Self-Administered Nasal Spray Flu Vaccine: Convenient or Concerning?

You may have heard there’s a newly approved nasal spray flu vaccine you can administer at home – no more needles and one less trip to the clinician’s office. But is it really that easy? If you look closely, there’s more to that self-administered flu vaccine than originally meets the eye. Here’s what you need to know.

Infectious diseases physician Amy Slenker, MD, with LVPG Infectious Diseases, advises anyone who is thinking of using the nasal spray flu vaccine to first check with their primary care clinician to see if they are a good candidate.

“The nasal spray flu vaccine is a live vaccine that can interfere with other vaccines and is not appropriate for everyone, so it’s important to talk with your primary care clinician or your child’s pediatrician,” Dr. Slenker says. “Very few Lehigh Valley Health Network (LVHN) practices are carrying the nasal spray flu vaccine and when they do, they only have a few. A flu vaccine given by a clinician is still the preferred method to ensure proper dosing and administration.”

The vaccine is marketed as available for everyone from ages 2 through 49; however, there are other factors to take into consideration. Katiemarie Vottero, DO, a pediatrician with LVPG Pediatrics–Gilbertsville, explains a few instances where the nasal spray flu vaccine may not be the best option.

“Depending on previous flu vaccination status, a pediatric patient may require one dose, or two doses four weeks apart,” Dr. Vottero says. “Also, because the nasal spray is a live vaccine, it should be given at least four weeks before or after other live vaccines. This is important since it could interfere with our schedule of giving the child their MMR and varicella vaccines.”

Additionally, if a child has certain existing health conditions, the vaccine may not be appropriate for them. David Burnham, MD, with LVPG Pediatrics–Palmer Township, says some parents would prefer the spray, but it’s not for everyone.

“Families ask for the nasal flu vaccine when they want a needleless option, but some children can’t receive it if they have asthma or immune suppression,” Dr. Burnham says.

The manufacturer’s website warns against people using the vaccine who have a severe egg allergy, who have ever had a severe allergic reaction to an influenza vaccine and children age 2 through 17 who take medicines containing aspirin.

Jarrod Kile, RPh, a clinical pharmacy specialist with LVHN, also notes that if someone needs proof of a flu shot, there’s not a great way to document the nasal spray.

“You can show that you ordered a nasal flu vaccine, but there’s no third-party documentation that the vaccine was actually administered,” Kile says. “Some people might need this for work or other reasons.”

Receiving and administering the nasal spray flu vaccine can present challenges that leave room for human error that could potentially render the vaccine ineffective.

First, the vaccine is required to stay within a certain temperature range. It is shipped in special packaging to keep it at temperature and then refrigeration is required if it’s not being used immediately. Special tags monitor the temperature of the vaccine during shipment, allowing users to check the temperature before administering.

Still, even with these measures in place and with careful handling, it leaves room for exposure to heat or other mishandling that may make the vaccine ineffective.

Second, while administering the vaccine is simple and works like many other nasal sprays, a needle provides 100% assurance that a vaccine has entered the body correctly.

For these and the other reasons listed above, Renee Morrow-Connelly, DO, with LVPG Pediatrics–Laurys Station, says, “Nasal flu vaccine does not appear to be the solution to improve influenza vaccination.”

LVHN pediatricians concur that if a family is open to other vaccines normally given by needle, they’ll most likely opt for the flu shot administered the same way.

“I have not had any parents ask about the home version of the nasal flu vaccine,” Debra Carter, MD, with LVPG Pediatrics–Trexlertown, says. “In the past, the parents who requested it primarily did so because of their child’s fear of needles.”

Dr. Vottero adds that a few people have asked about it but have not expressed a strong preference.

“I have only had a couple people ask about the nasal flu vaccine in past seasons,” says Dr. Vottero. “When I tell them the injection form is what we carry in the office, parents opt for that.”

Unlike most traditional flu vaccines which are comprised of inactivated flu virus or recombinant (synthetic and do not include flu virus), the nasal spray contains live viruses that stimulate your immune system to build immunity to the flu without causing infection. Once in your body, antibodies circulate throughout your body and your cells build up an immune response.

If you have a child or are an adult who prefers a needleless option, and have not had a reaction to past flu vaccines, the nasal spray vaccine might be right for you.

“Ultimately, if a patient is motivated and prepared to self-administer it at home, they should first discuss it with their primary care clinician to make sure they meet all the criteria,” Dr. Slenker says.