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According to the American Academy of Pediatrics (AAP), the shot, which is an inactivated flu vaccine, is the more effective option. The nasal spray should only be used as a last resort for kids who would otherwise go unvaccinated against the virus, the experts advised.
"We really want to immunize as many children as we can against the flu with what we think will be the most effective vaccine. That's why we're recommending the flu shot," Dr. Henry Bernstein, associate editor of the AAP Red Book Online, said in an academy news release.
"Influenza is unpredictable from season to season, which means vaccine effectiveness can vary by age, health status and type of vaccine. Recent history has shown the injected form of the vaccine to be more consistent in protecting against most strains of flu virus," Bernstein explained.
The recommendation follows a review of existing data on the effectiveness of the flu shot -- compared with the nasal spray -- that was carried out by the AAP Board of Directors.
The nasal spray contains a live "attenuated" -- or weakened -- flu virus. It's an option for healthy children and adults between 2 and 49 years old. Many people who don't like needles prefer this version of the flu vaccine.
But the AAP noted the nasal spray hasn't worked as well in recent years. It was not effective against the H1N1 strains of the flu virus and was less effective than expected against the H3N2 virus. As a result, the AAP did not recommend patients receive the nasal spray flu vaccine for the 2016-2017 and 2017-2018 flu seasons.
In February, the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices decided to make the nasal spray vaccine available for the coming flu season. The decision was based on indirect research from the vaccine's manufacturer, which suggests the vaccine has a new formulation that will be more effective against the flu virus, according to the AAP.
After reviewing the same data, however, the academy said it was advising against giving children the nasal spray flu vaccine. The group contends the flu shot has been proven to be more consistently effective against most strains of the flu virus over the past several years.
Healthy children older than 2 years of age may receive the nasal flu spray if they would otherwise go unvaccinated. The AAP cautioned, however, that these kids might be at higher risk for flu than those who receive the flu shot.
Dr. Flor Munoz is a member of the AAP Committee on Infectious Diseases. She said, "The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all. If you get the nasal spray vaccine, just be aware that, depending on the performance of the new vaccine formulation, there might be a chance you will not be fully protected against H1N1 strains of flu. The efficacy of this new formulation has not yet been determined."
The AAP said it plans to publish a formal policy statement on flu prevention in September. The group issued this early guidance because doctors are currently placing their vaccine orders for the coming flu season. The AAP also advises parents and guardians to discuss any concerns about the flu vaccine with their child's doctor.
Bernstein stressed that "the flu virus is common, but unpredictable. It can cause serious complications even in healthy children, which is why we strongly recommend annual flu vaccine for all people ages 6 months and older. Immunization is the best way to protect children from influenza."
-- Mary Elizabeth Dallas
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SOURCE: American Academy of Pediatrics, news release, May 2018