HCA image Rather than rolling up a sleeve for the annual flu shot, healthy people may opt to protect themselves with a nasal spray. The US Food and Drug Administration approved FluMist in June 2003. Expect to see the spray offered in the fall at doctors’ offices, drug stores, and workplaces.

“FluMist offers a new way to assist in the prevention of influenza in healthy children and adults without the discomfort of receiving a shot,” says Jeff Stoddard, MD, senior director of medical affairs for manufacturer MedImmune, Inc. He estimates as many as 160 million people in the United States are eligible to use the new vaccine.

Flu’s Toll

Few Americans ages 18-49 received flu shots last year, according to the National Center for Health Statistics. Many who skipped the needle ended up sick for a week or more. Flu symptoms include fever, headache, fatigue, cough, stuffy nose, and body aches. Most people lose, on average, three days of work or school.

About 114,000 Americans are admitted to the hospital each year with the flu and about 36,000 die. People older than 50 and those with underlying medical conditions are most at risk of flu complications. But they should not take the new live virus nasal spray vaccine.

“However, they are eligible and should receive the killed-flu vaccine that is given by injection,” says Pedro A. Piedra, MD, associate professor of medicine at Baylor College of Medicine in Texas. He has worked with live flu vaccines for more than 16 years.

Flu Vaccines

The traditional flu shot, made with an inactivated or killed virus, stimulates the body’s immune system to fight off the flu bug. It prevents the illness in about 70% to 90% of healthy adults, age 65 and younger, according to the June 28, 2002 issue of Morbidity and Mortality Weekly Report. It is less effective in older adults.

FluMist is made with a modified live virus. The body builds up immunity as the virus reproduces in the nasal passages. During clinical trials, it prevented flu in 87% of children and 85% of adults receiving it.

The vaccine virus does not cause classic flu systems. But during clinical trials, patients occasionally suffered from a runny nose, nasal congestion, sore throat, cough, irritability, headache, vomiting, muscle aches, and weakness. Piedra reports that most people who receive the live vaccine do not have side effects. When reactions occur, they generally last a day or two and usually do not require medical care or antibiotics.

“The vaccine is associated with side effects that are typically transient and quite mild,” Stoddard says. “Cold-like symptoms are a more common side effect. The flu itself was not seen during efficacy studies.”

Tailored for Healthy People

MedImmune developed FluMist with healthy adults and children in mind. Paul Richards, spokesperson for the FDA, says the vaccine has been proven safe and effective for healthy individuals ages 5-49, and for healthy children ages 2-4 (24-59 months) who have not had recurrent wheezing, but the agency leaves the definition of healthy up to doctors.

FluMist has not been tested in people with asthma or HIV. Stoddard recommends anyone with these conditions receive the inactivated, injectable vaccine. FluMist also should not be given to people:

  • Older than 50
  • Younger than 24 months
  • Older than 24 months with a history of recurrent wheezing
  • Allergic to eggs
  • People who have a medical conditions that make them have a higher risk of complications from influenza, including:
  • With weakened immune system due to either illness or medications that weaken the immune system
  • With cancer
  • Taking steroids
  • Children and teens who regularly take aspirin
  • With a history of Guillain-Barré syndrome
  • With heart, lung, kidney, or metabolic conditions
  • Pregnant women

People receiving the nasal vaccine may shed the modified virus when they cough or sneeze. This occurs more often with children. It is possible, although not likely, that someone shedding the virus could transmit the modified virus to another person. Therefore, those taking FluMist should avoid close contact for 21 days with people who have a weakened immune system.


Children as young as six months old can receive a flu shot. The Centers for Disease Control and Prevention (CDC) recommends vaccinating children ages 6-23 months, because they are at high risk for complications requiring hospital care. The nasal spray is approved for children aged two and older.

Piedra emphasizes the importance of protecting yourself and your family against flu. He says both the shot and nasal spray are good vaccines. But the nasal spray produces less anxiety and fewer cries from youngsters.

“As a pediatrician, I’m a strong advocate of prevention of disease,” Piedra says. “When one looks at the impact of influenza has in the community, it’s tremendous, and we underestimate that.”

Ask your health professional which vaccine is best for you and your loved ones. Don’t wait until the flu is in high gear. Take steps now to protect yourself.

Who Should Get a Flu Shot

People the CDC recommends receive flu shots:

  • People age 50 or older
  • Residents of nursing homes
  • People with heart and lung conditions, such as asthma
  • People with diabetes, kidney disease, or weakened immune systems
  • Children on long-term aspirin therapy
  • Pregnant women
  • People who live with someone at high risk for flu complications
  • Healthcare workers
  • Children ages 6-23 months