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Is the nasal flu vaccine right for people over 50?

Q: The nasal flu vaccine is supposed to be for people up to the age of 49. If a person is over 49, healthy, and not in any of the eligible groups for the now scarce flu shots, is the nasal flu vaccine better than nothing?

A: Though both the nasal vaccine (FluMist) and the flu shot aim to do the same thing—prevent the flu—there are important differences in the two that make one more appropriate for certain people. First, FluMist was tested primarily in children and younger adults. FluMist was not approved for patients under 5 because in clinical trials young children treated with the nasal mist had a higher rate of asthma attacks and wheezing within 42 days of the vaccination, compared to children who received a placebo. Pregnant women, people over 50, and people with chronic illnesses, including asthma, should not be given FluMist because its safety and effectiveness in these groups remain uncertain.

Second, FluMist uses a live but weakened virus, while the flu shot uses a killed virus. Health-care workers who care for severely immunocompromised patients should get the flu shot instead of the nasal vaccine because of a theoretical risk of passing the weakened live virus in FluMist to patients with severely weakened immune systems.

There are also three antiviral drugs (amantadine, rimantadine, and oseltamivir), that can be used to prevent the flu, but these work differently than either the nasal vaccine or the shot. Instead of taking them before you get the flu, you have to take the antivirals within two days of the first appearance of flu symptoms in order for them to be effective. When taken during this time, they are about 70% to 90% effective for preventing illness in healthy adults. Another drug, zanamivir, has also been approved for treatment of the flu. These medicines can reduce flu symptoms and help you get over the flu a few days sooner. And they can make you less contagious to others.

Anthony Komaroff, M.D. Editor in Chief, Harvard Health Letter http://www.health.harvard.edu/health


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