"Flu viruses are constantly changing so it's not unusual for new flu virus strains to appear each year. For more information about how flu viruses change, visit How the Flu Virus Can Change www.cdc.gov/flu/about/viruses/change.htm.
Risks Of Hospitalization And Wheezing In Children Younger Than 24 Months Of Age
In clinical trials, risks of hospitalization and wheezing were increased in children younger than 2 years of age who received FluMist (trivalent Influenza Vaccine Live, Intranasal) [see ADVERSE REACTIONS]. This observation with FluMist is relevant to FluMist Quadrivalent because both vaccines are manufactured using the same process and have overlapping compositions [see DESCRIPTION].
Asthma, Recurrent Wheezing, And Active Wheezing
Children younger than 5 years of age with recurrent wheezing and persons of any age with asthma may be at increased risk of wheezing following administration of FluMist Quadrivalent. FluMist Quadrivalent has not been studied in persons with severe asthma or active wheezing.
The 1976 swine influenza vaccine (inactivated) was associated with an elevated risk of Guillain-Barre syndrome (GBS). Evidence for causal relation of GBS with other influenza vaccines is inconclusive; if an excess risk exists, based on data for inactivated influenza vaccines, it is probably slightly more than 1 additional case per 1 million persons vaccinated1. If GBS has occurred within 6 weeks of any prior influenza vaccination, the decision to give FluMist Quadrivalent should be based on careful consideration of the potential benefits and potential risks.
FluMist Quadrivalent has not been studied in immunocompromised persons. The effectiveness of FluMist has not been studied in immunocompromised persons. Data on safety and shedding of vaccine virus after administration of FluMist in immunocompromised persons are limited to 173 persons with HIV infection and 10 mild to moderately immunocompromised children and adolescents with cancer [see CLINICAL PHARMACOLOGY].
Medical Conditions Predisposing To Influenza Complications
The safety of FluMist Quadrivalent in individuals with underlying medical conditions that may predispose them to complications following wild-type influenza infection has not been established.
Management Of Acute Allergic Reactions
Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine [see CONTRAINDICATIONS].
Limitations Of Vaccine Effectiveness
FluMist Quadrivalent may not protect all individuals receiving the vaccine.
Patient Counseling Information
Advise the vaccine recipient or caregiver to read the FDA-approved patient labeling (Information for Patients and Their Caregivers).
Inform vaccine recipients or their parents/guardians of the need for two doses at least 1 month apart in children 2 through 8 years of age, depending on vaccination history. Provide the Vaccine Information Statements (VIS) which are required by the National Childhood Vaccine Injury Act of 1986 to be given with each immunization.
Asthma And Recurrent Wheezing
Ask the vaccinee or their parent/guardian if the vaccinee has asthma. For children younger than 5 years of age, also ask if the vaccinee has recurrent wheezing since this may be an asthma equivalent in this age group. Inform the vaccinee or their parent/guardian that there may be an increased risk of wheezing associated with FluMist Quadrivalent in persons younger than 5 years of age with recurrent wheezing and persons of any age with asthma [see WARNINGS AND PRECAUTIONS].
Vaccination With A Live Virus Vaccine
Inform vaccine recipients or their parents/guardians that FluMist Quadrivalent is an attenuated live virus vaccine and has the potential for transmission to immunocompromised household contacts.
Adverse Event Reporting
Instruct the vaccine recipient or their parent/guardian to report adverse reactions to their healthcare provider.
Carcinogenesis, Mutagenesis, Impairment Of Fertility
FluMist Quadrivalent has not been evaluated for its carcinogenic or mutagenic potential or its potential to impair fertility.
Use In Specific Populations
Pregnancy Category B
A developmental and reproductive toxicity study has been performed in female rats administered FluMist Quadrivalent either three times (during the period of organogenesis) or six times (prior to gestation and during the period of organogenesis), 200 microliter/rat/occasion (approximately 150 human dose equivalents), by intranasal instillation and has revealed no evidence of impaired fertility or harm to the fetus due to FluMist Quadrivalent. There are however, no adequate and well controlled studies in pregnant women. Because animal studies are not always predictive of human response FluMist Quadrivalent should be administered during pregnancy only if clearly needed.
It is not known whether FluMist Quadrivalent is excreted in human milk. Because some viruses are excreted in human milk, caution should be exercised when FluMist Quadrivalent is administered to a nursing woman.
Safety and effectiveness of FluMist Quadrivalent in children 24 months of age and older is based on data from FluMist clinical studies and a comparison of post-vaccination antibody titers between persons who received FluMist Quadrivalent and those who received FluMist [see Clinical Studies]. FluMist Quadrivalent is not approved for use in children younger than 24 months of age because use of FluMist inchildren 6 through 23 months has been associated with increased risks of hospitalization and wheezing in clinical trials [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS].
FluMist Quadrivalent is not approved for use in persons 65 years of age and older because in a clinical study (AV009), effectiveness of FluMist to prevent febrile illness was not demonstrated in adults 50 through 64 years of age [see Clinical Studies]. In this study, solicited events among individuals 50 through 64 years of age were similar in type and frequency to those reported in younger adults. In a clinical study of FluMist in persons 65 years of age and older, subjects with underlying high-risk medical conditions (N = 200) were studied for safety. Compared to controls, FluMist recipients had a higher rate of sore throat.
1. Lasky T, Terracciano GJ, Magder L, et al. The Guillain-Barre syndrome and the 1992 - 1993 and 1993 - 1994 influenza vaccines. N Engl J Med 1998;339(25):1797-802.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 11/3/2015
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