parent, I’ll be keeping a closer eye on new data about the effectiveness of the nasal spray versus the shot. However, the most important thing is that my kids received an influenza vaccine this year.

Dr. Samira Mubareka is a microbiologist and infectious diseases consultant at Sunnybrook Health Sciences Centre.

Five misconceptions about the flu

There are many misconceptions about the flu, even among those of us who work in healthcare. Here are five of the top flu misconceptions you may hear people talk about this season:

  1. “It’s really just a bad cold”

The flu is not just a bad cold. Generally, people who have come down with the flu will say they’ve been “hit” with the flu — and that’s no exaggeration. Knowing the difference can make all the difference for everyone. Fever and chills are common flu symptoms, along with severe muscle pain and weakness. A sore throat, chest congestion and persistent cough are also signs that you’re suffering from the flu, not just a cold.

  1. “I don’t need the vaccine. I never get the flu. Even if I were to get it, I’d get through it.”

Chances are this individual, if healthy and hit with the virus, would likely recover with no complications. They would also likely spend time with family, relatives and friends — social circles that include the two most flu-vulnerable groups: very old and very young, and in some families, pregnant women. Transmission from an infected individual can cause serious complications and result in hospitalization for these vulnerable groups.

  1. “I’ve got too much work. I’ve got to come in. And besides… it’s just a bad cold.” (see )

Good work ethic is admirable and important, but the health of an individual and those around him/her is also important. Have a co-worker who’s got chills/high fever? Aches and pains? Persistent cough? It’s best to advise this individual to head home.

  1. “I’ve heard of people getting the flu from the vaccine”

The flu vaccine contains killed strains of the virus. People often associate the vaccine with a slight chill, sore arm, and not feeling 100 per cent. That’s not because they are coming down with the flu; it’s because they are experiencing an immune response. And that’s a good thing.

The sore arm, however, is from the needle – and for those with a quiet fear of needles, there is the needle-free nasal spray vaccine option. This option contains live virus, so is not recommended for older or very young individuals, or individuals with pre-existing medical conditions or weakened immunity.

No one can get the flu from the vaccine. But an individual can still get the flu even after getting the vaccine. However, evidence shows that being armed with the vaccine results in a less severe hit, should you get the flu.

  1. “The flu vaccine doesn’t work anyway”

Every year, the vaccine covers three strains of the flu virus: an H1N1 strain, an H3N2 strain and an influenza B strain. The nasal spray vaccine contains an additional influenza B strain. The influenza strains in this year’s vaccine have been updated to reflect what has been circulating over the last year. Don’t discount the flu vaccine based on what happened the previous year. The flu vaccine still provides, on average, 60 per cent protection against the flu. Think of it as a 60 per cent discount taken off the flu’s contagiousness – to you!