FluMist Quadrivalent (LAIV4; AstraZeneca) is currently approved by FDA only for healthy non-pregnant people age 2 through 49 years.
Ask the Experts: Influenza: Live Attenuated Influenza Vaccine (LAIV) Issues
No. Giving FluMist is not considered an aerosol-generating procedure.
The vaccine dose (0.2 mL) comes inside a special sprayer device. A plastic clip on the plunger divides the dose into two equal parts. The patient is seated in an upright position with head tilted back. Half of the contents of the sprayer (0.1 mL) is sprayed into each nostril.
Yes, unless clinical judgment suggests nasal congestion is present that might keep the vaccine from making good contact with the nasopharyngeal mucosa. In that case, consider either deferring its use until the congestion resolves or using an appropriate alternative influenza vaccine, if available.
Yes. Breastfeeding is not a contraindication for any routine vaccination including FluMist.
With rare exceptions, yes. Like other live vaccines, FluMist should not be administered to immunosuppressed people. ACIP has stated a preference for using inactivated influenza vaccine for all close contacts of severely immunosuppressed individuals (for example, patients with hematopoietic stem cell transplants) during those periods in which the immunosuppressed person requires care in a protective environment because of the theoretical risk that the live attenuated vaccine virus could be transmitted to the severely immunosuppressed individual and cause disease. Healthcare personnel or other people who have close contact with people with lesser degrees of immunosuppression (for example, people with diabetes, people with asthma taking corticosteroids, or people living with HIV) who are otherwise eligible for FluMist may receive it. No special precautions need to be taken by the vaccinated person.
People should avoid contact with any person who is severely immunosuppressed for at least 7 days after receiving FluMist. There are no restrictions on being in contact with any other patients.
Asthma is a precaution for FluMist in people 5 years of age and older. FluMist is contraindicated for children 2 through 4 years old who have had a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months.
An antiviral drug active against influenza virus may reduce the effectiveness of FluMist. ACIP has recommended different intervals between the last dose of an antiviral medication and FluMist administration, based upon the half-life of the antiviral medication. The new recommendations are as follows:
- Oseltamivir or zanamivir: wait at least 48 hours after last dose before administering FluMist
- Peramivir: wait at least 5 days before administering FluMist
- Baloxavir: wait at least 17 days before administering FluMist
If any influenza antiviral medication must be given within 14 days after FluMist administration, the patient should be revaccinated without delay with any age-appropriate injectable influenza vaccine. All inactivated influenza vaccines and recombinant influenza vaccine (Flublok Quadrivalent) may be administered at any time relative to antiviral medication.
A half dose of FluMist (or any other vaccine) is a non-standard dose and should not be counted. If you were unable to give the second half of the vaccine at that same appointment, you will have to provide another full dose of influenza vaccine at another time. If you want to give FluMist again, you should wait four weeks, because it is a live vaccine. Alternatively, you can give inactivated influenza vaccine any time after this partial dose.