Monday, June 27, 2016

UK PHE Stands By The Nasal Spray Flu Vaccine


It's a case of `PHE said - CDC said', but there's a sharp division between the two public health agencies over the effectiveness of the LAIV (live attenuated influenza vaccine) called FluMist Quadrivalent in the US market and Fluenz Tetra in the UK and EU market.

Both products are manufactured by AstraZeneca - Medimmune, and while sold under different banners, are pharmaceutically identical. 

Last week, in CDC Statement On ACIP Recommendation Against Use Of Inhaled (LAIV) Flu Vaccine, we looked at the surprising (and as yet, unexplained) drop in VE (vaccine effectiveness) of the inhaled flu vaccine reported by the CDC over the past three flu seasons.

After years of posting superior VE numbers, the first signs of trouble appeared in the fall of 2014 when the CDC announced they could find no measurable effectiveness against the H1N1 strain among children who received the 2013-2014 vaccine.

The LAIV posted another poor showing (against both H1N1 and a `drifted' H3N2) the following year (see CIDRAP ACIP drops preference for nasal-spray flu vaccine in kids).

And just last week, after reviewing yet another disappointing set of VE numbers from last year's flu season, ACIP voted against recommending the nasal spray LAIV vaccine for the upcoming flu season.

Citing their own studies, and a study from Finland, the UK's PHE finds the performance of the LAIV (57%) in children to be lower than commonly cited in previous years, but still acceptable and on par with the flu jab in adults. 

Why there would be such a stark difference between the US and UK VE studies is a mystery.   In any event, the UK continues to support the use of the LAIV vaccine for the upcoming flu season.  

This from the PHE.

Child flu vaccine plays important role in annual flu programme

Provisional figures show that the nasal spray flu vaccine has been effective in the UK.

Public Health England (PHE), the Department of Health and NHS England remain confident that the children’s nasal spray flu vaccine plays an important role in protecting children, their families and others in the community from flu during the winter.

Provisional figures released by PHE show that the childhood nasal spray flu vaccine has been effective in the UK, both in protecting the children themselves and their communities from flu. Reports from the US have suggested a possible lower vaccine effectiveness, unlike the findings in the UK.

The National Institute for Health and Welfare in Finland has confirmed that they saw similar effectiveness levels to the UK in 2015 to 2016 (46% against laboratory confirmed disease), and have confirmed the nasal spray flu vaccine will continue to be used in Finland for the forthcoming winter.

From October 2016, the vaccine will be extended to healthy children in school year 3 in England. Once again, children aged 2, 3 and 4, and in school years 1 and 2 will also be eligible to receive the free vaccine which is quick, effective and painless.

Dr Richard Pebody, head of flu surveillance for PHE said:

We estimate that overall, the vaccine was 57.6% (95% confidence interval: 25.1, 76) effective in preventing influenza infection amongst children in 2015 to 2016. These findings are encouraging and in line with what we also typically see for the adult flu vaccine.
Prior to offering vaccination to all our youngest primary school aged children this season, school age pilots took place in a number of areas across England in 2014 to 2015. In areas where flu vaccine was piloted amongst primary school age children, there was a 94% reduction in GP influenza like illness consultation rates, 74% reduction in A&E respiratory attendances and 93% reduction in hospital admissions due to confirmed influenza in primary school children. In the same pilot areas, GP ‘influenza like illness’ consultation rates for adults were 59% lower compared to non-pilot areas.

Flu vaccine is the best protection we have against an unpredictable virus which can cause severe illness and deaths each year not only amongst children but also amongst at-risk groups, including older people, pregnant women and those with an underlying health condition.
Based on intelligence to date, there is no reason to change current recommendations regarding use of the children’s nasal spray vaccine in the UK. We’re delighted that the UK leads the way in offering this vaccine to children and we remain confident that the vaccines used in the Annual Flu Vaccine programme are the most effective that are currently available in protecting both those vaccinated and in reducing transmission of the flu virus in our communities. We will continue to keep the vaccines used in our programmes under review and to take advice from our independent expert scientific committee, the Joint Committee on Vaccination and Immunisations (JCVI).
PHE will publish a complete report in late summer 2016.
PHE recently confirmed the use of the children’s nasal spray for the 2016 to 2017 flu vaccination programme through its annual flu plan and letter.

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