Influenza live attenuated

Live attenuated influenza LAIV 0.5 mL Intranasal Severe egg allergy Asthma Chronic health problems Immunocompromised host Pregnant women History of Guillain-Barre syndrome... 

Healthy individuals 5 to 49 years of age can receive the live attenuated influenza vaccine instead of the inactivated vaccine. There are limited data on transmission of the vaccine strain following intranasal vaccination however, secondary transmission does not appear to be a concern. 

The two vaccines currently available for prevention of influenza are the trivalent influenza vaccine (TIV) and the live-attenuated influenza vaccine (LAIV). The specific strains included in the vaccine each year change based on antigenic drift. 

LAIV, live-attenuated influenza vaccine TIV, trivalent influenza vaccine. 

Comparison of Trivalent (TIV) and Live-Attenuated Influenza Vaccine (LAIV)... 

Live-attenuated influenza A (H3N2), A (HI Nl), and B viruses Intranasal... 

Influenza vaccine. (Minimum age 6 months for trivalent inactivated influenza vaccine [HVJ 5 years for live, attenuated influenza vaccine [IAIZ])... 

Influenza. Although current influenza vaccine (subunit split vaccine) has been in use yearly for the elderly, it is not recommended for the general population or infants. Improvements to increase or prolong the immunogenicity, reduce the side-effects (due to egg production procedure), and provide mass protection are still being pursued. One approach is to use a live, attenuated vims though cold adaptation. A vaccine has been used in Russia and demonstrated to be safe and efficacious for infants (82). Clinical trials for a similar vaccine are being carried out in the United States (83). 

Influenza vaccines EMEA points to consider on the development of live attenuated influenza vaccines 2003... 

Influenza vaccine viruses are propagated in embryonated chicken eggs. The virus-containing extra-embryonic fluid is harvested, purified, and inactivated with formalin. Inactivated flu vaccine is produced either as whole virus vaccine or ether-disrupted split or subunit preparations. However, many other new or modified influenza vaccines are already available or are expected to appear in the near future, for example vaccines containing new adjuvants, live attenuated vaccines, and vaccines administered by alternative routes. 

In a randomized, double-blind study, trivalent, live, attenuated, cold-adapted intranasal influenza vaccine (FluMist) has been compared with intranasal placebo plus a trivalent injected inactivated influenza vaccine (5). The 200 patients were aged 65 years and over and had chronic cardiovascular or pulmonary conditions or diabetes mellitus. During the 7 days after immunization, sore throat was reported on at least one day by significantly more of the FluMist recipients (15 versus 2%). The increased frequency of sore throat may have been attributable to direct or indirect effects of vaccine virus replication. No other symptom was associated with FluMist. These findings were consistent with evaluations of other live, attenuated, cold-adapted influenza vaccine formulations in older adults. However, further studies of the safety of FluMist are warranted. 

Jackson LA, Holmes SJ, Mendelman PM, Huggins L, Cho I, Rhorer J. Safety of a trivalent live attenuated intranasal influenza vaccine, FluMist, administered in addition to parenteral trivalent inactivated influenza vaccine to seniors with chronic medical conditions. Vaccine 1999 17(15-16) 1905-9. 

Vaccination against viruses, such as influenza and measles, commonly involves parenteral (subcutaneous or intramuscular) administration of a live, attenuated virus or a killed virus. The inhalation route is being examined as a means of immunizing patients because it circumvents logistical problems associated with parenteral administration, such as needle sterility issues, patient aversion to needles, and the need for administration by a health care professional. In very young children, maternally derived IgG antibodies may prevent successful immunization [118]. The inhalation route may allow vaccination of these children because the immunological response of the airways is less likely to be influenced by maternal antibodies [118], Aerosol immunization has been shown to be effective against measles [119] and, in some respects, is more efficacious than parenteral immunization [120],... 

The live attenuated influenza vaccine is administered intra-nasally. A specially designed sprayer is inserted just inside the nostril, and the dose is squirted by depressing the plunger of the sprayer. The clip is removed from the plunger so that the second half of the dose can be administered into the other nostril. The vaccinated individual should breathe normally. There is no need to repeat the dose if the individual sneezes during or shortly after administration. ... 

Influenza vaccines are available as inactivated trivalent split or subunit vaccine or as a live attenuated vaccine administered in-tranasally. Though both types of influenza vaccine probably are equally effective in protection from infection, they are indicated for distinct populations and should not be considered interchangeable. 

Hib Hemophilus influenzae type b HSCT hematopoietic stem cell transplant IMIG intramuscular immunoglobulin IPV inactivated polio vaccine ITP immune thrombocytopenic purpura IVIG intravenous immunoglobulin LAIV live attenuated influenza vaccine MMR measles-mumps-rubeUa vaccine OPV oral polio vaccine... 

Belshe RB, Mendelman PM, Treanor J, et al. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine in children. N Engl J Med 1998 338 1405-1412. 

Nichol KL, Mendelman PM, Mallon KP, et al. Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults A randomized, controlled trial. JAMA 1999 282 137-144. 

CPMP/BWP/2289/01 Points to Consider on the Development of Live Attenuated Influenza Vaccines (CPMP adopted February 2003). 

Recommendations for the use of vaccines and toxoids are included where effective and safe versions are available. These may change over time and should be evaluated at the appropriate time. Appropriate precautions should be taken in the administration of live attenuated virus vaccines to individuals with altered immunocompetence. However, these specific recommendations should in no way preclude the routine use of such products as diphtheria-tetanus toxoids, polio virus vaccine, or influenza vaccine. 

Davidson LE, Fiorino AM, Snydman DR, Hibberd PL. Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults a randomized double-blind placebo-controlled trial. Eur J Clin Nutr. 2011 65 501-507. 

At its meeting on 3-4 December 2009, the Global Advisory Committee on Vaccine Safety (GACVS) preliminarily reviewed the safety of pandemic A (HlNl) influenza vaccines [29 ]. From 21 September to 2 December 2009, tens of millions of doses of the 2009 HlNl vaccine were administered, providing the basis for this first safety review by the GACVS. Pandemic influenza vaccines include live attenuated vaccines, inactivated unadjuvanted vaccines (split, subunit virion, or whole virion), and inactivated adjuvanted vaccines (split or subunit virion). At the time of the GACVS review, it was estimated that nearly 150 million doses of vaccine had been distributed in many countries around the world. About 30% of those 150 million doses were adjuvanted vaccines. 

Other routes of administration have been assessed. An interviewer analysis of a cohort of children from a paediatric walk-in clinic (with a respiratory focus) in Germany who had received a nasal, live attenuated influenza vaccine was undertaken. The children were matched to unvaccinated controls in order to assess safety and tolerability. Out of 146 children who received the vaccine, 48% had mild to moderate asthma, 11% reported nasal congestion following administrahon of the vaccine and there was one episode of bronchitis with urticaria [26 ]. 

---